Echocardiographic Evaluation of Hemodynamics in Patients With Systolic Heart Failure Supported by a Continuous-Flow LVAD

• Published in: Journal of the American College of Cardiology Vol. 64; no. 12; pp. 1231 - 1241
• Main Authors: Estep, Jerry D., MD, Vivo, Rey P., MD, Krim, Selim R., MD, Cordero-Reyes, Andrea M., MD, Elias, Barbara, RN, Loebe, Matthias, MD, PhD, Bruckner, Brian A., MD, Bhimaraj, Arvind, MD, Trachtenberg, Barry H., MD, Ashrith, Guha, MD, Torre-Amione, Guillermo, MD, PhD, Nagueh, Sherif F., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 23.09.2014; Elsevier Limited
• Subjects: Adult; Aged; Cardiac Catheterization - methods; Cardiology; Cardiovascular; Doppler; echocardiography; Echocardiography, Doppler - methods; Female; Heart failure; Heart Failure, Systolic - diagnostic imaging; Heart Failure, Systolic - surgery; Heart rate; Heart-Assist Devices; hemodynamics; Hemodynamics - physiology; Humans; Hypertension; Internal Medicine; Intubation; left ventricular assist device; Male; Middle Aged; Prospective Studies; Pulmonary arteries; Ventricular Function, Left - physiology; RAP; A; left atrial volume index; RV; CF-LVAD; E; echocardiography; systolic pulmonary artery pressure; LV; mitral inflow late diastolic filling peak velocity; PVR; LVAD; RVOT; right ventricular outflow tract; New York Heart Association; right atrial pressure; sPAP; left ventricular; left atrial pressure; continuous-flow left ventricular assist device; NYHA; heart failure; revolutions per minute; right ventricular; PCWP; pulmonary capillary wedge pressure; LAVi; hemodynamics; rpm; mitral inflow early diastolic filling peak velocity; early diastolic mitral annular velocity; LAP; left ventricular assist device; pulmonary vascular resistance; Doppler
• DOI: 10.1016/j.jacc.2014.06.1188
• ISSN: 0735-1097

Abstract 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 outflow tract 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 was 90% 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.