Clinical Significance of Change in Left Atrial Strain during Weaning from Venoarterial Extracorporeal Membrane Oxygenation

초록

Aims: Previous studies on echocardiographic predictors for weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) have explored various left ventricular systolic function parameters. Therefore, we investigated whether change in left atrial (LA) strain during the weaning trial was associated with successful weaning from VA-ECMO. Methods: A total of 120 patients with cardiogenic shock who received VA-ECMO between March 2016 and March 2024 were analyzed using a single-center prospective registry. During the weaning trial, flow gradually decreased by 30% to 50% of baseline flow. We assessed conventional echocardiographic parameters and LA reservoir strain (LARS) both at baseline and at minimal flow after flow reduction. The primary outcome was successful ECMO weaning. Results: Sixty-six patients (55.0%) were successfully weaned from VA-ECMO. At minimal flow, conventional echocardiographic parameters were higher in the weaning success group compared to the failure group, including left ventricular outflow tract velocity-time integral, left ventricular ejection fraction, and mitral annular systolic velocity (all P < .001). During the weaning trial, the percentage relative increase in LARS was significantly higher in the success group than in the failure group (median 39.5% vs −1.2%; P < .001). The percentage relative increase in LARS was independently associated with weaning success (per +1%, adjusted odds ratio 1.02; 95% CI, 1.01-1.03; P = .003). Adding the percentage relative change in LARS to conventional criteria improved discrimination between weaning success and failure (area under the curve from 0.75 to 0.83; P = .010). Conclusions: Left atrial reservoir strain improvement during ECMO weaning trial might be useful as a predictor of successful weaning from VA-ECMO when combined with conventional echocardiographic parameters.

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