Echocardiographic Parameters Associated with Clinical Heart Failure Due to Partial Left Ventricular Unloading in Patients with Continuous-Flow LVAD

Abstract

Purpose Patients with continuous-flow LVAD may develop clinical heart failure (HF) due to partial LV unloading. We aimed to examine clinical and echocardiographic predictors of HF defined by symptoms/signs and invasive hemodynamics. Methods and Materials Records of patients who received LVAD from 2008-12 in our center were reviewed. Patients with adverse events Results Of 140 patients who survived beyond 30 days post-LVAD, 11 (8%) had HF. Baseline pump speed (rpm) between subjects and controls: 9,091±466 vs 9,200±927. Patients with HF had higher echo-measured E/A ratio (2.0±1.1 vs 1.1±0.8, P=0.03) and right atrial pressure (RAP) (14.9±4.0 vs 5.0±1.3, P Conclusions Elevated E/A ratio and RAP, echo markers of diastolic dysfunction and high right-sided pressures, are associated with HF due to partial LV unloading in LVAD patients. These echo parameters may help guide diagnosis and appropriate management in this population. Echo parameters in LVAD patients with and without HF HF & PCWP ≥15 (N=11) No HF & PCWP P value RAP (mmHg) 14.9±4.0 5.0±1.3 E/A 2.0±1.1 1.1±0.8 0.03 E/e’ 15.3±4.1 11.1±4.7 0.05 E 88.8±26.9 66.6±25.1 0.06 LAVi (mL/m2) 34.1±13.4 24.3±8.6 0.06 TV PG (mmHg) 27.6±7.6 21.5±5.2 0.07 DT (ms) 179.9±48.4 194.5±66.9 0.5 E/A=Early/late mitral inflow, E/e’=Mitral early peak velocity/annular velocity, DT=Mitral deceleration time, LAVi=Left atrial volume index, RAP=Right atrial pressure, TV PG=Tricuspid pressure gradient