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Intraventricular Flow Patterns in Patients Treated with Left Ventricular Assist Devices

Rossini, Lorenzo ; Braun, Oscar LU ; Brambatti, Michela ; Benito, Yolanda ; Mizeracki, Adam ; Miramontes, Marissa ; Nguyen, Cathleen ; Martinez-Legazpi, Pablo ; Almeida, Shone and Kraushaar, Megan , et al. (2021) In ASAIO Journal 67(1). p.74-83
Abstract

The success of left ventricular assist device (LVAD) therapy is hampered by complications such as thrombosis and bleeding. Understanding blood flow interactions between the heart and the LVAD might help optimize treatment and decrease complication rates. We hypothesized that LVADs modify shear stresses and blood transit in the left ventricle (LV) by changing flow patterns and that these changes can be characterized using 2D echo color Doppler velocimetry (echo-CDV). We used echo-CDV and custom postprocessing methods to map blood flow inside the LV in patients with ongoing LVAD support (Heartmate II, N = 7). We compared it to healthy controls (N = 20) and patients with dilated cardiomyopathy (DCM, N = 20). We also analyzed... (More)

The success of left ventricular assist device (LVAD) therapy is hampered by complications such as thrombosis and bleeding. Understanding blood flow interactions between the heart and the LVAD might help optimize treatment and decrease complication rates. We hypothesized that LVADs modify shear stresses and blood transit in the left ventricle (LV) by changing flow patterns and that these changes can be characterized using 2D echo color Doppler velocimetry (echo-CDV). We used echo-CDV and custom postprocessing methods to map blood flow inside the LV in patients with ongoing LVAD support (Heartmate II, N = 7). We compared it to healthy controls (N = 20) and patients with dilated cardiomyopathy (DCM, N = 20). We also analyzed intraventricular flow changes during LVAD ramp tests (baseline ± 400 rpm). LVAD support reversed the increase in blood stasis associated with DCM, but it did not reduce intraventricular shear exposure. Within the narrow range studied, the ventricular flow was mostly insensitive to changes in pump speed. Patients with significant aortic insufficiency showed abnormalities in blood stasis and shear indices. Overall, this study suggests that noninvasive flow imaging could potentially be used in combination with standard clinical methods for adjusting LVAD settings to optimize flow transport and minimize stasis on an individual basis.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
ASAIO Journal
volume
67
issue
1
pages
10 pages
publisher
Amercian Society of Artificial Internal Organs
external identifiers
  • pmid:33346993
  • scopus:85098923722
ISSN
1538-943X
DOI
10.1097/MAT.0000000000001158
language
English
LU publication?
yes
id
3c01e447-8dc4-4ca4-ab85-1efa984189fe
date added to LUP
2021-01-20 11:11:46
date last changed
2025-01-11 03:44:30
@article{3c01e447-8dc4-4ca4-ab85-1efa984189fe,
  abstract     = {{<p>The success of left ventricular assist device (LVAD) therapy is hampered by complications such as thrombosis and bleeding. Understanding blood flow interactions between the heart and the LVAD might help optimize treatment and decrease complication rates. We hypothesized that LVADs modify shear stresses and blood transit in the left ventricle (LV) by changing flow patterns and that these changes can be characterized using 2D echo color Doppler velocimetry (echo-CDV). We used echo-CDV and custom postprocessing methods to map blood flow inside the LV in patients with ongoing LVAD support (Heartmate II, N = 7). We compared it to healthy controls (N = 20) and patients with dilated cardiomyopathy (DCM, N = 20). We also analyzed intraventricular flow changes during LVAD ramp tests (baseline ± 400 rpm). LVAD support reversed the increase in blood stasis associated with DCM, but it did not reduce intraventricular shear exposure. Within the narrow range studied, the ventricular flow was mostly insensitive to changes in pump speed. Patients with significant aortic insufficiency showed abnormalities in blood stasis and shear indices. Overall, this study suggests that noninvasive flow imaging could potentially be used in combination with standard clinical methods for adjusting LVAD settings to optimize flow transport and minimize stasis on an individual basis.</p>}},
  author       = {{Rossini, Lorenzo and Braun, Oscar and Brambatti, Michela and Benito, Yolanda and Mizeracki, Adam and Miramontes, Marissa and Nguyen, Cathleen and Martinez-Legazpi, Pablo and Almeida, Shone and Kraushaar, Megan and Vu, Vi and May-Newman, Karen and Bermejo, Javier and Adler, Eric D. and Kahn, Andrew M. and Del Alamo, Juan C.}},
  issn         = {{1538-943X}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{74--83}},
  publisher    = {{Amercian Society of Artificial Internal Organs}},
  series       = {{ASAIO Journal}},
  title        = {{Intraventricular Flow Patterns in Patients Treated with Left Ventricular Assist Devices}},
  url          = {{http://dx.doi.org/10.1097/MAT.0000000000001158}},
  doi          = {{10.1097/MAT.0000000000001158}},
  volume       = {{67}},
  year         = {{2021}},
}