Echocardiographic variables after LVAD surgery associated with adverse outcomes

Topilsky Y. Circ Cardiovasc Imaging. 2011;doi:10.1161/CIRCIMAGING.111.965335.

Issue: December 2011

Echocardiographic evidence of inefficient unloading of the left ventricle and persistent right ventricle dysfunction determined mortality and HF after left ventricular assist device surgery in a recent study.

Researchers performed echocardiographic examinations of 76 patients (62 men) receiving continuous flow device (Heart Mate II) 30 days after undergoing LVAD implantation between February 2007 and August 2010. Echocardiographic variables studied included LVAD flow, with and without native LV contribution; inter-ventricular septal position; status of aortic valve opening; estimated left atrial pressure; mitral flow E wave deceleration time; and ratio of deceleration time to E wave velocity (mitral deceleration index).

According to the results, four patients died during the 30- to 90-day period; six patients were readmitted for HF; and 25 patients reached at least NYHA Class III at 90 days. Increased estimated left atrial pressure (OR=1.30; 95% CI, 1.16-1.48), mitral deceleration index less than 2 ms/cm/s (OR=4.4; 95% CI, 1.22-18) and decreased tricuspid lateral annulus velocity (OR=0.70; 95% CI, 0.48-0.95) were associated with adverse outcome; worse outcome was associated with leftward deviation of inter-ventricular septum (OR=3.03; 95% CI, 1.21-13.3).

“An appropriate combination of flow, unloading and pulse pressure is yet to be determine for the best long-term outcome,” the researchers wrote. “[This] study was not designed to establish the cause-and-effect relationship between ‘optimizing’ LVAD variables and better clinical outcome, but it seems to suggest that such a concept should be explored further in a larger prospective study using serial changes in echo variables during long-term support.”

Disclosure: The researchers report no relevant financial disclosures.

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