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Ejection Fraction May Not Reflect Contractility: Example in Veno-Arterial Extracorporeal Membrane Oxygenation for Heart Failure

Morimont Philippe; Lambermont, Bernard; Guiot, Julien; Sato, Vincent Tchana; Clotuche, Christophe; Goffoy, Jonathan; Defraigne, Jean-Olivier
doi: 10.1097/MAT.0000000000000661
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Precise assessment of left ventricular (LV) contractility during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support is crucial. However, changes in loading conditions may mask changes in LV function when assessed with load-dependent parameters. We compared end-systolic elastance (Ees, mm Hg/ml), the reference load-independent parameter of LV contractility, with LV ejection fraction (LVEF) in two patients. The first patient was a 54-year-old patient supported with femoro-femoral VA-ECMO for a cardiogenic shock. Afterload was calculated by using arterial elastance (Ea, mm Hg/ml). Although Ees near doubled from day 0 to day 3, no significant change was observed in LVEF. The second patient was a 61-year-old patient supported with femoro-femoral VA-ECMO for severe heart failure complicated with sepsis. We retrospectively showed that discrepancy between LVEF and Ees resulted from changes in LV-arterial coupling. We concluded that LVEF may be misleading in the assessment of LV function during VA-ECMO for heart failure.

Submitted for consideration September 2016 ; accepted for publication in revised form August 2017.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Philippe Morimont, Doctor Philippe Morimont, Medical Intensive Care Unit, Department of Medicine, University Hospital of Liege, 4000 Liege, Belgium. Email:

Copyright © 2018 by the American Society for Artificial Internal Organs