Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices

详细信息    查看全文

• 作者：Nir Uriel ; MD ; MSc^a ; ^{nuriel@medicine.bsd.uchicago.edu" class="auth_mail" title="E-mail the corresponding author} ; Gabriel Sayer ; MD^a ; Karima Addetia ; MD^a ; Savitri Fedson ; MD^a ; Gene H. Kim ; MD^a ; Daniel Rodgers ; BA^a ; Eric Kruse ; RDCS^a ; Keith Collins ; RDCS^a ; Sirtaz Adatya ; MD^a ; Nitasha Sarswat ; MD^a ; Ulrich P. Jorde ; MD^b ; Colleen Juricek ; RN^c ; Takeyoshi Ota ; MD ; PhD^c ; Valluvan Jeevanandam ; MD^c ; Daniel Burkhoff ; MD ; PhD^d ; ^e ; Roberto M. Lang ; MD^a
• 关键词：3D echocardiography ; hemodynamics ; left ventricular assist device ; ramp ; unloading
• 刊名：JACC: Heart Failure
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：4
• 期：3
• 页码：208-217
• 全文大小：1526 K

文摘

This study tested whether combined invasive hemodynamic and echocardiographic ramp tests can help optimize patient management.

Background

Guidelines for optimizing speed and medications in continuous flow ventricular assist device (cfLVAD) patients are mainly based on expert opinion.

Methods

Thirty-five cfLVAD patients (21 HeartMate II [Thoratec, Pleasanton, California] and 14 HVAD [HeartWare International, Framingham, Massachusetts]) underwent ramp tests with right heart catheterization (including central venous pressure [CVP], pulmonary artery pressure, pulmonary capillary wedge pressure [PCWP], and blood pressure) and echocardiography. Data were recorded at up to 9 speed settings. Speed changes were in steps of 400 revolutions per minute (RPM) for HeartMate II (8,000 to 12,000 RPM) and 100 RPM for HVAD (2,300 to 3,200 RPM) patients.

Results

Only 42.9% of patients had normal CVPs and PCWPs at their original RPM settings. Going from lowest to highest speeds, cardiac output improved by 0.16 ± 0.19 l/min/step (total change 1.28 ± 1.41 l/min) and PCWP decreased by 1.23 ± 0.85 mm Hg/step (total change 9.9 ± 6.5 mm Hg). CVP and systolic blood pressure did not change significantly with RPM. RPM were adjusted based on test results to achieve CVPs and PCWPs as close to normal limits as possible, which was feasible in 56% of patients. For the remainder, results indicated which type of medical management should be pursued.

Conclusions

Use of combined hemodynamic and echocardiographic ramp tests in patients provides objective means of optimizing RPM, and has the potential to guide medical management. It remains to be tested whether this strategy has a beneficial impact on quality of life or clinical outcomes.