Abstract 18981: Diagnostic Utility and Safety of Contrast Enhanced Gated Multislices Cardiac Computed Tomography (CT) for Evaluation of Patient s with Left Ventricular Assist Device (LVAD)
Background Visualization of the entire LVAD and surrounding cardiovascular structure is paramount for comprehensive assessment of LVAD-patients. Transthoracic echocardiogram is often limited by the artifacts and acoustic window. We studied the diagnostic utility and safety of Cardiac CT for evaluation of patients with LVAD.
Method Between 2010-2012, 16 consecutive LVADs-Pts ( 14 Heart-Mate II) underwent 64 slices cardiac CT. The primary clinical indications were : 6 suspected cannula malposition ( frequent LVAD alarm, low output , recurrent VT, and hemolysis ), 5 source of emboli/infection, 3 effusion/hematoma, and 2 LV function/aortic valve assessment . Abnormal finding were defined as presence of inflow cannula (IC) malposition , significant outflow cannula (OC) kinking , mass/clot in the LVAD or heart/aorta or large effusion/hematoma . CT was considered diagnostic if the finding answered the clinical indications as determined by the LVAD/transplant cardiologist. CT-related complication was defined as worsened heart failure (HF) , anaphylaxis or contrast induced nephropathy (CIN : creatinine increase over 25 % at 7 days post CT ) . Beta-blocker was given prior to CT in 12 pts. Median contrast volume was 120 ml.
Result The mean age was 55 +-14 yrs , 50 % male and history of ischemic cardiomyopathy in 10 pts. Abnormal findings were present in 11 cases including 6 IC malposition , 1 IC malposition plus significant OC kinking , 1 clot in the aortic root and 3 large effusion/hematoma . In 11 pts (70 %) , the CT findings were considered diagnostic for the primary clinical indication . And in 9 pts (55%) , therapeutic changes were made according to the CT findings . Four were medical ( LVAD speed or anticoagulation changes ) and 5 were surgical ( 1 transplant, 3 LVAD exchange and 1 surgical evacuation of mediastinal hematoma with RV collapse) . There were no cases of worsened HF , anaphylaxis after CT. The mean GFR pre CT was 1 +-0.4 mg/dl . Eight pts was in stage 2 or 3 chronic kidney disease. CIN developed in only 1 pt with creatinine increased from 0.8 to 1.1 mg/dl.
Conclusion For evaluation of pts with LVAD, cardiac CT appeared to be safe, had good diagnostic utility and often lead to therapeutic changes . However, the impact on outcomes remains to be determined.
- © 2012 by American Heart Association, Inc.