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Hemodynamic Stress Echocardiography in Patients Supported With a Continuous-Flow Left Ventricular Assist Device

Mads Andersen, MD^_*, Finn Gustafsson, MD, PhD^_*, Per Lav Madsen, MD, DmSc^_*, Patrice Brassard, PhD, Anette Schophuus Jensen, MD^_*, Niels Secher, MD, DmSc, Christian Hassager, MD, DmSc^_*, Nikolai Nordsborg, PhD, Jacob Eifer Møller, MD, PhD, DmSc^_*,_*

^_* Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
Department of Anesthesia, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

^_* Reprint requests and correspondence: Dr. Jacob Eifer Møller, Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej, 2100 Copenhagen, Denmark (Email: jem{at}dadlnet.dk).

Section Editor: Thomas Marwick, MBBS, PHD

Functional assessment of continuous-flow left ventricular assist devices (LVADs) is usually performed with the patient at rest. This study compared echocardiographic indices of contraction and filling pressure with invasive measures in 12 ambulatory LVAD patients undergoing symptom-limited bicycle exercise. Exercise induced an increase in cardiac output, systolic pulmonary artery pressure, and diastolic pulmonary artery pressure. Although no changes in left ventricular dimensions or fractional shortening were seen on echocardiography, systolic mitral annular motion (S') increased significantly (in parallel with cardiac output) and diastolic E/e' ratio decreased (correlating inversely with diastolic pulmonary artery pressure). These findings emphasize the potential role of exercise echocardiography in studying exercise hemodynamics in LVAD patients.

Key Words: echocardiography • exercise test • heart failure • left ventricular assist device

Abbreviations and Acronyms   CO = cardiac output   LV = left ventricular   LVAD = left ventricular assist device   PAP = pulmonary artery pressure   PVR = pulmonary vascular resistance