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3D Morphological Changes in LV and RV During LVAD Ramp Studies
Karima Addetia1, Nir Uriel1, Francesco Maffessanti1
1Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
JACC. Cardiovascular Imaging
|April 17, 2017
Summary
Different left ventricular assist device (LVAD) types impact the heart uniquely. Three-dimensional echocardiography revealed distinct changes in left and right ventricular volumes and shapes, suggesting RV assessment can optimize LVAD speed.
Area of Science:
- Cardiology and Medical Devices
- Advanced Heart Failure Therapies
- Echocardiography and Cardiac Imaging
Background:
- Left ventricular assist devices (LVADs) are crucial for advanced heart failure treatment.
- Two primary LVADs, HeartMate II (HMII) and HVAD, exhibit differential effects on cardiac response.
- Understanding these differences is key to optimizing patient outcomes.
Purpose of the Study:
- To investigate the differential impact of HMII and HVAD on right ventricle (RV) and left ventricle (LV) morphology.
- To utilize 3D echocardiography for detailed analysis of ventricular volume and shape changes.
- To correlate LVAD type and speed with specific cardiac structural alterations.
Main Methods:
- 31 LVAD patients (19 HMII, 12 HVAD) underwent simultaneous 3D echocardiography, ramp testing, and right heart catheterization.
- LVAD speeds were incrementally increased to assess dynamic cardiac responses.
- Custom software analyzed 3D echocardiographic datasets to quantify LV sphericity, conicity, and RV septal/free-wall curvature.
Main Results:
- Both LVADs increased cardiac output and decreased wedge pressure with speed.
- HMII led to significant LV volume reduction and decreased sphericity, with RV volume increase and septal bulging at high speeds.
- HVAD showed less pronounced LV and RV volume changes, with preserved LV sphericity and no significant RV septal changes.
Conclusions:
- The two main LVAD types induce distinct volumetric and morphologic changes in both the LV and RV.
- Incorporating RV assessment into echo-ramp studies may improve LVAD speed optimization.
- Further research is needed to determine if these findings translate to improved patient outcomes.