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

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.