Author + information
- Received March 20, 2014
- Revision received May 16, 2014
- Accepted June 3, 2014
- Published online September 23, 2014.
- Jerry D. Estep, MD∗∗ (, )
- Rey P. Vivo, MD∗,†,
- Selim R. Krim, MD‡,
- Andrea M. Cordero-Reyes, MD∗,
- Barbara Elias, RN∗,
- Matthias Loebe, MD, PhD∗,
- Brian A. Bruckner, MD∗,
- Arvind Bhimaraj, MD∗,
- Barry H. Trachtenberg, MD∗,
- Guha Ashrith, MD∗,
- Guillermo Torre-Amione, MD, PhD∗,§ and
- Sherif F. Nagueh, MD∗
- ∗Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
- †Mechanical Circulatory Support and Heart Transplantation Program, UCLA Ahmanson Cardiomyopathy Center, Los Angeles, California
- ‡John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana
- §Catedra de Cardiologia y Medicina Vascular, Tecnológico de Monterrey, Nuevo León, Mexico
- ↵∗Reprint requests and correspondence:
Dr. Jerry D. Estep, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower Suite 1901, Houston, Texas 77030.
Background Hemodynamics assessment is important for detecting and treating post-implant residual heart failure, but its accuracy is unverified in patients with continuous-flow left ventricular assist devices (CF-LVADs).
Objectives We determined whether Doppler and 2-dimensional transthoracic echocardiography reliably assess hemodynamics in patients supported with CF-LVADs.
Methods Simultaneous echocardiography and right heart catheterization were prospectively performed in 50 consecutive patients supported by using the HeartMate II CF-LVAD at baseline pump speeds. The first 40 patients were assessed to determine the accuracy of Doppler and 2-dimensional echocardiography parameters to estimate hemodynamics and to derive a diagnostic algorithm for discrimination between mean pulmonary capillary wedge pressure ≤15 versus >15 mm Hg. Ten patients served as a validation cohort.
Results Doppler echocardiographic and invasive measures of mean right atrial pressure (RAP) (r = 0.863; p < 0.0001), systolic pulmonary artery pressure (sPAP) (r = 0.880; p < 0.0001), right ventricular outflow tract stroke volume (r = 0.660; p < 0.0001), and pulmonary vascular resistance (r = 0.643; p = 0.001) correlated significantly. Several parameters, including mitral ratio of the early to late ventricular filling velocities >2, RAP >10 mm Hg, sPAP >40 mm Hg, left atrial volume index >33 ml/m2, ratio of mitral inflow early diastolic filling peak velocity to early diastolic mitral annular velocity >14, and pulmonary vascular resistance >2.5 Wood units, accurately identified patients with pulmonary capillary wedge pressure >15 mm Hg (area under the curve: 0.73 to 0.98). An algorithm integrating mitral inflow velocities, RAP, sPAP, and left atrial volume index was 90% accurate in distinguishing normal from elevated left ventricular filling pressures.
Conclusions Doppler echocardiography accurately estimated intracardiac hemodynamics in these patients supported with CF-LVAD. Our algorithm reliably distinguished normal from elevated left ventricular filling pressures.
Dr. Estep has received consulting fees from Thoratec Corp. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 20, 2014.
- Revision received May 16, 2014.
- Accepted June 3, 2014.
- American College of Cardiology Foundation