한빛사논문
- 조회1,039
Darae Kim MD, PhDa, Yoonjee Park MDa, Ki Hong Choi MDa, Taek Kyu Park MDa, Joo Myung Lee MD, PhDa, Yang Hyun Cho MD, PhDb, Jin-Oh Choi MD, PhDa, Eun-Seok Jeon MD, PhDa, Jeong Hoon Yang MD, PhDa,c,*
aDivision of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
bDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
cDepartment of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
*Address for correspondence: Dr. Jeong Hoon Yang, Division of Cardiology, Department of Critical Care Medicine and Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 0631, Republic of Korea.
Abstract
Objectives
The aim of this study was to explore if right ventricular (RV) contractile function and its coupling to pulmonary circulation (PC) were associated with successful weaning from venoarterial−extracorporeal membrane oxygenation (VA-ECMO) at maintenance of pump flow.
Background
Limited data are available on predictors of successful weaning from VA-ECMO. under full cardiac support of VA-ECMO.
Methods
A total of 79 patients with cardiogenic shock underwent transthoracic echocardiography to evaluate weaning from ECMO and were prospectively enrolled between 2016 and 2019. The noninvasively measured RV-PC coupling index was acquired by indexing tricuspid annular S' velocity, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and RV free-wall longitudinal strain (FWLS) to right ventricular systolic pressure (RVSP).
Results
Transthoracic echocardiography was performed at a median 3.0 days (range 1 to 6 days) after ECMO initiation at a median ECMO flow of 3.2 l/min (range 3.0 to 3.6 l/min). The RV-PC coupling matrix, tricuspid annular S'/RVSP, TAPSE/RVSP, and RV FWLS/RVSP exhibited satisfactory predictive performances for predicting successful weaning from ECMO. Using the best cutoff values derived from the area under the receiver-operator characteristic curve, tricuspid annular S'/RVSP demonstrated a significantly better predictive performance than conventional echocardiographic parameters (left ventricular ejection fraction >20%, left ventricular outflow tract time-velocity integral ≥10 cm, and mitral annular S' ≥6 cm/s).
Conclusions
Echocardiographic RV-PC coupling metrics exhibited a significantly better performance for predicting successful weaning from VA ECMO compared with conventional echocardiographic criteria at maintenance of pump flow.
Key Words : echocardiography, extracorporeal membrane oxygenation, RV-PC coupling, weaning
논문정보
- Research article
- 2021년 04월 (BRIC 등록일 2021-05-25)
- 국내 연구진
- 의약학 > 응용의학
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