Echocardiographic evaluation of hemodynamics in patients with systolic heart failure supported by a continuous-flow LVAD

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

Research output: Contribution to journalArticle

33 Scopus citations

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 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.

Original languageEnglish (US)
Pages (from-to)1231-1241
Number of pages11
JournalJournal of the American College of Cardiology
Volume64
Issue number12
DOIs
StatePublished - Sep 23 2014
Externally publishedYes

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Keywords

  • assist device
  • Doppler
  • echocardiography
  • heart failure
  • hemodynamics
  • left ventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Estep, J. D., Vivo, R. P., Krim, S. R., Cordero-Reyes, A. M., Elias, B., Loebe, M., Bruckner, B. A., Bhimaraj, A., Trachtenberg, B. H., Ashrith, G., Torre-Amione, G., & Nagueh, S. F. (2014). Echocardiographic evaluation of hemodynamics in patients with systolic heart failure supported by a continuous-flow LVAD. Journal of the American College of Cardiology, 64(12), 1231-1241. https://doi.org/10.1016/j.jacc.2014.06.1188