Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices

Uriel, Nir; Sayer, Gabriel; Addetia, Karima; Fedson, Savitri; Kim, Gene; Rodgers, D.; Kruse, Eric; Collins, Katie S.; Adatya, Sirtaz; Sarswat, Nitasha; Jorde, Ulrich P.; Juricek, C.; Ota, Takeyoshi; Jeevanandam, Valluvan; Burkhoff, Daniel; Lang, Roberto M.

doi:10.1016/j.jchf.2015.10.001

Cited by 190 publications

(203 citation statements)

References 21 publications

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“…Hemodynamic assessment during LVAD support may clarify the role of hemodynamic derangements in the development of LVAD complications. Our group has developed echocardiographic and hemodynamic ramp tests as a tool to facilitate hemodynamic optimization by adjusting LVAD speed and medical therapy [8]. Such procedures may be key to overcoming adverse events and improving clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Imamura

Chung

Nguyen

et al. 2018

Journal of Cardiology

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Left ventricular assist devices (LVADs) significantly improve outcomes of advanced heart failure patients. However, patients continue to have high readmission rates due to complications ranging from bleeding, thrombosis, heart failure, and infection. Considering that the hallmark benefit of LVAD therapy is improvement in hemodynamics (cardiac unloading and increased cardiac output), hemodynamic assessment on LVAD support is key to better understand these difficult complications and may serve as a tool to resolving them. In this review, we will discuss the hemodynamic changes following LVAD implantation, and the implications and prognostic impact of hemodynamic optimization on outcomes and complications.

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Section: Introductionmentioning

confidence: 99%

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Imamura

Chung

Nguyen

et al. 2018

Journal of Cardiology

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“…5 A portion of these patients exhibit an excessive difference between diastolic pulmonary artery pressure (dPAP) and pulmonary capillary wedge pressure (PCWP). Such decoupling, defined as an excessive increase of dPAP gradient, provides an index of precapillary pulmonary hypertension (PH) which may be superimposed on post-capillary PH in patients with left heart disease.…”

mentioning

confidence: 99%

Decoupling Between Diastolic Pulmonary Artery Pressure and Pulmonary Capillary Wedge Pressure as a Prognostic Factor After Continuous Flow Ventricular Assist Device Implantation

Imamura¹,

Chung²,

Nguyen³

et al. 2017

Circ: Heart Failure

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BACKGROUND A cohort of heart failure (HF) patients receiving left ventricular assist devices (LVADs) has decoupling of their diastolic pulmonary artery pressure and pulmonary capillary wedge pressure. However, the clinical implications of this decoupling remain unclear. METHODS AND RESULTS In this prospective study, patients with LVADs underwent routine invasive hemodynamic ramp testing with right heart catheterization, during which LVAD speeds were adjusted. Inappropriate decoupling was defined as a >5 mm Hg difference between diastolic pulmonary artery pressure and pulmonary capillary wedge pressure. The primary outcomes of survival and heart failure readmission rates after ramp testing were assessed. Among 63 LVAD patients (60±12 years old and 25 female [40%]), 27 patients (43%) had inappropriate decoupling at their baseline speed. After adjustment of their rotation speed during ramp testing, 30 patients (48%) had inappropriate decoupling. Uni/multivariable Cox analyses demonstrated that decoupling was the only significant predictor for the composite end point of death and heart failure readmission during the 1 year following the ramp study (total of 18 events; hazards ratio, 1.09; 95% confidence interval, 1.04–1.24; P<0.05). Furthermore, normalization of decoupling (n=8) during ramp testing was significantly associated with higher 1-year heart failure readmission–free survival rate compared with the non-normalized group (n=19, 100% versus 53%; P=0.035). CONCLUSIONS The presence of inappropriate decoupling was associated with worse outcomes in patients with LVADs. Prospective, large-scale multicenter studies to validate the result are warranted.

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“…In Protocol 1, 30 patients were studied before and after LVAD implantation. In Protocol 2, 25 patients underwent simultaneous 3DE imaging and right-heart catheterization during a ramp study [4,5]. This protocol included analysis of rotational deformation at 5 increasing pump speeds.…”

Section: Methodsmentioning

confidence: 99%

“…The ramp test protocol has been previously described [4][5][6]. Briefly, LVAD speed was initially set at the lowest range for each pump and then gradually increased to the highest range.…”

Section: Methodsmentioning

confidence: 99%

“…Although we previously described a systematic protocol for LVAD speed optimization using hemodynamic and 2DE ramp tests, the identification of optimal LVAD settings remains a challenging clinical task [4][5][6]. Also, these ramp tests fail to quantify residual native LV function, because conventional ejection phase indices, such as ejection fraction (EF), are not useful in patients with LVADs.…”

Section: Introductionmentioning

confidence: 99%

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3D Echocardiographic Optimization of Residual Native Myocardial Function in Patients with Left Ventricular Assist Devices

Medvedofsky

Lang

Sayer

et al. 2017

Computing in Cardiology Conference (CinC)

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Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices

Abstract: Use of combined hemodynamic and echocardiographic ramp tests in patients provides objective means of optimizing RPM, and has the potential to guide medical management. It remains to be tested whether this strategy has a beneficial impact on quality of life or clinical outcomes.

Cited by 190 publications

References 21 publications

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Decoupling Between Diastolic Pulmonary Artery Pressure and Pulmonary Capillary Wedge Pressure as a Prognostic Factor After Continuous Flow Ventricular Assist Device Implantation

3D Echocardiographic Optimization of Residual Native Myocardial Function in Patients with Left Ventricular Assist Devices

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