Abstract 14151: Transthoracic Echocardiographic Assessment of Normal Left Ventricular Assist Device Function
Continuous flow left ventricular assist devices (LVAD) are emerging to become the standard of care for the treatment of advanced heart failure. However, knowledge of normal values for transthoracic echocardiographic (TTE) examination and measurements in these patients are lacking.
Methods: We retrospectively analyzed all TTE examinations in 63 consecutive patients, performed at 90 and 180 days after surgery with implantation of a HeartMate II continuous flow LVAD between February 2007 and January 2010. All patients had to be considered stable on LVAD therapy, without the need for inotropic support at the time of examination.
Results: End diastolic and end systolic diameters, and left ventricle mass decreased considerably. Mitral inflow deceleration time prolonged, left atrial volume and E/e' ratio decreased, all consistent with decreased left ventricular filling pressure. Estimated right ventricular (RV), and right atrial pressure decreased significantly. Quantitatively estimated RV function and the right index of myocardial performance (RIMP) improved, suggesting improved RV efficiency. LVAD therapy resulted in significant decreases in the severity of mitral regurgitation, tricuspid regurgitation, and pulmonary regurgitation, but aortic regurgitation severity increased 3 months after LVAD implantation. There were no significant differences in the six months evaluation compared to the three months evaluation. Echocardiographically estimated LVAD flow, and total output flow were feasible in 28 out of 63 patients. The correlation between estimated LVAD flow by the controller and echocardiography was highly significant (r=0.71, p<0.0001).
Conclusion: This is the first report analyzing the normal echocardiographic values during continuous LVAD function. Stable functioning continuous LVAD is associated with evidence of efficient unloading of the left ventricle, improved RV efficiency, significant improvement in mitral, tricuspid, and pulmonary regurgitation, but increased aortic regurgitation. These normal data provide a basis for future echocardiographic studies post LVAD implantation.
- © 2010 by American Heart Association, Inc.