Lung Ultrasound in Left Ventricular Assist Device Patients: A Feasibility Study

Abstract

PurposeSpeed optimization in left ventricular assist device (LVAD) recipients remains a key feature in patient management. Noninvasive evaluation with echocardiography is routinely performed, however, around 38% of LVAD patients considered stable had non-optimal hemodynamics at baseline speed. Pulmonary congestion can be seen on lung ultrasound (LUS) in the form of B-lines. In heart failure (HF) patients, the number of B-lines has proven to be an excellent prognostic marker and a strategy of treatment guided by LUS appears to decrease the number of HF admissions. LUS, a noninvasive point of care test, seems an attractive tool to complement echocardiographic assessment in LVAD recipients; however, this has never been studied.MethodsThis is a single center, observational, prospective study. Heart Mate 3 (HM3) patients 18 years or older were invited to participate during an outpatient clinic visit or during a right heart catheterization. Patients with known severe pulmonary diseases were excluded. We examined eight thoracic sites (4 in each hemithorax) and the number of B-lines was reported in real time as the sum of the B-lines visualized in each site.ResultsThis is the report of the first 10 patients included. Mean age was 49 ± 11 years. 80% of patients were male, 80% had a nonischemic cardiomyopathy, and 20% had a history of COPD. The median BMI was 36 kg/m^2 (25-37). 100% of the thoracic sites examined were interpretable and the median number of B-lines was 2.5 (1-7). 2 patients also had a pleural effusion. In contrast, patients had very few signs of congestion on physical examination (Figure).ConclusionLUS in HM3 patients is feasible and no interference with the LVAD has been encountered in an 8-site protocol. Whether LUS can help LVAD optimization and improve outcomes in this challenging population remains to be determined. Speed optimization in left ventricular assist device (LVAD) recipients remains a key feature in patient management. Noninvasive evaluation with echocardiography is routinely performed, however, around 38% of LVAD patients considered stable had non-optimal hemodynamics at baseline speed. Pulmonary congestion can be seen on lung ultrasound (LUS) in the form of B-lines. In heart failure (HF) patients, the number of B-lines has proven to be an excellent prognostic marker and a strategy of treatment guided by LUS appears to decrease the number of HF admissions. LUS, a noninvasive point of care test, seems an attractive tool to complement echocardiographic assessment in LVAD recipients; however, this has never been studied. This is a single center, observational, prospective study. Heart Mate 3 (HM3) patients 18 years or older were invited to participate during an outpatient clinic visit or during a right heart catheterization. Patients with known severe pulmonary diseases were excluded. We examined eight thoracic sites (4 in each hemithorax) and the number of B-lines was reported in real time as the sum of the B-lines visualized in each site. This is the report of the first 10 patients included. Mean age was 49 ± 11 years. 80% of patients were male, 80% had a nonischemic cardiomyopathy, and 20% had a history of COPD. The median BMI was 36 kg/m^2 (25-37). 100% of the thoracic sites examined were interpretable and the median number of B-lines was 2.5 (1-7). 2 patients also had a pleural effusion. In contrast, patients had very few signs of congestion on physical examination (Figure). LUS in HM3 patients is feasible and no interference with the LVAD has been encountered in an 8-site protocol. Whether LUS can help LVAD optimization and improve outcomes in this challenging population remains to be determined.