دورية أكاديمية
أعرض في EDS

Contrast Ultrasound Assessment of Skeletal Muscle Recruitable Perfusion after Permanent Left Ventricular Assist Device Implantation: Implications for Functional Recovery.

التفاصيل البيبلوغرافية
العنوان: Contrast Ultrasound Assessment of Skeletal Muscle Recruitable Perfusion after Permanent Left Ventricular Assist Device Implantation: Implications for Functional Recovery.
المؤلفون: Soman D; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon., Hodovan J; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon., Macon CJ; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon., Davidson BP; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon., Belcik JT; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon., Mudd JO; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon., Park BS; School of Public Health, Oregon Health & Science University, Portland, Oregon., Lindner JR; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon. Electronic address: lindnerj@ohsu.edu.
المصدر: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography [J Am Soc Echocardiogr] 2022 May; Vol. 35 (5), pp. 495-502. Date of Electronic Publication: 2021 Dec 29.
نوع المنشور: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Mosby-Year Book Country of Publication: United States NLM ID: 8801388 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6795 (Electronic) Linking ISSN: 08947317 NLM ISO Abbreviation: J Am Soc Echocardiogr Subsets: MEDLINE
أسماء مطبوعة: Publication: St. Louis Mo : Mosby-Year Book
Original Publication: St. Louis, Mo. : C.V. Mosby Co., [c1988-
مواضيع طبية MeSH: Heart Failure*/diagnostic imaging , Heart Failure*/therapy , Heart-Assist Devices*, Humans ; Muscle, Skeletal/diagnostic imaging ; Perfusion ; Stroke Volume
مستخلص: Background: In heart failure with reduced ejection fraction (HFrEF), abnormal regulation of skeletal muscle perfusion contributes to reduced exercise tolerance. The aim of this study was to test the hypothesis that improvement in functional status after permanent left ventricular assist device (LVAD) implantation in patients with HFrEF is related to improvement in muscle perfusion during work, which was measured using contrast-enhanced ultrasound (CEUS).
Methods: CEUS perfusion imaging of calf muscle at rest and during low-intensity plantar flexion exercise (20 W, 0.2 Hz) was performed in patients with HFrEF (n = 22) at baseline and 3 months after placement of permanent LVADs. Parametric analysis of CEUS data was used to quantify muscle microvascular blood flow (MBF), blood volume index, and red blood cell flux rate. For subjects alive at 3 months, comparisons were made between those with New York Heart Association functional class I or II (n = 13) versus III or IV (n = 7) status after LVAD. Subjects were followed for a median of 5.7 years for mortality.
Results: Echocardiographic data before and after LVAD placement and LVAD parameters were similar in subjects classified with New York Heart Association functional class I-II versus functional class III-IV after LVAD. Skeletal muscle MBF at rest and during exercise before LVAD implantation was also similar between groups. After LVAD placement, resting MBF remained similar between groups, but during exercise those with New York Heart Association functional class I or II had greater exercise MBF (111 ± 60 vs 52 ± 38 intensity units/sec, P = .03), MBF reserve (median, 4.45 [3.95 to 6.80] vs 2.22 [0.98 to 3.80]; P = .02), and percentage change in exercise MBF (median, 73% [-28% to 83%] vs -45% [-80% to 26%]; P = .03). During exercise, increases in MBF were attributable to faster microvascular flux rate, with little change in blood volume index, indicating impaired exercise-mediated microvascular recruitment. The only clinical or echocardiographic feature that correlated with post-LVAD exercise MBF was a history of diabetes mellitus. There was a trend toward better survival in patients who demonstrated improvement in muscle exercise MBF after LVAD placement (P = .05).
Conclusions: CEUS perfusion imaging can quantify peripheral vascular responses to advanced therapies for HFrEF. After LVAD implantation, improvement in functional class is seen in patients with improvements in skeletal muscle exercise perfusion and flux rate, implicating a change in vasoactive substances that control resistance arteriolar tone.
(Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
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معلومات مُعتمدة: P51 OD011092 United States OD NIH HHS; R01 HL078610 United States HL NHLBI NIH HHS; R01 HL130046 United States HL NHLBI NIH HHS
فهرسة مساهمة: Keywords: Contrast-enhanced ultrasound; Heart failure; Left ventricular assist device; Muscle blood flow
تواريخ الأحداث: Date Created: 20220101 Date Completed: 20220509 Latest Revision: 20230502
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC9081119
DOI: 10.1016/j.echo.2021.12.014
PMID: 34973393
قاعدة البيانات: MEDLINE
الوصف
تدمد:1097-6795
DOI:10.1016/j.echo.2021.12.014