Preoperative and mid-term right ventricular systolic function assessment, at rest and during exercise, with speckle-tracking echocardiography after left ventricular assist device implantation

OBJECTIVES The study aimed to compare pre- and postoperative resting as well as postprocedural resting and exertional right ventricular speckle-tracking echocardiographic parameters at a mid-term follow-up after left ventricular assist device (LVAD) implantation. METHODS Patients with implanted third-generation LVADs with hydrodynamic bearings were prospectively enrolled (NCT05063006). Myocardial deformation was evaluated before pump implantation and at least three months after the procedure, both at rest and during exercise. RESULTS We included 22 patients, 7.3 months (IQR, 4.7-10.2) after the surgery. The mean age was 58.4 f 7 years, 95.5% were men, and 45.5% had dilated cardiomyopathy. The RV strain analysis was feasible in all subjects both at rest and during exercise. The RV free wall strain (RVFWS) worsened from - 13% (IQR, - 17.3 to - 10.9) to - 11.3% (IQR, - 12.9 to - 6; p = 0.033) after LVAD implantation with a particular decline in the apical RV segment [-11.3% (IQR, - 16.4 to - 6.2) vs - 7.8% (IQR, - 11.7 to - 3.9; p = 0.012)]. The RV four-chamber longitudinal strain (RV4CSL) remained unchanged [-8.5% (IQR, - 10.8 to - 6.9) vs - 7.3% (IQR, - 9.8 to - 4.7; p = 0.184)]. Neither RVFWS ( - 11.3% (IQR, - 12.9 to - 6) vs - 9.9% (IQR, - 13.5 to - 7.5; p = 0.077) nor RV4CSL [ - 7.3% (IQR, - 9.8 to - 4.7) vs - 7.9% (IQR, - 9.8 to - 6.3; p = 0.548)] changed during the exercise test. CONCLUSIONS In patients who are pump-supported, the right ventricular free wall strain tends to worsen after LVAD implantation and remains unchanged during a cycle ergometer stress test. (Hellenic Journal of Cardiology 2024;76:31 -39) (c) 2023 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).