{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T15:36:29Z","timestamp":1782401789830,"version":"3.54.5"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T00:00:00Z","timestamp":1681257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>We evaluated the effects of varying blood flow rate during peripheral veno-arterial extracorporeal membrane oxygen (V-A ECMO) on left ventricular function measured by two-dimensional strain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adult patients who were supported by peripheral V-A ECMO were recruited. Serial hemodynamic and cardiac performance parameters were measured by transthoracic echocardiogram within the first 48\u2005h after implementation of V-A ECMO. Measurements at 100%, 120%, and 50% of target blood flow (TBF) were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 54 patients were included and the main indications for V-A ECMO were myocardial infarction [32 (59.3%)] and myocarditis [6 (11.1%)]. With extracorporeal blood flow at 50% compared with 100% TBF, the mean arterial pressure was lower [66\u2009\u00b1\u200919 vs. 75\u2009\u00b1\u200918\u2005mmHg, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001], stroke volume was greater [23 (12\u201334) vs. 15 (8\u201326) ml, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001], and cardiac index was higher [1.2 (0.7\u20131.7) vs. 0.8 (0.5\u20131.3) L\/min\/m<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001]. Left ventricular contractile function measured by global longitudinal strain improved at 50% compared with 100% TBF [\u22122.8 (\u22127.6- \u22120.1) vs. \u22121.2 (\u22125.2\u20130) %, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001]. Similarly, left ventricular ejection fraction increased [24.4 (15.8\u201335.5) vs. 16.7 (10.0\u201328.5) %, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001] and left ventricular outflow tract velocity time integral increased [7.7 (3.8\u201311.4) vs. 4.8 (2.5\u20138.5) cm, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001]. Adding echocardiographic parameters of left ventricular systolic function to the Survival After Veno-arterial ECMO (SAVE) score had better discriminatory value in predicting eventual hospital mortality (AUROC 0.69, 95% CI 0.55\u20130.84, <jats:italic>p<\/jats:italic>\u2009=\u20090.008) and successful weaning from V-A ECMO (AUROC 0.68, 95% CI 0.53\u20130.83, <jats:italic>p<\/jats:italic>\u2009=\u20090.017).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the initial period of V-A ECMO support, measures of left ventricular function including left ventricular ejection fraction and global longitudinal strain were inversely related to ECMO blood flow rate. Understanding the heart-ECMO interaction is vital to interpretation of echocardiographic measures of the left ventricle while on ECMO.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1147783","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T05:17:20Z","timestamp":1681276640000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Effects of varying blood flow rate during peripheral veno-arterial extracorporeal membrane oxygen (V-A ECMO) on left ventricular function measured by two-dimensional strain"],"prefix":"10.3389","volume":"10","author":[{"given":"Pauline Yeung","family":"Ng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammy Sin Kwan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"April","family":"Ip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy Chak Cheung","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred Sai Kuen","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun Wai","family":"Ngai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai Ming","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai Ching","family":"Sin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,4,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.jchf.2017.11.017","article-title":"Venoarterial extracorporeal membrane oxygenation in cardiogenic shock","volume":"6","author":"Keebler","year":"2018","journal-title":"JACC Heart Fail"},{"key":"B2","doi-asserted-by":"publisher","first-page":"10265","DOI":"10.1016\/S0140-6736(20)32338-2","article-title":"Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial","volume":"396","author":"Yannopoulos","year":"2020","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/S0735-1097(03)00084-6","article-title":"Left ventricular support by catheter-mounted axial flow pump reduces infarct size","volume":"41","author":"Meyns","year":"2003","journal-title":"J Am Coll Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12967-020-02250-x","article-title":"Increasing venoarterial extracorporeal membrane oxygenation flow puts higher demands on left ventricular work in a porcine model of chronic heart failure","volume":"18","author":"H\u00e1la","year":"2020","journal-title":"J Transl Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1177\/0310057x1604400518","article-title":"Speckle tracking echocardiography in the critically ill: enticing research with minimal clinical practicality or the answer to non-invasive cardiac assessment?","volume":"44","author":"Orde","year":"2016","journal-title":"Anaesth Intensive Care"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40635-019-0264-z","article-title":"Low flow rate alters haemostatic parameters in an ex-vivo extracorporeal membrane oxygenation circuit","volume":"7","author":"Ki","year":"2019","journal-title":"Intensive Care Med Exp"},{"key":"B8","year":""},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.echo.2018.06.004","article-title":"Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American society of echocardiography","volume":"32","author":"Mitchell","year":"2019","journal-title":"J Am Soc Echocardiogr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1093\/eurheartj\/ehv194","article-title":"Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score","volume":"36","author":"Schmidt","year":"2015","journal-title":"Eur Heart J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.jacc.2015.10.017","article-title":"Hemodynamics of mechanical circulatory support","volume":"66","author":"Burkhoff","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.echo.2012.02.009","article-title":"Two-dimensional strain rate and Doppler tissue myocardial velocities: analysis by echocardiography of hemodynamic and functional changes of the failed left ventricle during different degrees of extracorporeal life support","volume":"25","author":"Aissaoui","year":"2012","journal-title":"J Am Soc Echocardiogr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1097\/MAT.0000000000000824","article-title":"What is the optimal blood pressure on veno-arterial extracorporeal membrane oxygenation? Impact of mean arterial pressure on survival","volume":"65","author":"Tanaka","year":"2019","journal-title":"ASAIO J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.jacc.2018.10.085","article-title":"Left ventricular unloading during extracorporeal membrane oxygenation in patients with cardiogenic shock","volume":"73","author":"Russo","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1161\/CIRCULATIONAHA.120.048792","article-title":"Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study","volume":"142","author":"Schrage","year":"2020","journal-title":"Circulation"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12967-020-02599-z","article-title":"Hemolysis at low blood flow rates: in-vitro and in-silico evaluation of a centrifugal blood pump","volume":"19","author":"Sch\u00f6ps","year":"2021","journal-title":"J Transl Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.echo.2012.04.005","article-title":"ECMO And ECHO: the evolving role of quantitative echocardiography in the management of patients requiring extracorporeal membrane oxygenation","volume":"25","author":"Firstenberg","year":"2012","journal-title":"J Am Soc Echocardiogr"},{"key":"B18","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.echo.2020.12.002","article-title":"Echocardiographic predictors of successful extracorporeal membrane oxygenation weaning after refractory cardiogenic shock","volume":"34","author":"Kim","year":"2021","journal-title":"J Am Soc Echocardiogr"},{"key":"B19","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/echo.13446","article-title":"Reproducibility and experience dependence of echocardiographic indices of left ventricular function: side-by-side comparison of global longitudinal strain and ejection fraction","volume":"34","author":"Medvedofsky","year":"2017","journal-title":"Echocardiography"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13054-015-1042-2","article-title":"Echocardiography for adult patients supported with extracorporeal membrane oxygenation","volume":"19","author":"Doufl\u00e9","year":"2015","journal-title":"Crit Care"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.ijcard.2014.09.124","article-title":"Developing a risk prediction model for survival to discharge in cardiac arrest patients who undergo extracorporeal membrane oxygenation","volume":"177","author":"Park","year":"2014","journal-title":"Int J Cardiol"},{"key":"B22","author":"Ng","year":""}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1147783\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T05:17:22Z","timestamp":1681276642000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1147783\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,12]]},"references-count":22,"alternative-id":["10.3389\/fcvm.2023.1147783"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2023.1147783","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,12]]},"article-number":"1147783"}}