Author + information
- Received June 8, 2017
- Revision received January 18, 2018
- Accepted January 25, 2018
- Published online March 14, 2018.
- Simone Frea, MDa,∗ (, )
- Paolo Centofanti, MDb,
- Stefano Pidello, MDa,
- Francesca Giordana, MDa,
- Virginia Bovolo, MDa,
- Andrea Baronetto, MDb,
- Beatrice Franco, MDa,
- Marco Matteo Cingolani, MDa,
- Matteo Attisani, MDb,
- Mara Morello, MDa,
- Serena Bergerone, MDa,
- Mauro Rinaldi, MDb and
- Fiorenzo Gaita, MDa
- aDivision of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
- bDivision of Cardiac Surgery, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
- ↵∗Address for correspondence:
Dr. Simone Frea, Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Corso Bramante 88, 10126 Torino, Italy.
Objectives The aim of this prospective study was to validate an echocardiographic protocol derived from 5 HeartWare left ventricular assist device (HVAD) patients for the noninvasive evaluation of right atrial pressure (RAP) and left atrial pressure (LAP) in HVAD patients.
Background Echocardiography is an invaluable tool to optimize medical treatment and pump settings and also for troubleshooting residual heart failure. Little is known about the echocardiographic evaluation of hemodynamic status in HVAD patients.
Methods Right heart catheterization and Doppler echocardiography were performed in 35 HVAD patients. Echocardiography-estimated RAP (eRAP) was assessed using inferior vena cava diameter, hepatic venous flow analysis, and tricuspid E/e′ ratio. Echocardiography-estimated LAP was assessed using E/A ratio, mitral E/e′ ratio, and deceleration time.
Results eRAP and estimated LAP significantly correlated with invasive RAP and LAP (respectively, r = 0.839, p < 0.001, and r = 0.889, p < 0.001) and accurately detected high RAP and high LAP (respectively, area under the curve 0.94, p < 0.001, and area under the curve 0.91, p < 0.001). High eRAP was associated with high LAP (area under the curve 0.92, p < 0.001) and correlated with death or hospitalization at 180 days (odds ratio: 8.2; 95% confidence interval: 1.1 to 21.0; p = 0.04). According to estimated LAP and eRAP, patients were categorized into 4 hemodynamic profiles. Fifteen patients (43%) showed the optimal unloading profile (normal eRAP and normal wedge pressure). This profile showed a trend toward a lower risk for adverse cardiac events at follow-up (odds ratio: 0.2; 95% confidence interval: 0.1 to 1.0; p = 0.05) compared with other hemodynamic profiles.
Conclusions Doppler echocardiography accurately estimated hemodynamic status in HVAD patients. This algorithm reliably detected high RAP and LAP. Notably, high RAP was associated with high wedge pressure and adverse outcome. The benefit of noninvasive estimation of hemodynamic status in the clinical management of patients with left ventricular assist devices needs further evaluation.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 8, 2017.
- Revision received January 18, 2018.
- Accepted January 25, 2018.
- 2018 American College of Cardiology Foundation
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