Aortic Valve Opening at Hospital Discharge After HeartMate II Left Ventricular Assist Device Implantation Is Associated With Improved Renal Function at 3 Months

Abstract

Background: While novel therapies may assist in myocardial recovery in patients maintained on LVassist devices (LVADs), it is not clear how best to measure intrinsic cardiac contractile function in the unloaded state. We sought to determine if global and regional cardiac strain measured by echocardiographic deformation imaging could be accurately and reproducibly measured in LVAD patients, and to determine the relationship between these measures and estimates of myocardial metabolism and blood flow by positron emission tomography (PET). Objective: To describe the interrelation between measures of cardiac function and structure, myocardial blood flow and metabolism in patients with advanced heart disease living on left ventricular assist devices. Methods: 7 Patients with end-stage heart failure (4 ischemic, 3 nonischemic) on LVAD support were prospectively evaluated using both PET and ECHO, imaged on the same day, at the same VAD settings. Regional circumferential strain, myocardial blood flow, and glucose metabolism were assessed in mid-short axis slices at the level of the papillary muscles and related. Results: Mid-ventricular global strain was low in all patients, but it was lower in patients with CAD versus non-ischemic patients (-4.6% 6 0.4 vs. -7.3% 6 2.9, p50.054; normal 5 O -23%). Despite 4 patients labelled with ischemic cardiomyopathy, only 1 had a definite region of infarction on PET. Regional strain correlated well with myocardial perfusion (r5 -0.89, p50.01) and metabolism (r5 -0.843, p50.03) in the CAD patient with an infarcted region (Figure 1), but not in CAD patients without MI or in non-ischemic patients.