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Echocardiographic assessment of myocardial function and mechanics during veno-venous extracorporeal membrane oxygenation

Echo Research & Practice volume 6, pages 25–35 (2019)Cite this article

Abstract

Background: Transthoracic echocardiography (TTE) plays a fundamental role in the management of patients supported with extra-corporeal membrane oxygenation (ECMO). In light of fluctuating clinical states, serial monitoring of cardiac function is required. Formal quantification of ventricular parameters and myocardial mechanics offer benefit over qualitative assessment. The aim of this research was to compare unenhanced (UE) versus contrast-enhanced (CE) quantification of myocardial function and mechanics during ECMO in a validated ovine model.

Methods: Twenty-four sheep were commenced on peripheral veno-venous ECMO. Acute smoke-induced lung injury was induced in 21 sheep (3 controls). CE-TTE with Definity using Cadence Pulse Sequencing was performed. Two readers performed image analysis with TomTec Arena. End diastolic area (EDA, cm2), end systolic area (ESA, cm2), fractional area change (FAC, %), endocardial global circumferential strain (EGCS, %), myocardial global circumferential strain (MGCS, %), endocardial rotation (ER, degrees) and global radial strain (GRD, %) were evaluated for UE-TTE and CE-TTE.

Results: Full data sets are available in 22 sheep (92%). Mean CE EDA and ESA were significantly larger than in unenhanced images. Mean FAC was almost identical between the two techniques. There was no significant difference between UE and CE EGCS, MGCS and ER. There was significant difference in GRS between imaging techniques. Unenhanced inter-observer variability was from 0.48–0.70 but significantly improved to 0.71–0.89 for contrast imaging in all echocardiographic parameters.

Conclusion: Semi-automated methods of myocardial function and mechanics using CE-TTE during ECMO was feasible and similar to UE-TTE for all parameters except ventricular areas and global radial strain. Addition of contrast significantly decreased inter-observer variability of all measurements.

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Funding

This research was supported in part by funding from the National Health and Medical Research Council (grant no. 1010939)and The Prince Charles Hospital Foundation. John Fraser holds a Health Research Fellowship awarded by the Office of Health and Medical research, Queensland, Australia. The Siemens Sequoia scanner used for this research was obtained with a research grant awarded to David Platts from the Private Practice Fund, The Prince Charles Hospital.

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  1. Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia

    David G. Platts MBBS MD FRACP FCSANZ FESC FASE, Kenji Shiino MD PhD, Jonathan Chan MBBS PhD FRACP FRCP FCSANZ FSCCT FACC, Darryl J. Burstow MBBS FRACP FCSANZ & Gregory M. Scalia MBBS MMedSc, FRACP FACC FCSANZ FASE

  2. Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia

    David G. Platts MBBS MD FRACP FCSANZ FESC FASE & John F. Fraser MB ChB PhD MRCP FRCA FFARCSI FCICM

  3. The University of Queensland, Brisbane, Queensland, Australia

    David G. Platts MBBS MD FRACP FCSANZ FESC FASE, Darryl J. Burstow MBBS FRACP FCSANZ, Gregory M. Scalia MBBS MMedSc, FRACP FACC FCSANZ FASE & John F. Fraser MB ChB PhD MRCP FRCA FFARCSI FCICM

  4. School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia

    Kenji Shiino MD PhD & Jonathan Chan MBBS PhD FRACP FRCP FCSANZ FSCCT FACC

  5. Fujita Health University, Toyoake, Japan

    Kenji Shiino MD PhD

  6. Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia

    John F. Fraser MB ChB PhD MRCP FRCA FFARCSI FCICM

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  1. David G. Platts MBBS MD FRACP FCSANZ FESC FASE
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Platts, D.G., Shiino, K., Chan, J. et al. Echocardiographic assessment of myocardial function and mechanics during veno-venous extracorporeal membrane oxygenation. Echo Res Pract 6, 25–35 (2019). https://doi.org/10.1530/ERP-18-0071

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  • DOI: https://doi.org/10.1530/ERP-18-0071

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Echo Research & Practice

ISSN: 2055-0464

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