Perioperative Non-Invasive Right Ventricular Myocardial Work in Left Ventricular Assist Device Implantation.

Non-invasive right ventricular (RV) myocardial work (MW) is a novel echocardiographic technique evaluating cardiac mechanics, contractility, and energetics beyond conventional echocardiographic measurements. This technique is an advancement of myocardial strain analysis and combines RV strain with loading conditions. It correlates well with invasively measured myocardial work and with myocardial oxygen consumption. RV MW is independent of afterload and seems best suitable for perioperative assessment of RV function. However, this technique has not yet been well described in the perioperative setting. Therefore, we aimed to evaluate this innovative method in the perioperative course of left ventricular assist device (LVAD) implantation and compare it to conventional echocardiographic and hemodynamic measurements. We conducted a retrospective analysis of all 78 patients that underwent LVAD implantation from January 2014 to January 2024 at our institution. 32 patients had echocardiographic images performed with echocardiographic machines and software appropriate for RV MW analysis, of whom ten patients had complete pre- and postoperative images required for estimation of RV MW indices. Transthoracic echocardiography (TTE) was completed during the preoperative evaluation (T1) and before discharge from hospital (T2), without any vasoactive support under stable hemodynamic conditions. EchoPAC v204 software (GE Vingmed Ultrasound AS, Norway) was used for analysis of RV global work index (GWI), RV global constructive work (GCW), RV global wasted work (GWW), RV global work efficiency (GWE), RV global longitudinal strain (GLS), RV free-wall strain (FWS), longitudinal strain of the interventricular septum (IVS), RV fractional area change (FAC), and tricuspid annular systolic excursion (TAPSE). Moreover, RV filling pressures were estimated echocardiographically to evaluate loading conditions. RV contractile pattern changed significantly in our patient population through the perioperative course of LVAD implantation [T1 v T2]. RV free-wall longitudinal function decreased (FWS, -8.2% (IQR -5.7;-10.9) v -5.9% (IQR -5.2;-8.1), p=0.04; TAPSE, 16mm (IQR 14;20) v 9mm (IQR 8;11), p<0.01), while septal contribution and global RV function improved (IVS, -2.2% (IQR -1.5;-3.9) v -5.0% (IQR -3;-9), p=0.04; FAC, 25% (IQR 18;32) v 36% (24;43), p=0.03). RV MW analysis showed a reduction of RV effective (GWI, 212mmHg% (IQR 128;266) v 96mmHg% (IQR 63;150), p=0.02; GCW, 331mmHg% (IQR 263;476) v 198mmHg% (IQR 136;274), p<0.01) and ineffective myocardial work (GWW, 171mmHg% (IQR 102;243) v 98mmHg% (IQR 48;153), p=0.04), suggesting a reduction of RV myocardial oxygen consumption after device implantation. RV filling pressures declined, while RV efficiency remained unchanged (GWE, 69% (IQR 37;78) v 64% (IQR (61;78), p=0.26) in the same period. In conclusion, there was a change of RV contractile pattern in our patient population after LVAD implantation with a reduction of RV longitudinal function, which was compensated by an increase of RV circumferential contraction and interventricular septum contribution that even improved global RV function. Assessment of RV MW indices showed decreased RV myocardial workload after device implantation, suggesting a reduction of RV myocardial oxygen consumption in our patient population. RV MW is an evolving non-invasive technique providing deeper insights into perioperative RV energetics and could support individualized decision making in cardiac surgery patients. [ABSTRACT FROM AUTHOR]