Novel Echocardiographic Parameters of Aortic Insufficiency in Continuous-flow Left Ventricular Assist Devices and Clinical Outcome

Overview

Journal J Heart Lung Transplant

Publisher Elsevier

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2016 Jul 5

PMID 27373822

Citations 18

Authors

Jonathan Grinstein

Eric Kruse

Gabriel Sayer

Savitri Fedson

Gene H Kim

Nitasha Sarswat

Sirtaz Adatya

Takeyoshi Ota

Valluvan Jeevanandam

Victor Mor-Avi

Roberto M Lang

Nir Uriel

Affiliations

Soon will be listed here.

Abstract

Background: The aim of this study was to evaluate the prognostic performance of novel echocardiographic (transthoracic echocardiography, or TTE) parameters for grading aortic insufficiency (AI) severity in patients with continuous-flow left ventricular assist devices (CF-LVADs). The development of AI after CF-LVAD implantation is common, although the clinical significance remains unclear. We previously described novel TTE parameters that outperformed traditional TTE parameters in grading AI severity in these patients.

Methods: CF-LVAD patients with varying degrees of AI (N = 57) underwent Doppler TTE of the LVAD outflow cannula. Patients had AI severity graded by the novel parameters (systolic/diastolic velocity ratio and the diastolic acceleration of the LVAD outflow cannula) and the traditional vena contracta. The prognostic performance of novel and traditional AI parameters was determined by comparing rates of congestive heart failure re-admission, need for aortic valve intervention, urgent transplantation and death (composite end-points) for each parameter.

Results: Grading AI severity using novel AI parameters led to reclassification of 32% of patients from trace/mild AI to moderate or greater AI (N = 18). Using traditional AI parameters, there was no difference in the occurrence of the composite end-point between the moderate or greater group and the trace/mild group (1.50 vs 1.18 events/person, p = 0.46). With the novel AI parameters, there were significantly more events in the patients with moderate or greater AI compared to those with trace/mild AI (1.57 vs 0.13 events/person, p = 0.002). Novel parameters also better predicted the need for aortic valve intervention, urgent transplantation or death than traditional methods (p = 0.024 vs p = 0.343).

Conclusions: In patients with CF-LVADs, traditional parameters tend to underestimate AI severity and future cardiac events. Novel AI TTE parameters are better able to discriminate AI severity and predict clinically meaningful outcomes.

Citing Articles

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Transcatheter Aortic Valve Replacement for Left Ventricular Assist Device-Related Aortic Regurgitation: The Michigan Medicine Experience.

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Acharya D, Kazui T, Al Rameni D, Acharya T, Betterton E, Juneman E Front Cardiovasc Med. 2023; 10:1098348.

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PMID: 36698950 PMC: 9870593. DOI: 10.3389/fcvm.2022.1094796.

References

Atkins B, Hashmi Z, Ganapathi A, Harrison J, Hughes G, Rogers J . Surgical correction of aortic valve insufficiency after left ventricular assist device implantation. J Thorac Cardiovasc Surg. 2013; 146(5):1247-52. DOI: 10.1016/j.jtcvs.2013.05.019. View

Estep J, Stainback R, Little S, Torre G, Zoghbi W . The role of echocardiography and other imaging modalities in patients with left ventricular assist devices. JACC Cardiovasc Imaging. 2010; 3(10):1049-64. DOI: 10.1016/j.jcmg.2010.07.012. View

Holtz J, Teuteberg J . Management of aortic insufficiency in the continuous flow left ventricular assist device population. Curr Heart Fail Rep. 2013; 11(1):103-10. DOI: 10.1007/s11897-013-0172-6. View

Siontis K, Nkomo V, Pislaru C, Enriquez-Sarano M, Pellikka P, Pislaru S . Mechanism of aortic valve opening: beyond the pressure gradient. JACC Cardiovasc Imaging. 2014; 7(6):633-4. DOI: 10.1016/j.jcmg.2013.12.017. View

Pak S, Uriel N, Takayama H, Cappleman S, Song R, Colombo P . Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices. J Heart Lung Transplant. 2010; 29(10):1172-6. DOI: 10.1016/j.healun.2010.05.018. View

Mudd J, Cuda J, Halushka M, Soderlund K, Conte J, Russell S . Fusion of aortic valve commissures in patients supported by a continuous axial flow left ventricular assist device. J Heart Lung Transplant. 2008; 27(12):1269-74. DOI: 10.1016/j.healun.2008.05.029. View

