A simplified echocardiographic technique for detecting continuous-flow left ventricular assist device malfunction due to pump thrombosis

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:33

Article

Estep, Jerry D.¹  Vivo, Rey P.^1,2  Cordero-Reyes, Andrea M.¹  Bhimaraj, Arvind¹  Trachtenberg, Barry H.¹  Torre-Amione, Guillermo^1,3  Chang, Su Min¹  Elias, Barbara¹  Bruckner, Brian A.¹  Suarez, Erik E.¹  Loebe, Matthias¹ 

[1] Houston Methodist DeBakey Heart & Vasc Ctr, Houston, TX USA

[2] Univ Calif Los Angeles, Ahmanson Cardiomyopathy Ctr, Mech & Circulatory Support & Heart Transplantat P, Los Angeles, CA USA

[3] Catedra Cardiol & Med Vasc Tecnol Monterrey, Monterrey, Nuevo Leon, Mexico

关键词: heart failure;    left ventricular assist device;    thrombosis;    echocardiography;    cardiomyopathy;   

DOI  :  10.1016/j.healun.2014.01.865

来源: Elsevier

【 摘 要 】

BACKGROUND: Malfunction of a continuous-flow left ventricular assist device (CF-LVAD) due to device thrombosis is a potentially life-threatening event that currently presents a diagnostic challenge. We aimed to propose a practical echocardiographic assessment to diagnose LVAD malfunction secondary to pump thrombosis. METHODS: Among 52 patients implanted with a CF-LVAD from a single center who underwent echocardiographic pump speed-change testing, 12 had suspected pump thrombosis as determined by clinical, laboratory, and/or device parameters. Comprehensive echocardiographic evaluation was performed at baseline pump speed and at each 1,000-rpm interval from the low setting of 8,000 rpm to the high setting of 11,000 rpm in 11 of these patients. RESULTS: Receiver operating characteristic curves and stepwise logistic regression analyses showed that the best diagnostic parameters included changes in the LV end-diastolic diameter (<0.6 cm), aortic valve opening time (<80 msec), and deceleration time of mitral inflow (<70 msec) from lowest to highest pump speed. One parameter was predictive of pump malfunction, with 100% sensitivity and 89% specificity, whereas 2 of 3 parameters increased the sensitivity to 100% and specificity to 95%. CONCLUSIONS: The 3 echocardiographic variables of measured changes in LV end-diastolic diameter, aortic valve opening time, and deceleration time of mitral inflow between the lowest (8,000 rpm) and highest pump speed settings (11,000 rpm) during echo-guided pump speed-change testing appear highly accurate in diagnosing device malfunction in the setting of pump thrombosis among patients supported with CF-LVAD. Further investigation is warranted to create and validate a prediction score. (C) 2014 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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