Left Ventricular Outflow Tract Time Research Articles

Longitudinal Echocardiographic Assessment of Donor Hearts in DCD Donors Using Thoracoabdominal Normothermic Regional Perfusion

<h3>Purpose</h3> In the U.S., multiple centers are beginning to develop protocols for DCD organ donation. We describe our intraoperative echo thoracoabdominal normothermic regional perfusion (TA-NRP) DCD protocol for initial donor acceptance and mid-term follow up <h3>Methods</h3> After identification of a suitable DCD donor, withdrawal of life support is performed in the OR until circulatory death occurs. After 5 minutes of observation, circulatory death is declared. The sternum is opened, cerebral vessels are ligated, and cardiopulmonary bypass (CPB) is initiated. Transesophageal echocardiogram (TEE) monitors the following parameters to ensure the heart is acceptable: left ventricular ejection fraction (LVEF) ≥50%, mitral valve annulus lateral S wave (MV S wave) ≥10 cm/sec, left ventricular outflow tract time integral (LVOT VTI) ≥15 cm, and right ventricular systolic function (RVEF) normal by visual estimation. The recipient's LVEF and global longitudinal strain rate (GLS) were followed longitudinally for up to 18 months <h3>Results</h3> From January 2020 to October 2021, 10 TA-NRP DCD transplants were performed: 7 isolated hearts, 2 heart-bilateral lung, and 1heart-kidney. Median donor age was 43.5 years (26-51) and there were 9 males (90%). Fifty percent of donors had a history of opioid drug overdose. The mean preoperative donor LVEF was 68%. Mean TEE parameters while weaning off CPB: LVEF 65%, MV lateral S wave 12 cm/sec, and LVOT VTI 19 cm. RVSF was normal for all donors. None of the donors required inotropic support. The recipient median age was 54 years (44-72) and 70% were male. None of the recipients developed cardiac graft failure. At mean follow-up of 392 days, mean LVEF is 64% and mean GLS is -16.7% and all patients are alive. <h3>Conclusion</h3> A standardized intraoperative TEE protocol to assess TA-NRP DCD donor heart function while weaning CPB is of paramount importance to ensure excellent longitudinal recipient graft function.

Echocardiographic recovery changes in patients supported with veno-arterial extracorporeal membrane oxygenator and weaning success

Abstract Introduction The weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decision involves a meticulous evaluation of different factors, among which echocardiography is a decisive factor. Purpose Evaluate echocardiographic changes from the beginning of the support to the weaning test. Methods Analysis of VA-ECMO cases in a referral hospital which completed a weaning test. We evaluated the changes of echocardiographic parameters during the VA-ECMO support (initial and during weaning test) and successful weaning (survival &amp;gt;24h after explant and no mortality from cardiogenic shock/heart failure or cardiac arrest during admission). Results 85 out of 134 VA-ECMO patients were included from 2013 to Oct-2020 (table 1.1). Successful weaning was achieved in 61.2% and final survival at discharge 49.4%. We observed a significant increase in left ventricular ejection fraction (LVEF), left ventricular outflow tract time–velocity integral (LVOT VTI), tricuspid annular plane systolic excursion (TAPSE) and the percentage of patients with normal qualitative right ventricular function and 1:1 aortic valve opening from the initial to the weaning echocardiography (table 1.2), without significant changes in ventricular diameters. Among these changes, the increase in LVOT VTI was the only parameter that was related to weaning success (p=0.037, table 1.2). A higher LVEF increase from the initial value showed a trend to greater successful VA-ECMO disconnection (p=0.053 table 1.2). Conclusion Left and right ventricular function parameters improved significantly from baseline to weaning test echocardiography in VA-ECMO supported patients. Of these changes, the increase in LVOT VTI was related to successful disconnection from VA-ECMO and the LVEF improvement showed a trend to weaning success. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Instituto de Salud Carlos III in Spain (Co-funded by European Social Fund “Investing in your future”). Characteristics ECMO-VA patients

Usefullness of peak mitral regurgitation velocity to left ventricular outflow tract time velocity integral ratio as a new prognostic marker for one year and long term mortality in failing heart

Abstract Background and aim Systemic vascular resistance (SVR) is useful for risk estimation and therapy guidance in HF. It has been showed that the ratio of peak mitral regurgitation velocity (MRV) to left ventricular outflow tract velocity-time integral (LVOT VTI) correlated positively with SVR. We aimed to assess the association of MRV/LVOT VTI ratio with established prognostic markers and its prognostic role for predicting one year and long term composite end-points in patients with HF and reduced ejection fraction (HFrEF). Material and methods We prospectively enrolled a total of 72 patients with HFrEF and 10 control subjects. Patients were followed up patients for median 40.5 months. Primary composite endpoint (CEP) was defined as any of these outcomes including requiring mechanical circulatory support, cardiac transplantation and all-cause mortality. Results CEP(+) patients had higher MRV/LVOT VTI ratio than others (0.48±0.15 vs. 0.39±0.18 p=0.012). MRV/LVOT VTI ratio was positively correlated with functional status (β=0.539, p=0&amp;lt;001), serum BNP level (β=0.479, p&amp;lt;0.001),troponin I (β=0.415, p&amp;lt;0.001), and Uric acid level (β=0.235 p=0.018) and negatively correlated with SEATTLE score derived life expectancy (β=−0.248, p=0.032). Adjusted with other parameters, every 0.1 increase in MRV/LVOT VTI ratio increased the one-year CEP risk by 27% and long-term CEP risk by 24.6%. In Kaplan Meier analysis, patients with MRV/LVOTVTI ratio ≥0.39 had more long-term CEP compared to others. Conclusion MRV/LVOT VTI ratio seemed to be useful predictor of poor prognosis associated with other established HF prognostic markers. Figure 1 Funding Acknowledgement Type of funding source: None

