TY - JOUR
T1 - Echocardiographic evaluation of hemodynamics in patients with systolic heart failure supported by a continuous-flow LVAD
AU - Estep, Jerry D.
AU - Vivo, Rey P.
AU - Krim, Selim R.
AU - Cordero-Reyes, Andrea M.
AU - Elias, Barbara
AU - Loebe, Matthias
AU - Bruckner, Brian A.
AU - Bhimaraj, Arvind
AU - Trachtenberg, Barry H.
AU - Ashrith, Guha
AU - Torre-Amione, Guillermo
AU - Nagueh, Sherif F.
N1 - Publisher Copyright:
© 2014 by the American College of Cardiology Foundation.
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2014/9/23
Y1 - 2014/9/23
N2 - BACKGROUND: Hemodynamics assessment is important for detecting and treating post-implant residual heart failure, but its accuracy is unverified in patients with continuous-flow left ventricular assist devices (CF-LVADs).OBJECTIVES: We determined whether Doppler and 2-dimensional transthoracic echocardiography reliably assess hemodynamics in patients supported with CF-LVADs.METHODS: Simultaneous echocardiography and right heart catheterization were prospectively performed in 50 consecutive patients supported by using the HeartMate II CF-LVAD at baseline pump speeds. The first 40 patients were assessed to determine the accuracy of Doppler and 2-dimensional echocardiography parameters to estimate hemodynamics and to derive a diagnostic algorithm for discrimination between mean pulmonary capillary wedge pressure ≤15 versus >15 mm Hg. Ten patients served as a validation cohort.RESULTS: Doppler echocardiographic and invasive measures of mean right atrial pressure (RAP) (r = 0.863; p < 0.0001), systolic pulmonary artery pressure (sPAP) (r=0.880; p<0.0001), right ventricular outflowtract stroke volume (r=0.660; p < 0.0001), and pulmonary vascular resistance (r = 0.643; p = 0.001) correlated significantly. Several parameters, including mitral ratio of the early to late ventricular filling velocities >2, RAP >10 mm Hg, sPAP >40 mm Hg, left atrial volume index >33 ml/m2, ratio of mitral inflow early diastolic filling peak velocity to early diastolic mitral annular velocity >14, and pulmonary vascular resistance >2.5 Wood units, accurately identified patients with pulmonary capillary wedge pressure >15 mm Hg (area under the curve: 0.73 to 0.98). An algorithm integrating mitral inflow velocities, RAP, sPAP, and left atrial volume index was90%accurate in distinguishing normal from elevated left ventricular filling pressures.CONCLUSIONS: Doppler echocardiography accurately estimated intracardiac hemodynamics in these patients supported with CF-LVAD. Our algorithm reliably distinguished normal from elevated left ventricular filling pressures.
AB - BACKGROUND: Hemodynamics assessment is important for detecting and treating post-implant residual heart failure, but its accuracy is unverified in patients with continuous-flow left ventricular assist devices (CF-LVADs).OBJECTIVES: We determined whether Doppler and 2-dimensional transthoracic echocardiography reliably assess hemodynamics in patients supported with CF-LVADs.METHODS: Simultaneous echocardiography and right heart catheterization were prospectively performed in 50 consecutive patients supported by using the HeartMate II CF-LVAD at baseline pump speeds. The first 40 patients were assessed to determine the accuracy of Doppler and 2-dimensional echocardiography parameters to estimate hemodynamics and to derive a diagnostic algorithm for discrimination between mean pulmonary capillary wedge pressure ≤15 versus >15 mm Hg. Ten patients served as a validation cohort.RESULTS: Doppler echocardiographic and invasive measures of mean right atrial pressure (RAP) (r = 0.863; p < 0.0001), systolic pulmonary artery pressure (sPAP) (r=0.880; p<0.0001), right ventricular outflowtract stroke volume (r=0.660; p < 0.0001), and pulmonary vascular resistance (r = 0.643; p = 0.001) correlated significantly. Several parameters, including mitral ratio of the early to late ventricular filling velocities >2, RAP >10 mm Hg, sPAP >40 mm Hg, left atrial volume index >33 ml/m2, ratio of mitral inflow early diastolic filling peak velocity to early diastolic mitral annular velocity >14, and pulmonary vascular resistance >2.5 Wood units, accurately identified patients with pulmonary capillary wedge pressure >15 mm Hg (area under the curve: 0.73 to 0.98). An algorithm integrating mitral inflow velocities, RAP, sPAP, and left atrial volume index was90%accurate in distinguishing normal from elevated left ventricular filling pressures.CONCLUSIONS: Doppler echocardiography accurately estimated intracardiac hemodynamics in these patients supported with CF-LVAD. Our algorithm reliably distinguished normal from elevated left ventricular filling pressures.
KW - assist device
KW - Doppler
KW - echocardiography
KW - heart failure
KW - hemodynamics
KW - left ventricular
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U2 - 10.1016/j.jacc.2014.06.1188
DO - 10.1016/j.jacc.2014.06.1188
M3 - Article
C2 - 25236515
AN - SCOPUS:84908030072
SN - 0735-1097
VL - 64
SP - 1231
EP - 1241
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 12
ER -