Echocardiography and Continuous-Flow Left Ventricular Assist Devices: Evidence and Limitations

Echocardiography is the most used imaging modality in the growing population of patients with advanced heart failure undergoing continuous-flow, durable mechanical circulatory support. However, no guidelines for the use of echocardiography in this population exist, evidence for core applications is limited and conflicting, and newer centrifugal-flow devices have been subject to minimal study. As a first step toward addressing these deficits, this review summarizes the evidence and expert opinion for the use of echocardiography in pre-operative planning and perioperative management, prediction of post-operative right ventricular failure, the use of echocardiographic surrogates for invasive hemodynamic measurements, and the performance of speed ramp studies for the diagnosis of thrombosis and optimization of device settings.