Abstract
PurposePoor left ventricular (LV) function may affect the physiological intraventricular blood flow and physiological vortex formation. The aim of this study was to investigate the pattern of intraventricular blood flow dynamics in patients with LV assist devices (LVADs) using echocardiographic particle image velocimetry.Materials and methodsThis prospective study included 17 patients (mean age 57 ± 11 years, 82% male) who had received an LVAD (HeartMate 3, Abbott Laboratories, Chicago, Illinois, USA) because of end-stage heart failure and poor LV function. Eleven (64%) patients had ischemic cardiomyopathy, and six patients (36%) had nonischemic cardiomyopathy. All patients underwent echocardiography, including intravenous administration of an ultrasound-enhancing agent (SonoVue, Bracco, Milan, Italy). Echocardiographic particle image velocimetry was used to quantify LV blood flow dynamics, including vortex formation (Hyperflow software, Tomtec imaging systems Gmbh, Unterschleissheim, Germany).ResultsContrast-enhanced ultrasound was well tolerated in all patients and was performed without adverse reactions or side effects. The LVAD function parameters did not change during or after the ultrasound examination. The LVAD flow was on average 4.3 ± 0.3 L/min, and the speed was 5247 ± 109 rotations/min. The quantification of LV intraventricular flow demonstrated substantial impairment of vortex parameters. The energy dissipation, vorticity, and kinetic energy fluctuation indices were severely impaired.ConclusionsEcho particle velocimetry is safe and feasible for the quantitative assessment of intraventricular flow in patients with an LVAD. The intraventricular LV flow and vortex parameters are severely impaired in these patients.
Highlights
Patients with end-stage heart failure and poor left ventricular (LV) function due to ischemic or nonischemic cardiomyopathy may benefit from therapy with an LV assist device (LVAD)
There were no signs that the LVAD caused substantial destruction of the ultrasound contrast agent; a regular dose of contrast agent could be used in all cases
This study demonstrates that LV intraventricular flow quantification with contrast-enhanced echocardiography in patients with an LVAD is safe and feasible
Summary
Patients with end-stage heart failure and poor left ventricular (LV) function due to ischemic or nonischemic cardiomyopathy may benefit from therapy with an LV assist device (LVAD). The ultrasound-enhancing agent consists of microbubbles, which have a size comparable to that of erythrocytes and which serve as a tracer of intraventricular blood flow [5, 6]. This method has successfully been explored in experimental and clinical research settings [7,8,9,10,11]. The physiological vortex formation is supposed to be an energy-efficient
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