Evaluation of right ventricular function and post-operative findings using cardiac computed tomography in patients with left ventricular assist devices

Imaging for Ventricular Function and Myocardial Recovery on Nonpulsatile Ventricular Assist Devices

“…One study in 36 patients explored the role of cardiac MDCT in the assessment of ventricular function in patients with continuous-flow LVADs. 6 The intraobserver and interobserver concordance for MDCT-derived LV and RV volumes and EFs was good to excellent (intraclass correlation coefficient range 0.93-0.99 and 0.89 -0.99 for LV and RV parameters, respectively). Compared with echocardiography, MDCT was highly effective and reproducible for the determination of RVFAC, which may be important when the echocardiography acoustic window is compromised.…”

“…Because of these limitations, ventricular volumes can be underestimated when assessed by echocardiography. 6 However, investigators have used standard echocardiographic measurements (biplane method of discs) to demonstrate a significant reduction (Ϸ47%) in LV size as early as 1 month after continuous-flow LVAD implantation (127Ϯ68 versus 242Ϯ108 mL pre-LVAD). 7 This reduction in LV size is similar to that reported for pulsatile pumps.…”

“…11 There are, however, major problems with using fractional shortening in these patients because of interventricular dependence and discordant septal and posterior wall motion. Another LVEF calculation uses the Simpson method from the apical 4-chamber view 6 ; however, it may be difficult to measure LVEF by the Simpson method solely based on the 4-chamber view, because the presence of the LVAD apical inflow cannula and its associated apical imaging limitations can make apex imaging and measured volumes highly variable and unreliable. In our experience, LVEF quantification for LVAD patients is most reliably and reproducibly performed by the modified biplane method of discs 7,10 if visualization of the LV appears reliable from the apex, or by the Quinones method, in which multiple diameters are measured from multiple parasternal and apical views from multiple windows.…”

“…7 Others have reported suboptimal study quality in the majority of early postoperative patients, with a fair interobserver variability for RV function indices (intraclass correlation coefficient range 0.50 -0.67). 6 The overall reported experience reflects variability in the observed RV structural and functional changes after continuous-flow LVAD implantation. Topilsky et al 5 demonstrated a 34% increase in RVFAC 3 months after continuousflow LVAD support (nϭ63), whereas others 7,11,18 report no significant consistent changes or worsening RV function based on measured RVFAC and tricuspid annular plane systolic excursion.…”

Cardiac CT Angiography in Congestive Heart Failure

“…An accurate echocardiographic assessment of RV size and function after LVAD implantation can be technically difficult because of postoperative changes and artifacts from the LVAD itself. CTA, without the limitations of an acoustic window, is highly effective and reproducible for the assessment of RV volume and function in patients with LVADs (52).…”