Jerry D Estep1, Rey P Vivo2, Andrea M Cordero-Reyes3, Arvind Bhimaraj3, Barry H Trachtenberg3, Guillermo Torre-Amione4, Su Min Chang3, Barbara Elias3, Brian A Bruckner3, Erik E Suarez3, Matthias Loebe3. 1. Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas. Electronic address: jestep@houstonmethodist.org. 2. Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Mechanical and Circulatory Support and Heart Transplantation Program, UCLA Ahmanson Cardiomyopathy Center, UCLA, Los Angeles, California. 3. Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas. 4. Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Cátedra de Cardiologia y Medicina Vascular, Tecnológico de Monterrey, Monterrey, Nuevo León, México.
Abstract
BACKGROUND: Malfunction of a continuous-flow left ventricular assist device (CF-LVAD) due to device thrombosis is a potentially life-threatening event that currently presents a diagnostic challenge. We aimed to propose a practical echocardiographic assessment to diagnose LVAD malfunction secondary to pump thrombosis. METHODS: Among 52 patients implanted with a CF-LVAD from a single center who underwent echocardiographic pump speed-change testing, 12 had suspected pump thrombosis as determined by clinical, laboratory, and/or device parameters. Comprehensive echocardiographic evaluation was performed at baseline pump speed and at each 1,000-rpm interval from the low setting of 8,000 rpm to the high setting of 11,000 rpm in 11 of these patients. RESULTS: Receiver operating characteristic curves and stepwise logistic regression analyses showed that the best diagnostic parameters included changes in the LV end-diastolic diameter (<0.6 cm), aortic valve opening time (<80 msec), and deceleration time of mitral inflow (<70 msec) from lowest to highest pump speed. One parameter was predictive of pump malfunction, with 100% sensitivity and 89% specificity, whereas 2 of 3 parameters increased the sensitivity to 100% and specificity to 95%. CONCLUSIONS: The 3 echocardiographic variables of measured changes in LV end-diastolic diameter, aortic valve opening time, and deceleration time of mitral inflow between the lowest (8,000 rpm) and highest pump speed settings (11,000 rpm) during echo-guided pump speed-change testing appear highly accurate in diagnosing device malfunction in the setting of pump thrombosis among patients supported with CF-LVAD. Further investigation is warranted to create and validate a prediction score.
BACKGROUND: Malfunction of a continuous-flow left ventricular assist device (CF-LVAD) due to device thrombosis is a potentially life-threatening event that currently presents a diagnostic challenge. We aimed to propose a practical echocardiographic assessment to diagnose LVAD malfunction secondary to pump thrombosis. METHODS: Among 52 patients implanted with a CF-LVAD from a single center who underwent echocardiographic pump speed-change testing, 12 had suspected pump thrombosis as determined by clinical, laboratory, and/or device parameters. Comprehensive echocardiographic evaluation was performed at baseline pump speed and at each 1,000-rpm interval from the low setting of 8,000 rpm to the high setting of 11,000 rpm in 11 of these patients. RESULTS: Receiver operating characteristic curves and stepwise logistic regression analyses showed that the best diagnostic parameters included changes in the LV end-diastolic diameter (<0.6 cm), aortic valve opening time (<80 msec), and deceleration time of mitral inflow (<70 msec) from lowest to highest pump speed. One parameter was predictive of pump malfunction, with 100% sensitivity and 89% specificity, whereas 2 of 3 parameters increased the sensitivity to 100% and specificity to 95%. CONCLUSIONS: The 3 echocardiographic variables of measured changes in LV end-diastolic diameter, aortic valve opening time, and deceleration time of mitral inflow between the lowest (8,000 rpm) and highest pump speed settings (11,000 rpm) during echo-guided pump speed-change testing appear highly accurate in diagnosing device malfunction in the setting of pump thrombosis among patients supported with CF-LVAD. Further investigation is warranted to create and validate a prediction score.
Authors: Alexander Wuschek; Sara Iqbal; Jerry Estep; Eamonn Quigley; David Richards Journal: World J Gastroenterol Date: 2015-05-14 Impact factor: 5.742
Authors: Zaid I Almarzooq; Anubodh S Varshney; Muthiah Vaduganathan; Manan Pareek; Garrick C Stewart; Jerry D Estep; Mandeep R Mehra Journal: JACC Cardiovasc Imaging Date: 2019-09-18
Authors: Thomas E Hurst; Andrew Xanthopoulos; John Ehrlinger; Jeevanantham Rajeswaran; Amol Pande; Lucy Thuita; Nicholas G Smedira; Nader Moazami; Eugene H Blackstone; Randall C Starling Journal: ESC Heart Fail Date: 2019-07-18