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

Abstract

Background: The novel method of non-invasive right ventricular (RV) myocardial work (MW) analysis provides a load-independent assessment of RV function by combining myocardial strain with loading conditions. However, its use has not been well described in the perioperative setting to date. We aimed to evaluate the feasibility of assessing RV MW, and to describe the perioperative course of this new technique. Methods: In this retrospective study, patients scheduled for LVAD surgery were evaluated for feasibility of RV MW analysis. Preoperative (T1) and postoperative (T2) transthoracic echocardiography (TTE) included the assessment of conventional echocardiographic measurements, myocardial strain, global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) for the evaluation of RV function. Results: Ten patients had complete TTE data available for RV MW analysis, which indicated significant reduction of effective and ineffective RV MW (GWI, 212 mmHg% (IQR 128; 266) v 96 mmHg% (IQR 63; 150), P = 0.02; GCW, 331 mmHg% (IQR 263; 476) v 198 mmHg% (IQR 136; 274), P < 0.01; GWW, 171 mmHg% (IQR 102; 243) v 98 mmHg% (IQR 48; 153), P = 0.04), while GWE remained stable (69% (IQR 37; 78) v 64% (IQR 61; 78), P = 0.26) after LVAD implantation. Conventional parameters were not able to detect these changes. Moreover, there were different trends of RV MW indices in patients with and without postimplant RV failure. Conclusion: This study demonstrates that non-invasive RV MW assessment is feasible in the perioperative setting of LVAD implantation and provides valuable insights into RV function that are not captured by conventional echocardiographic methods. Further research is warranted to validate these findings.