Grinstein J, Kruse E, Sayer G, Fedson S, Kim G, Jorde U . Accurate Quantification Methods for Aortic Insufficiency Severity in Patients With LVAD: Role of Diastolic Flow Acceleration and Systolic-to-Diastolic Peak Velocity Ratio of Outflow Cannula. JACC Cardiovasc Imaging. 2015; 9(6):641-51. DOI: 10.1016/j.jcmg.2015.06.020. View

Horton S, Khodaverdian R, Chatelain P, McIntosh M, Horne B, Muhlestein J . Left ventricular assist device malfunction: an approach to diagnosis by echocardiography. J Am Coll Cardiol. 2005; 45(9):1435-40. DOI: 10.1016/j.jacc.2005.01.037. View

Lang R, Bierig M, Devereux R, Flachskampf F, Foster E, Pellikka P . Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of.... J Am Soc Echocardiogr. 2005; 18(12):1440-63. DOI: 10.1016/j.echo.2005.10.005. View

10.

Zoghbi W, Enriquez-Sarano M, Foster E, Grayburn P, Kraft C, Levine R . Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003; 16(7):777-802. DOI: 10.1016/S0894-7317(03)00335-3. View

11.

Uriel N, Morrison K, Garan A, Kato T, Yuzefpolskaya M, Latif F . Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: the Columbia ramp study. J Am Coll Cardiol. 2012; 60(18):1764-75. PMC: 3545519. DOI: 10.1016/j.jacc.2012.07.052. View

12.

Toda K, Fujita T, Domae K, Shimahara Y, Kobayashi J, Nakatani T . Late aortic insufficiency related to poor prognosis during left ventricular assist device support. Ann Thorac Surg. 2011; 92(3):929-34. DOI: 10.1016/j.athoracsur.2011.04.115. View

13.

Parikh K, Mehrotra A, Russo M, Lang R, Anderson A, Jeevanandam V . Percutaneous transcatheter aortic valve closure successfully treats left ventricular assist device-associated aortic insufficiency and improves cardiac hemodynamics. JACC Cardiovasc Interv. 2013; 6(1):84-9. DOI: 10.1016/j.jcin.2012.08.021. View

14.

Cowger J, Aaronson K, Romano M, Haft J, Pagani F . Consequences of aortic insufficiency during long-term axial continuous-flow left ventricular assist device support. J Heart Lung Transplant. 2014; 33(12):1233-40. DOI: 10.1016/j.healun.2014.06.008. View

15.

Cowger J, Rao V, Massey T, Sun B, May-Newman K, Jorde U . Comprehensive review and suggested strategies for the detection and management of aortic insufficiency in patients with a continuous-flow left ventricular assist device. J Heart Lung Transplant. 2014; 34(2):149-57. DOI: 10.1016/j.healun.2014.09.045. View

16.

Soleimani B, Haouzi A, Manoskey A, Stephenson E, El-Banayosy A, Pae W . Development of aortic insufficiency in patients supported with continuous flow left ventricular assist devices. ASAIO J. 2012; 58(4):326-9. DOI: 10.1097/MAT.0b013e318251cfff. View

17.

Kato T, Maurer M, Sera F, Homma S, Mancini D . Aortic regurgitation during systolic-phase accompanied by mitral regurgitation in patients with continuous-flow left ventricular assist device. Eur Heart J Cardiovasc Imaging. 2013; 14(10):1022. PMC: 3859253. DOI: 10.1093/ehjci/jet054. View

18.

Martina J, de Jonge N, Sukkel E, Lahpor J . Left ventricular assist device-related systolic aortic regurgitation. Circulation. 2011; 124(4):487-8. DOI: 10.1161/CIRCULATIONAHA.111.020891. View

19.

Jorde U, Uriel N, Nahumi N, Bejar D, Gonzalez-Costello J, Thomas S . Prevalence, significance, and management of aortic insufficiency in continuous flow left ventricular assist device recipients. Circ Heart Fail. 2014; 7(2):310-9. DOI: 10.1161/CIRCHEARTFAILURE.113.000878. View

20.

Myers T, Frazier O, Mesina H, Radovancevic B, Gregoric I . Hemodynamics and patient safety during pump-off studies of an axial-flow left ventricular assist device. J Heart Lung Transplant. 2006; 25(4):379-83. DOI: 10.1016/j.healun.2005.11.459. View