Biventricular longitudinal strain as a predictor of functional improvement after D-shant device implantation in patients with heart failure

Yi Zhou; He Li; Lingyun Fang; Wenqian Wu; Zhenxing Sun; Ziming Zhang; Manwei Liu; Jie Liu; Lin He; Yihan Chen; Yuji Xie; Yuman Li; Mingxing Xie

doi:10.3389/fcvm.2023.1121689

Biventricular longitudinal strain as a predictor of functional improvement after D-shant device implantation in patients with heart failure

Front Cardiovasc Med. 2023 Apr 17:10:1121689. doi: 10.3389/fcvm.2023.1121689. eCollection 2023.

Authors

Yi Zhou^{1

2

3}, He Li^{1

2

3}, Lingyun Fang^{1

2

3}, Wenqian Wu^{1

2

3}, Zhenxing Sun^{1

2

3}, Ziming Zhang^{1

2

3}, Manwei Liu^{1

2

3}, Jie Liu^{1

2

3}, Lin He^{1

2

3}, Yihan Chen^{1

2

3}, Yuji Xie^{1

2

3}, Yuman Li^{1

2

3}, Mingxing Xie^{1

2

3}

Affiliations

¹ Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.
³ Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.

Abstract

Background: The creation of an atrial shunt is a novel approach for the management of heart failure (HF), and there is a need for advanced methods for detection of cardiac function response to an interatrial shunt device. Ventricular longitudinal strain is a more sensitive marker of cardiac function than conventional echocardiographic parameters, but data on the value of longitudinal strain as a predictor of improvement in cardiac function after implantation of an interatrial shunt device are scarce. We aimed to investigate the exploratory efficacy of the D-Shant device for interatrial shunting in treating heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), and to explore the predictive value of biventricular longitudinal strain for functional improvement in such patients.

Methods: A total of 34 patients were enrolled (25 with HFrEF and 9 with HFpEF). All patients underwent conventional echocardiography and two-dimensional speckle tracking echocardiogram (2D-STE) at baseline and 6 months after implantation of a D-Shant device (WeiKe Medical Inc., WuHan, CN). Left ventricular global longitudinal strain (LVGLS) and right ventricular free wall longitudinal strain (RVFWLS) were evaluated by 2D-STE.

Results: The D-Shant device was successfully implanted in all cases without periprocedural mortality. At 6-month follow-up, an improvement in New York Heart Association (NYHA) functional class was observed in 20 of 28 patients with HF. Compared with baseline, patients with HFrEF showed significant reduced left atrial volume index (LAVI) and increased right atrial (RA) dimensions, as well as improved LVGLS and RVFWLS, at 6-month follow-up. Despite reduction in LAVI and increase in RA dimensions, improvements in biventricular longitudinal strain did not occur in HFpEF patients. Multivariate logistic regression demonstrated that LVGLS [odds ratio (OR): 5.930; 95% CI: 1.463-24.038; P = 0.013] and RVFWLS (OR: 4.852; 95% CI: 1.372-17.159; P = 0.014) were predictive of improvement in NYHA functional class after D-Shant device implantation.

Conclusion: Improvements in clinical and functional status are observed in patients with HF 6 months after implantation of a D-Shant device. Preoperative biventricular longitudinal strain is predictive of improvement in NYHA functional class and may be helpful to identify patients who will experience better outcomes following implantation of an interatrial shunt device.

Keywords: D-Shant device; HFpEF; HFrEF; NYHA functional class; speckle-tracking echocardiography.

Grants and funding

This work was supported by the National Natural Science Foundation of China (Grant Nos. 82230066, 82001854, 82001852), the Key Research and Development Program of Hubei (2020DCD015, 2021BCA138), and the National Natural Science Foundation of Hubei province (No. 2020CFB781).