J Cardiovasc Ultrasound.  2017 Jun;25(2):39-46. 10.4250/jcu.2017.25.2.39.

Systematic Left Ventricular Assist Device Implant Eligibility with Non-Invasive Assessment: The SIENA Protocol

• Cameli M
• Loiacono F
• Sparla S
• Solari M
• Iardino E
• Mandoli GE
• Bernazzali S
• Maccherini M
• Mondillo S

• KMID: 2385074
• DOI: http://doi.org/10.4250/jcu.2017.25.2.39

Abstract

In patients with end-stage left ventricular (LV) heart failure who receive LV assist device (LVAD) implantation, right ventricular (RV) failure represents a possible critical complication that heavily affects morbidity and mortality. Several clinical, laboratory, hemodynamic, and echocardiographic variables have been found to be associated with RV failure occurrence after surgery. Different models and risk scores have been proposed, with poor results. No accordance has ever been reached about RV pre-operative evaluation, and time has come to introduce a standardized systematic protocol for LVAD suitability assessment according to RV function. We analyzed imaging parameters associated with LVAD implantation-related RV failure, in order to identify the minimum number for pre-operative reliable prediction of post-operative RV failure. A few echocardiographic parameters have been identified as the most reliable, or promising, and reproducible tools in this field: free-wall RV longitudinal strain, RV fractional area change, RV sphericity index, and RV ejection fraction with 3D-echocardiography. We propose the Systematic LVAD Implant Eligibility with Non-invasive Assessment protocol-the SIENA protocol-as a new and simple way of pre-operative evaluation of patients candidates to LVAD implantation.

Keyword

Right ventricle; Heart failure; Left ventricular assist device; Strain; Echocardiography

MeSH Terms

Echocardiography
Heart Failure
Heart Ventricles
Heart-Assist Devices*
Hemodynamics
Humans
Mortality

Figure

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  Fig. 1 Tricuspid annular plane systolic excursion (TAPSE) in a patient with end-stage left ventricular heart failure. In this case TAPSE is depressed (13 mm). Image acquired with a high quality sonogram (Vivid 7, GE General Electric, Horten, Norway) with 2.5 MHz transducer.

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  Fig. 2 Tissue Doppler imaging of the right ventricle with pulsed Doppler sample volume placed in the tricuspid annulus in a patient with end-stage left ventricular heart failure. In this case S' is depressed (0.07 m/s). Image acquired with a high quality sonogram (Vivid 7, GE General Electric, Horten, Norway) with 2.5 MHz transducer.

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  Fig. 3 Free-wall right ventricular longitudinal strain (RVLS) with speckle tracking echocardiography in a patient with end-stage left ventricular heart failure. In this case, free-wall RVLS is normal (> -16%). Image acquired with a high quality sonogram (Vivid 7, GE General Electric, Horten, Norway) with 2.5 MHz transducer and a semi-automatic 2D strain software (EchoPAC, GE General Electric).

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  Fig. 4 Right ventricular sphericity index in a patient with end-stage left ventricular heart failure (0.66). Image acquired with a high quality sonogram (Vivid 7, GE General Electric, Horten, Norway) with 2.5 MHz transducer.

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  Fig. 5 A visual summary of the echocardiographic parameters included in the SIENA protocol. RVSI: right ventricular sphericity index, RVFAC: right ventricular fractional area change, RVLS: right ventricular longitudinal strain, RVEF: right ventricular ejection fraction.

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