Echo Useful In Measuring Cardiac Hemodyanamics In LVAD Patients

Jerry D. Estep, M.D., FACC Assistant Professor of Medicine, Weill Cornell Medical College Medical Director, Heart Transplant & LVAD Program Methodist DeBakey Heart & Vascular Center Houston Methodist HospitalMedicalResearch.com Interview with:
Jerry D. Estep, M.D., FACC
Assistant Professor of Medicine, Weill Cornell Medical College
Medical Director, Heart Transplant & LVAD Program
Methodist DeBakey Heart & Vascular Center
Houston Methodist Hospital

Medical Research: What are the main findings of the study?

Dr. Estep: There were two major findings:

1-Non-invasive Doppler echocardiographic and invasive measures of mean right atrial pressure (RAP) (r = 0.863; p < 0.0001), systolic pulmonary artery pressure (sPAP) (r=0.880; p<0.0001), right ventricular outflow tract stroke volume (r=0.660; p < 0.0001), and pulmonary vascular resistance (r = 0.643; p= 0.001) correlated significantly.

2-An algorithm integrating mitral inflow velocities, RAP, sPAP, and left atrial volume index was 90% accurate in distinguishing normal from elevated left ventricular filling pressures.

Medical Research: Were any of the findings unexpected?

Dr. Estep: Several isolated echo parameters (i.e. E/e’ ratio, a good marker of filling pressure in patients with heart failure) did not differ very significantly between CF-LVAD patients with and without high LA pressure. Instead a composite of multiple variables best estimates underlying elevated left atrial pressure.

Medical Research: What should clinicians and patients take away from your report?

Dr. Estep: Doppler echocardiography accurately estimated intra-cardiac hemodynamics in these patients supported with CF-LVAD.  In our experience the algorithm is useful in clinical practice to evaluate patients with heart failure symptoms despite being on an LVAD to detect partial LV unloading and to avoid right heart cathetherization.

Medical Research What recommendations do you have for future research as a result of this study?

Dr. Estep: There are two recommendations:

1-Validation of the provided algorithm in a large multicenter study.

2- Future research should focus on whether these echocardiographic parameters or a combination of parameters are sensitive to filling pressure changes and if the algorithm can be used clinically to minimize readmissions post LVAD related to left and/or right sided heart failure.

Citation:

Estep JD, Vivo RP, Krim SR, et al. Echocardiographic Evaluation of Hemodynamics in Patients With Systolic Heart Failure Supported by a Continuous-Flow LVAD. J Am Coll Cardiol. 2014;64(12):1231-1241. doi:10.1016/j.jacc.2014.06.1188.