A simplified echocardiographic technique for detecting continuous-flow left ventricular assist device malfunction due to pump thrombosis

Jerry D. Estep, Rey P. Vivo, Andrea M. Cordero-Reyes, Arvind Bhimaraj, Barry H. Trachtenberg, Guillermo Torre-Amione, Su Min Chang, Barbara Elias, Brian A. Bruckner, Erik E. Suarez, Matthias Loebe

Research output: Contribution to journalArticle

25 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)575-586
Number of pages12
JournalJournal of Heart and Lung Transplantation
Volume33
Issue number6
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Heart-Assist Devices
Thrombosis
Deceleration
Aortic Valve
Equipment and Supplies
ROC Curve
Logistic Models
Regression Analysis
Sensitivity and Specificity

Keywords

  • cardiomyopathy
  • echocardiography
  • heart failure
  • left ventricular assist device
  • thrombosis

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery
  • Medicine(all)

Cite this

A simplified echocardiographic technique for detecting continuous-flow left ventricular assist device malfunction due to pump thrombosis. / Estep, Jerry D.; Vivo, Rey P.; Cordero-Reyes, Andrea M.; Bhimaraj, Arvind; Trachtenberg, Barry H.; Torre-Amione, Guillermo; Chang, Su Min; Elias, Barbara; Bruckner, Brian A.; Suarez, Erik E.; Loebe, Matthias.

In: Journal of Heart and Lung Transplantation, Vol. 33, No. 6, 2014, p. 575-586.

Research output: Contribution to journalArticle

Estep, JD, Vivo, RP, Cordero-Reyes, AM, Bhimaraj, A, Trachtenberg, BH, Torre-Amione, G, Chang, SM, Elias, B, Bruckner, BA, Suarez, EE & Loebe, M 2014, 'A simplified echocardiographic technique for detecting continuous-flow left ventricular assist device malfunction due to pump thrombosis', Journal of Heart and Lung Transplantation, vol. 33, no. 6, pp. 575-586. https://doi.org/10.1016/j.healun.2014.01.865
Estep, Jerry D. ; Vivo, Rey P. ; Cordero-Reyes, Andrea M. ; Bhimaraj, Arvind ; Trachtenberg, Barry H. ; Torre-Amione, Guillermo ; Chang, Su Min ; Elias, Barbara ; Bruckner, Brian A. ; Suarez, Erik E. ; Loebe, Matthias. / A simplified echocardiographic technique for detecting continuous-flow left ventricular assist device malfunction due to pump thrombosis. In: Journal of Heart and Lung Transplantation. 2014 ; Vol. 33, No. 6. pp. 575-586.
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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.",
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AU - Estep, Jerry D.

AU - Vivo, Rey P.

AU - Cordero-Reyes, Andrea M.

AU - Bhimaraj, Arvind

AU - Trachtenberg, Barry H.

AU - Torre-Amione, Guillermo

AU - Chang, Su Min

AU - Elias, Barbara

AU - Bruckner, Brian A.

AU - Suarez, Erik E.

AU - Loebe, Matthias

PY - 2014

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N2 - 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.

AB - 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.

KW - cardiomyopathy

KW - echocardiography

KW - heart failure

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KW - thrombosis

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