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Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
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Clinical findings associated with incomplete hemodynamic left ventricular unloading in patients with a left

María J Ruiz-Cano1, René Schramm1, Lech Paluszkiewicz1

  • 1Division of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW Bad Oeynhausen, Ruhr-University Bochum, Germany.

Revista Espanola De Cardiologia (English Ed.)
|July 25, 2021
PubMed

Insights

Optimal hemodynamic left ventricular unloading (HLVU) is achievable in 72% of centrifugal continuous-flow left ventricular assist device (cfLVAD) patients. Brain natriuretic peptide levels and reverse left ventricular remodeling can help assess HLVU.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Hemodynamic left ventricular unloading (HLVU) is crucial for patients with centrifugal continuous-flow left ventricular assist devices (cfLVADs).
  • The factors influencing successful HLVU and hemodynamic optimization are not fully understood.

Purpose of the Study:

  • To assess the incidence of incomplete HLVU in ambulatory cfLVAD patients.
  • To identify clinical, hemodynamic, and echocardiographic predictors of incomplete HLVU.

Main Methods:

  • Retrospective analysis of 104 ambulatory cfLVAD patients.
  • Evaluation of high pulmonary capillary wedge pressure (hPCWP > 15mmHg) as a marker for incomplete HLVU.
  • Assessment of variables predicting hPCWP.

Main Results:

  • Twenty-eight percent of patients experienced incomplete HLVU (hPCWP).
  • Higher risk of hPCWP was associated with age, central venous pressure, absence of RAAS inhibitors, and elevated BNP levels.
  • Brain natriuretic peptide <300 pg/mL predicted freedom from hPCWP with 86% NPV.

Conclusions:

  • Optimal HLVU is achievable in up to 72% of cfLVAD patients using current speed setting recommendations.
  • Age, central venous pressure, and RAAS inhibitor therapy significantly impact HLVU.
  • BNP levels and left ventricular remodeling are valuable noninvasive tools for HLVU assessment.
Abstract

Keywords:
Asistencia ventricular izquierdaHeart failureHemodinámicaHemodynamicsInsuficiencia cardiacaLeft ventricular assist device

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