Comparison of Instantaneous Effect of Speed Change on Invasive Hemodynamics and Echocardiographic Parameters Between Heartware and Heartmate 3 LVADs

Abstract

Introduction Left ventricular assist device (LVAD) has shown to improve hemodynamics (HD). Right heart catheterization (RHC) and echocardiogram (ECHO) are used to define the optimal LVAD speed. This study evaluates the instantaneous effect of speed change on the HD and ECHO parameters in HeartWare (HVAD) and HeartMate 3 (HM3). Methods Patients with LVAD between January 2016 to March 2020, who had undergone speed optimization using RHC and ECHO, were included in this study. Generalized estimating equation or multilevel ordered logistic regression models were used to examine the effect of speed on all parameters to account for the correlation within conditions. Speed was standardized using the mean and standard deviation for HVAD and HM3. The estimated slope or odds ratio showed the effect on the parameters when standardized speed increased one standard deviation from its mean. Results Forty-two patients (13 HVAD and 29 HM3) were included. With increasing the speed, both devices similarly decreased pulmonary capillary wedge pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary artery pressure, and improved cardiac index calculated by Fick method. Increasing the speed also had a similar decrement on left ventricular end-diastolic diameter and right ventricular systolic pressure. Worsening right ventricular (RV) function with the increasing speed only occurred in HVAD. At any given standardized speed, HVAD had a higher chance of having worse aortic valve regurgitation (AVR), worse tricuspid regurgitation (TR), and less frequent aortic valve opening compared to HM3 (Table 1). Conclusion HVAD and HM3 overall have a similar instantaneous hemodynamic effect with speed change; however, increasing speed had a higher chance of worsening AVR, TR, and RV function in HVAD compared to HM3.