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Related Experiment Video

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Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
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Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

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Longitudinal analysis left ventricular chamber responses under durable LVAD support.

Aaron Gunawan1, Desiree Robson2, Rohan J Krishnaswamy1

  • 1Heart Failure and Transplant Unit, Cardiology Department, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, UNSW, Sydney, Australia.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|October 16, 2023
PubMed
Summary
This summary is machine-generated.

Noninvasive pressure-volume loops reveal factors influencing cardiac function improvement in patients with left ventricular assist devices (LVADs). Lower pump speeds and higher pulsatility index predict better outcomes, aiding in selecting candidates for myocardial recovery.

Keywords:
LV chamber functionLV remodellingPV analysiscontinuous flowleft ventricular assist device

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Heart Failure Management

Background:

  • Left ventricular assist device (LVAD) support can promote cardiac remodeling in select patients.
  • Assessing serial changes in cardiac function under LVAD support is crucial for patient management.

Purpose of the Study:

  • To utilize noninvasively derived pressure-volume (PV) loops to investigate the impact of demographic and device variables on cardiac function changes during LVAD support.
  • To understand factors influencing ventricular energetics and hemodynamics for optimizing myocardial remodeling.

Main Methods:

  • Prospective recruitment of 32 Medtronic HeartWare Ventricular Assist Device (HVAD) patients.
  • Estimation of single-cycle ventricular pressure and volume using a validated algorithm to derive PV loops and cardiac chamber dynamics at 1, 3, and 6 months post-implantation.
  • Mixed-effects modeling to characterize sustained changes in PV loop parameters and assess the influence of demographic and device variables.

Main Results:

  • Mean ventricular function parameters remained stable over 6 months.
  • Lower pump speeds (2400 rpm), a high pulsatility index (>1.0), and ischemic cardiomyopathy as an indication for LVAD implantation were significant predictors of monthly stroke work improvement.
  • Improvements were also observed in cardiac power, peak systolic pressure, and LV elastance in specific patient cohorts.

Conclusions:

  • Noninvasive PV loops can identify factors associated with improved ventricular energetics and hemodynamics under LVAD support.
  • Understanding the determinants of increased ventricular load is valuable for selecting patients eligible for cardiac recovery.