Abstract 14516: Systolic Slope of the Outflow Cannula Predicts Heart Failure Readmission Risk in Patients With Heartmate 3 Left Ventricular Assist Device

Abstract

Introduction: Left ventricular assist devices (LVAD) may lead to left ventricular (LV) recovery in patients with heart failure with reduced ejection fraction (HFrEF) via LV offloading and subsequent positive remodeling. Current echocardiographic markers of LV recovery in LVAD patients are not well defined. The peak systolic slope, also known as systolic acceleration, of the outflow cannula has recently been shown to be a marker of underlying LV contractility and a tool to assess for LV recovery. We hypothesized that variations in the systolic slope would predict heart failure (HF) admissions. Methods: A total of 63 unique patients with LVAD at The University of Chicago Medical Center had HeartMate 3 (HM3) outflow tract Doppler signals obtained during routine transthoracic echocardiography (TTE) of suitable quality between 2015 and 2022. Systolic acceleration, systolic deceleration, diastolic acceleration, and the presence of flow reversal were measured. Mortality and HF admissions were recorded up to one year from the date of the TTE. Results: Increased systolic acceleration through the HM3 outflow cannula was associated with a decreased 1-year HF admission risk (352.8 [241.9, 515.8] cm/sec 2 vs 249.2 [164.0, 316.5] cm/sec 2 among readmitted patients, p = 0.03; Figure 1A). Systolic deceleration also predicted 1-year HF admission (-318.6 [-477.9, -244.0] cm/sec 2 vs -217.8 [-304.5, -188.8] cm/sec 2 among readmitted patients, p = 0.04; Figure 1B). Other variables, including the presence of flow reversal and diastolic acceleration, were not significantly associated with HF admission risk. Conclusions: Systolic acceleration, which reflects LV contractility, and systolic deceleration, which represents LV relaxation, are predictive of HF admission in patients with the HM3 LVAD.