The Safety of Right Heart Catheterization in Patients with Continuous-Flow Left Ventricular Assist Devices

Patel, Kershaw V.; Rodgers, D.; Henderson, Cory; Anyanwu, Emeka; Fedson, Savitri; Kim, Gene; Sarswat, Nitasha; Juricek, C.; Ota, Takeyoshi; Jeevanandam, Valluvan; Sayer, Gabriel; Uriel, Nir

doi:10.1016/j.cardfail.2015.06.123

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“…Tailoring LVAD speed to the physiologic needs of the patients, as assessed by invasive hemodynamic testing, leads to improved survival and reduced readmission rates 15. Although invasive hemodynamic assessment can be safely performed in the majority of LVAD patients, it remains an invasive test that carries risk and inconvenient to the patients 16. Physical examination poorly predicts LVAD hemodynamics, because traditional auscultatory and visual examination techniques are unpredictable and unstudied in the setting of continuous unloading of the left ventricle 17.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Predictors of Hemodynamics in Patients Supported With Left Ventricular Assist Devices

Grinstein

Imamura

Kruse

et al. 2018

Journal of Cardiac Failure

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Background: The assessment of hemodynamics in patients supported with left ventricular assist devices (LVADs) is often challenging. Physical examination maneuvers correlate poorly with true hemodynamics. We assessed the value of novel transthoracic echocardiography (TTE)–derived variables to reliably predict hemodynamics in patients supported with LVAD. Methods and Results: A total of 102 Doppler-TTE images of the LVAD outflow cannula were obtained during simultaneous invasive right heart catheterization (RHC) in 30 patients supported with continuous-flow LVADs (22 HMII, 8 HVAD) either during routine RHC or during invasive ramp testing. Properties of the Doppler signal though the outflow cannula were measured at each ramp stage (RS), including the systolic slope (SS), diastolic slope (DS), and velocity time integral (VTI). Hemodynamic variables were concurrently recorded, including Doppler opening pressure (MAP), heart rate (HR), right atrial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP), Fick cardiac output (CO) and systemic vascular resistance (SVR). Univariate and multivariate regression analyses were used to explore the dependence of PCWP, CO, and SVR on DS, SS, VTI, MAP, HR, and RS. Multivariate linear regression analysis revealed significant contributions of DS on PCWP (PCWPpred = 0.164DS + 4.959; R = 0.68). Receiver operating characteristic (ROC) curve analysis revealed that PCWPpred could predict an elevated PCWP ≥18 mm Hg with a sensitivity (Sn) of 94% and specificity (Sp) of 85% (area under the ROC curve 0.88). CO could be predicted by RS, VTI, and HR (COpred = 0.017VTI + 0.016HR + 0.12RS + 2.042; R = 0.61). COpred could predict CO ≤4.5 L/min with Sn 73% and Sp 79% (AUC 0.81). SVR could be predicted by MAP, VTI, and HR (SVRpred = 15.44MAP − 5.453VTI − 6.349HR + 856.15; R = 0.84) with Sn 84% and Sp 79% (AUC 0.91) to predict SVR ≥ 1200 dyn·s/cm5. Conclusions: Doppler-TTE variables derived from the LVAD outflow cannula can reliably predict PCWP, CO, and SVR in patients supported with LVADs and may mitigate the need for invasive testing.

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Section: Discussionmentioning

confidence: 99%