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

JOURNAL OF CARDIAC FAILURE

卷:24

Article

Grinstein, Jonathan¹  Imamura, Teruhiko²  Kruse, Eric²  Kalantari, Sara²  Rodgers, Daniel²  Adatya, Sirtaz³  Sayer, Gabriel²  Kim, Gene H.²  Sarswat, Nitasha²  Raihkelkar, Jayant²  Ota, Takeyoshi⁴  Jeevanandam, Valluvan⁴  Burkhoff, Daniel⁵  Lang, Roberto²  Uriel, Nir² 

[1] MedStar Heart & Vasc Inst, Div Cardiol, Washington, DC 20010 USA

[2] Univ Chicago, Med Ctr, Dept Med, Chicago, IL 60637 USA

[3] Kaiser Permanente Adv Heart Failure, Santa Clara, CA USA

[4] Univ Chicago, Med Ctr, Dept Surg, Chicago, IL 60637 USA

[5] Columbia Univ, Div Cardiol, New York, NY USA

关键词: LVAD;    hemodynamics;    noninvasive;   

DOI  :  10.1016/j.cardfail.2018.07.004

来源: Elsevier

【 摘 要 】

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-FIE 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 - 5.453 VTI - 6.349HR + 856.15; R = 0.84) with Sn 84% and Sp 79% (AUC 0.91) to predict SVR >= 1200 dyn-s/cm(5). 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.

【 授权许可】

Free