BACKGROUND: The assessment of hemodynamics in patients supported with left ventricular assist devices (LVADs) is often challenging. Physical examination maneuvers correlate poorly with true hemodynamics. We assessed the value of novel transthoracic echocardiography (TTE)-derived variables to reliably predict hemodynamics in patients supported with LVAD. METHODS AND RESULTS: A total of 102 Doppler-TTE images of the LVAD outflow cannula were obtained during simultaneous invasive right heart catheterization (RHC) in 30 patients supported with continuous-flow LVADs (22 HMII, 8 HVAD) either during routine RHC or during invasive ramp testing. Properties of the Doppler signal though the outflow cannula were measured at each ramp stage (RS), including the systolic slope (SS), diastolic slope (DS), and velocity time integral (VTI). Hemodynamic variables were concurrently recorded, including Doppler opening pressure (MAP), heart rate (HR), right atrial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP), Fick cardiac output (CO) and systemic vascular resistance (SVR). Univariate and multivariate regression analyses were used to explore the dependence of PCWP, CO, and SVR on DS, SS, VTI, MAP, HR, and RS. Multivariate linear regression analysis revealed significant contributions of DS on PCWP (PCWPpred = 0.164DS + 4.959; R = 0.68). Receiver operating characteristic (ROC) curve analysis revealed that PCWPpred could predict an elevated PCWP ≥18 mm Hg with a sensitivity (Sn) of 94% and specificity (Sp) of 85% (area under the ROC curve 0.88). CO could be predicted by RS, VTI, and HR (COpred = 0.017VTI + 0.016HR + 0.12RS + 2.042; R = 0.61). COpred could predict CO ≤4.5 L/min with Sn 73% and Sp 79% (AUC 0.81). SVR could be predicted by MAP, VTI, and HR (SVRpred = 15.44MAP - 5.453VTI - 6.349HR + 856.15; R = 0.84) with Sn 84% and Sp 79% (AUC 0.91) to predict SVR ≥1200 dyn-s/cm5. CONCLUSIONS: Doppler-TTE variables derived from the LVAD outflow cannula can reliably predict PCWP, CO, and SVR in patients supported with LVADs and may mitigate the need for invasive testing.
BACKGROUND: The assessment of hemodynamics in patients supported with left ventricular assist devices (LVADs) is often challenging. Physical examination maneuvers correlate poorly with true hemodynamics. We assessed the value of novel transthoracic echocardiography (TTE)-derived variables to reliably predict hemodynamics in patients supported with LVAD. METHODS AND RESULTS: A total of 102 Doppler-TTE images of the LVAD outflow cannula were obtained during simultaneous invasive right heart catheterization (RHC) in 30 patients supported with continuous-flow LVADs (22 HMII, 8 HVAD) either during routine RHC or during invasive ramp testing. Properties of the Doppler signal though the outflow cannula were measured at each ramp stage (RS), including the systolic slope (SS), diastolic slope (DS), and velocity time integral (VTI). Hemodynamic variables were concurrently recorded, including Doppler opening pressure (MAP), heart rate (HR), right atrial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP), Fick cardiac output (CO) and systemic vascular resistance (SVR). Univariate and multivariate regression analyses were used to explore the dependence of PCWP, CO, and SVR on DS, SS, VTI, MAP, HR, and RS. Multivariate linear regression analysis revealed significant contributions of DS on PCWP (PCWPpred = 0.164DS + 4.959; R = 0.68). Receiver operating characteristic (ROC) curve analysis revealed that PCWPpred could predict an elevated PCWP ≥18 mm Hg with a sensitivity (Sn) of 94% and specificity (Sp) of 85% (area under the ROC curve 0.88). CO could be predicted by RS, VTI, and HR (COpred = 0.017VTI + 0.016HR + 0.12RS + 2.042; R = 0.61). COpred could predict CO ≤4.5 L/min with Sn 73% and Sp 79% (AUC 0.81). SVR could be predicted by MAP, VTI, and HR (SVRpred = 15.44MAP - 5.453VTI - 6.349HR + 856.15; R = 0.84) with Sn 84% and Sp 79% (AUC 0.91) to predict SVR ≥1200 dyn-s/cm5. CONCLUSIONS: Doppler-TTE variables derived from the LVAD outflow cannula can reliably predict PCWP, CO, and SVR in patients supported with LVADs and may mitigate the need for invasive testing.
Authors: Nir Uriel; Sirtaz Adatya; Jiří Malý; Eric Kruse; Daniel Rodgers; Gerald Heatley; Aleš Herman; Poornima Sood; Dominik Berliner; Johann Bauersachs; Axel Haverich; Michael Želízko; Jan D Schmitto; Ivan Netuka Journal: J Heart Lung Transplant Date: 2016-07-17 Impact factor: 10.247
Authors: Jerry D Estep; Rey P Vivo; Selim R Krim; Andrea M Cordero-Reyes; Barbara Elias; Matthias Loebe; Brian A Bruckner; Arvind Bhimaraj; Barry H Trachtenberg; Guha Ashrith; Guillermo Torre-Amione; Sherif F Nagueh Journal: J Am Coll Cardiol Date: 2014-09-23 Impact factor: 24.094
Authors: Nir Uriel; Allison P Levin; Gabriel T Sayer; Kanika P Mody; Sunu S Thomas; Sirtaz Adatya; Melana Yuzefpolskaya; Arthur R Garan; Alexander Breskin; Hiroo Takayama; Paolo C Colombo; Yoshifumi Naka; Daniel Burkhoff; Ulrich P Jorde Journal: J Card Fail Date: 2015-06-25 Impact factor: 5.712
Authors: Nir Uriel; Gabriel Sayer; Karima Addetia; Savitri Fedson; Gene H Kim; Daniel Rodgers; Eric Kruse; Keith Collins; Sirtaz Adatya; Nitasha Sarswat; Ulrich P Jorde; Colleen Juricek; Takeyoshi Ota; Valluvan Jeevanandam; Daniel Burkhoff; Roberto M Lang Journal: JACC Heart Fail Date: 2015-12-30 Impact factor: 12.035
Authors: James K Kirklin; David C Naftel; Francis D Pagani; Robert L Kormos; Lynne W Stevenson; Elizabeth D Blume; Susan L Myers; Marissa A Miller; J Timothy Baldwin; James B Young Journal: J Heart Lung Transplant Date: 2015-10-08 Impact factor: 10.247