PULMONARY VASCULAR RESISTANCE: A NOVEL METHOD OF NON-INVASIVE ESTIMATION AND ASSOCIATION WITH MORTALITY IN CRITICALLY ILL SURGICAL PATIENTS

Doppler-derived ratio of peak tricuspid regurgitant velocity (TRV, ms) to the right ventricular outflow tract time velocity integral (TVIRVOT, cm) is a reliable non-invasive method of estimating pulmonary vascular resistance (PVR). The easier to measure left ventricular outflow tract time velocity

Afterload mismatch revealed by an exercise biphasic response in aortic stenosis

A 71-year-old man with asymptomatic severe aortic stenosis was referred to our stress echocardiography laboratory for risk stratification. He had no coronary risk factors but led a sedentary life. A symptom-limited bicycle exercise was performed in the supine position. The patient reached the target heart rate (128beats/min) and developed moderate dyspnoea at a workload of 100W. The systolic blood pressure initially increased from 130 to 150 mmHg whereas no further changes occurred at a higher exercise level. Baseline transthoracic echocardiography (rest) confirmed the presence of severe valvular aortic stenosis, with an aortic valve area of 0.78 cm 2 (outflow tract time velocity integral 20cm) and a mean transaortic pressure gradient of 40 mmHg. At low-level exercise, the increase in longitudinal long-axis function (peak negative strain rate obtained off-line by tissue Doppler reconstruction at the level of the septal and lateral walls) (Fig. Top panel) was accompanied by a significant rise in transaortic pressure gradients (Fig. Bottom panel). The calculated aortic valve area was 0.71 cm 2 (outflow tract time velocity integral 19 cm) indicating absence of valve compliance. At peak exercise, the transaortic pressure gradient decreased as a result of a significant impairment of left ventricular function (decrease in peak negative strain rate). The aortic valve area remained fairly unchanged (0.69 cm 2 ) whereas the left ventricular outflow tract time velocity integral decreased (15 cm), indicating reduced flow across the aortic valve. No inducible ischaemia was observed during test and no concomitant coronary artery stenosis was found at angiography.

Doppler Echocardiography of 240 Normal Carpentier-Edwards Duraflex Porcine Mitral Bioprostheses: A Comprehensive Assessment Including Time Velocity Integral Ratio and Prosthesis Performance Index

Normal Doppler-derived echocardiographic data for Carpentier-Edwards Duraflex (Edwards Lifesciences, Irvine, CA) porcine bioprosthesis function in the mitral position are limited to 2 small series that did not include all Doppler-derived variables. The purpose of this study was to provide a comprehensive Doppler echocardiographic assessment of normal Carpentier-Edwards Duraflex mitral bioprosthesis function in a large number of patients assessed in the early postoperative phase. All of the important Doppler-derived hemodynamic variables reported to date were used. All patients had either a mitral valve prosthesis time velocity integral to left ventricular outflow tract time velocity integral ratio < 3.9 or an E velocity < 2.8. The pressure half-time was < 130 msec in all patients. Nearly all patients (97%) had an E velocity < 2.8 msec and a mitral valve prosthesis time velocity integral to left ventricular outflow tract time velocity integral ratio < 3.9 regardless of bioprosthesis size, left ventricular function, heart rate, hemoglobin, or hematocrit. With increasing bioprosthesis size, effective orifice area significantly increased, whereas the prosthesis performance index significantly decreased.

Short Deceleration Time of Mitral Inflow E Velocity: Prognostic Implication with Atrial Fibrillation Versus Sinus Rhythm

The present study retrospectively identified 367 patients who had restrictive physiology as defined by deceleration time ≤130 msec; 293 were in sinus rhythm (SR) (194 men and 99 women; mean age 64 ± 14 years) and 74 were in atrial fibrillation (AF) (51 men and 23 women; mean age 72 ± 11 years; p < 0.001). Both groups had similar underlying diagnoses and no significant difference in Doppler indices (E wave, 96 ± 23 vs 99 ± 22 cm/sec in SR and AF, respectively; deceleration time, 116 ± 12 vs 116 ± 13 msec; and left ventricular outflow tract time velocity integral, 14.8 ± 4.8 vs 14.5 ± 4.4 cm). Left ventricular ejection fraction was significantly lower in SR patients (29% ± 16% vs 39% ± 20%; p = 0.0003). There were 120 deaths (41%) in the SR group and 35 (47%) in the AF group (median follow-up for both groups, 2.2 years). Restrictive physiology as defined by Doppler echocardiography (deceleration time H130 msec) appears to predict a similar poor prognosis with AF as with SR. (J Am Soc Echocardiography 1998;11:450-7.)