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

Echocardiography in the Management of Patients with Left Ventricular Assist Devices: Recommendations from the American Society of Echocardiography

“…[70][71][72] Several studies suggest that persistent AV closure is a risk factor for de novo AR after LVAD implantation, even without the presence of aortic root thrombus ( Figure 18). 68,73,74 For the reasons noted above in the postimplant TEE section, standard methods for quantifying AR 32 may be challenging to use after LVAD implantation.…”

“…LVAD optimization echocardiography consists of routine comprehensive TTE at the baseline speed setting (Appendix E), followed by stepwise incremental adjustments to the LVAD speed (in rpm), with collection of prespecified echocardiographic parameters (Appendix F) at each new speed, that reflects LVAD and/or native LV function (eg, LVIDd, interventricular septal position, AV-opening frequency/duration, TR and/or MR severity). 49,70,77 HM-II Speeds. The minimum and maximum speed settings for the HM-II LVAD are 6,000 and 15,000 rpm, respectively.…”

“…Others have chosen to include the optimization protocol only with the initial surveillance echo examination (eg, index hospitalization discharge/2 weeks postimplantation) and then only as needed when a routine surveillance echo (without speed changes) reveals a less-than-optimal LVAD speed according to predefined criteria. 63,70 It is important to note that utilization of echocardiography to optimize the LVAD speed is relatively new, and the impact of echocardiography-guided LVAD speed optimization protocols on shortand long-term clinical outcomes is currently unknown. Appendix D shows summary benchmark echocardiography parameters from three cohorts of patients from three different institutions, beginning before LVAD implantation and extending up to 12 months afterward.…”

“…70 The initial phase of the LVAD recovery protocol should be the same as for any comprehensive LVAD echo exam performed at the baseline speed setting. Very low LVAD pump speeds are associated with retrograde device flow ( Figure 26).…”

Continuous Flow Left Ventricular Assist Devices: Shared Care Goals of Monitoring and Treating Patients

“…13,14 Given the clinical implications of the type of LVAD and pump speed on heart function, these parameters should be recorded in the echo report. In our practice, the comprehensive LVAD exam (obtained at 1, 3, 6, and 12 months post-LVAD implant) consists of a standard echocardiographic examination (Table 6), recording several cardiac cycles to assess ventricular dimensions and AV function ( Figure 5), visualization of apical inflow cannula with Doppler, assessment of peak systolic and diastolic inflow velocity (Figure 6), and a complete LV diastolic function assessment based on the transmitral Doppler inflow pattern (peak early and late velocity and deceleration time), septal and lateral mitral valve annular velocities, left atrial volume, and right atrial and systolic pulmonary artery pressure.…”