Sensitivity of ventricular systolic function to afterload during veno-arterial extracorporeal membrane oxygenation.

Autor: Ng PY; Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR.; Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, Hong Kong SAR., Ma TSK; Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, Hong Kong SAR., Ip A; Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR., Lee MK; Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR., Ng AK; Cardiac Medical Unit, Grantham Hospital, Hong Kong, Hong Kong SAR., Ngai CW; Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, Hong Kong SAR., Chan WM; Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, Hong Kong SAR., Siu CW; Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR., Sin WC; Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, Hong Kong SAR.; Department of Anesthesiology, The University of Hong Kong, Hong Kong, Hong Kong SAR.
Jazyk: angličtina
Zdroj: ESC heart failure [ESC Heart Fail] 2022 Oct; Vol. 9 (5), pp. 3241-3253. Date of Electronic Publication: 2022 Jul 01.
DOI: 10.1002/ehf2.13959
Abstrakt: Aims: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) increases afterload to the injured heart and may hinder myocardial recovery. We aimed to compare the sensitivity of left ventricular (LV) systolic function to the afterload effects of peripheral V-A ECMO during the acute and delayed stages of acute myocardial dysfunction.
Methods and Results: A total of 46 adult patients who were supported by peripheral V-A ECMO between April 2019 and June 2021 were analysed. Serial cardiac performance parameters were measured by transthoracic echocardiography (TTE) on mean day 1 ± 1 of V-A ECMO initiation (n = 45, 'acute phase') and mean day 4 ± 2 of V-A ECMO initiation (n = 36, 'delayed phase'). Measurements were obtained at 100%, 120%, and 50% of ECMO target blood flow (TBF). LV global longitudinal strain (GLS) significantly improved from -6.1 (-8.9 to -4.0)% during 120% TBF to -8.8 (-11.5 to -6.0)% during 50% TBF (P < 0.001). The sensitivity of LV GLS to changes in ECMO flow was significantly greater in the acute phase of myocardial injury compared with the delayed phase [median (IQR) percentage change: 72.7 (26.8-100.0)% vs. 22.5 (14.9-43.8)%, P < 0.001]. Findings from other echocardiographic parameters including LV ejection fraction [43.0 (29.1-56.8)% vs. 22.8 (9.2-42.2)%, P = 0.012] and LV outflow tract velocity-time integral [45.8 (18.6-58.7)% vs. 24.2 (12.6-34.0)%, P = 0.001] were similar. A total of 24 (52.2%) patients were weaned off ECMO successfully.
Conclusions: We demonstrated that LV systolic function was significantly more sensitive to the afterload effects of V-A ECMO during the acute stage of myocardial dysfunction compared with the delayed phase. Understanding the evolution of the heart-ECMO interaction over the course of acute myocardial dysfunction informs the clinical utility of echocardiographic assessment in patients on V-A ECMO.
(© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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