Incidence and Clinical Findings Associated to Incomplete Hemodynamic Unloading of the Left Ventricle under LVAD Support

Abstract

Purpose Normalization of hemodynamics plays an important role in achieving an optimal clinical benefit after LVAD Implantation. However the hemodynamic optimization during follow-up continues to be a challenge. We assessed the likelihood of effective hemodynamic unloading of the Left ventricle (HLVU) during LVAD support, when the current standard recommendations for LVAD speed optimization were applied in the clinical practice, and its association with different clinical and echocardiographic (TTE) conditions. Methods Retrospective study that included consecutive patients who had primary received an LVAD as bridge to heart transplantation (BTT) and underwent a right-side catheterization (RHC) at least 3 months after the LVAD implantation as part of the screening process for BTT candidacy.Routinely ambulatory follow-up consisted in clinical, TTE and hematological examination.LVAD rotor speed was optimized during each follow-up visit according to the current clinical recommendations. Results 104 p (87% male, 55+/-6 years, 42% HeartWare LVAD, 58% HM3 LVAD) were studied. Incomplete HLVU was defined if the pulmonary capillary wedge pressure was above 15 mmHg (hPCWP), and it was present in 29 p (28%). Patients with hPCWP were older, had worse postoperative renal function, higher BNP levels, received fewer renin-angiotensin-Aldosteron blocking agents(RAB) and required higher dose of diuretics (p 300 pg/dl could predict hPCWP with 78% accuracy, 74% specificity and a 78% sensitivity (p Conclusion An incomplete HLVU under LVAD support is common in the clinical practice, when the current standard recommendations are applied. Our study highlights the negative effect of age and renal dysfunction in the likehood of effective HLVU and the potential contribution of the RAB to achieve this goal.The BNP levels and the magnitude of the echocardiographic reverse LV remodeling seem to be useful non-invasive tools to evaluate the degree of effective LV unloading during follow-up.