Author + information
- Received April 12, 2013
- Revision received June 7, 2013
- Accepted June 13, 2013
- Published online November 1, 2013.
- Nowell M. Fine, MD∗,
- Yan Topilsky, MD∗,
- Jae K. Oh, MD∗,
- Tal Hasin, MD∗,
- Sudhir S. Kushwaha, MD∗,
- Richard C. Daly, MD†,
- Lyle D. Joyce, MD, PhD†,
- John M. Stulak, MD†,
- Naveen L. Pereira, MD∗,
- Barry A. Boilson, MD∗,
- Alfredo L. Clavell, MD∗,
- Brooks S. Edwards, MD∗ and
- Soon J. Park, MD, MS†∗ ()
- ∗Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- †Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
- ↵∗Reprint requests and correspondence:
Dr. Soon J. Park, Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55901.
Objectives This study sought to characterize the echocardiographic findings of patients presenting with intravascular hemolysis (IVH) due to suspected continuous-flow left ventricular assist device (LVAD) pump thrombosis.
Background LVAD patients who develop pump thrombosis often present with IVH. Echocardiography may be able to detect device dysfunction in this setting.
Methods Continuous-flow LVAD patients presenting with IVH due to suspected pump thrombosis were identified. Patients underwent echocardiography with cannula Doppler flow velocity interrogation. Findings were compared with baseline and follow-up studies, and with 49 stable LVAD control patients.
Results Of 145 patients, 14 (10%) had IVH due to suspected pump thrombosis. The mean age was 55 ± 15 years, 93% were men, and 50% received LVAD as destination therapy. Mean duration between implantation and IVH was 231 ± 218 days. Eleven (79%) patients presented with hemoglobinuria, 9 (64%) with jaundice, and 5 (36%) with acute heart failure. Reduced cannula diastolic flow velocity and increased systolic/diastolic (S/D) flow velocity ratio were the only echocardiographic parameters significantly different from controls (outflow cannula 0.3 ± 0.2 m/s vs. 0.8 ± 0.3 m/s, p = 0.03, and 5.9 ± 2.8 vs. 1.7 ± 0.7, p < 0.01, respectively), and were worse for IVH patients with acute heart failure compared with those without (outflow cannula 0.2 ± 0.1 m/s vs. 0.5 ± 0.2 m/s, p = 0.04, and 7.2 ± 3.3 vs. 5.3 ± 2.0, p = 0.02, respectively). Outflow cannula diastolic flow velocity and S/D flow velocity ratio changed significantly from baseline (p = 0.01 and p < 0.01, respectively) in IVH patients, whereas systolic flow velocity did not change (p = 0.59). Odds ratios for outflow cannula diastolic flow velocity and S/D flow velocity ratio for predicting IVH were 0.60 (95% confidence interval [CI]: 0.51 to 0.73), p = 0.02, and 2.45 (95% CI: 2.37 to 2.52) p < 0.01, respectively. Corresponding inflow cannula values were similarly significant. Pump thrombosis was confirmed in 7 (50%) patients after LVAD retrieval.
Conclusions Reduced cannula diastolic flow velocity and increased S/D flow velocity ratio identified continuous-flow LVAD dysfunction in patients with IVH due to suspected pump thrombosis better than other echocardiographic parameters.
Dr. Daly holds a patent with Neochord, Inc. Dr. Park has performed consulting services for Thoratec Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 12, 2013.
- Revision received June 7, 2013.
- Accepted June 13, 2013.