Background: Ventricular assist devices are now used as a bridge to recovery/decision/transplant or as destination therapy in end-stage heart failure. Continued improvements in technology and pump design have made implantation an easier process with reduced operative risks and pump-related adverse events. Considering the beneficial effects of these devices in the clinical setting, it seemed logical to address the long-term effect of the continuous flow pumps on diastolic dysfunction. Methods: This study addresses the effect of HeartMate IITM(HMII) support for 284+/－97 days on echocardiographic parameters of diastolic function. Data from fifteen patients was retrospectively studied status post left ventricular assist device (LVAD) implantation. The data at approximately 1-year post implantation was compared with that obtained prior to implantation. Statistical analyses were performed using the Microsoft Excel Program/MSExcel Stats. Echocardiographic measurements were carried out in accordance with the American Society of Echocardiography guidelines. Results: Of all the echocardiographic parameters assessed only E/Ea and calculated left atrial pressure (LAP) showed a statistically significant decrease. Two parameters that showed a trend towards significance are Ea (septal) and global functional index (p = 0.05). Conclusions: Continuous Flow LVAD support appears to improve diastolic dysfunction. This study has limitations in that we used a single type of continuous flow device (HeartMate IITM) and was conducted as a retrospective analysis. Further studies with larger populations and longer support are required to validate this finding.
References
[1]
Rose, E.A., Gelijns, A.C., Moskowitz, A.J., et al. (2001) Long-Term Use of a Left Ventricular Assist Device for End-Stage Heart Failure. New England Journal of Medicine, 345, 1435-1443. http://dx.doi.org/10.1056/NEJMoa012175
[2]
Park, S.J., Tector, A., Piccioni, W., et al. (2005) Left Ventricular Assist Devices as Destination Therapy: A New Look at Survival. Journal of Thoracic and Cardiovascular Surgery, 129, 9-17. http://dx.doi.org/10.1016/j.jtcvs.2004.04.044
[3]
Frazier, O.H., Rose, E.A., Oz, M.C., et al. (2001) Multicenter Clinical Evaluation of the HeartMate Vented Electric Left Ventricular Assist System in Patients Awaiting Heart Transplantation. Journal of Thoracic and Cardiovascular Surgery, 122, 1186-1195. http://dx.doi.org/10.1067/mtc.2001.118274
[4]
Frazier, O.H., RoseE, A., Oz, M.C., et al. (2001) Multicenter Clinical Evaluation of the Heartmate; Vented Electric Left Ventricular Assist System in Patients Awaiting Heart Transplantation. The Journal of Heart and Lung Transplantation, 20, 201-202.
[5]
Frazier, O.H., Myers, T.J., Westaby, S. and Gregoric I.D. (2004) Clinical Experience with an Implantable, Intracardiac, Continuous Flow Circulatory Support Device: Physiologic Implications and Their Relationship to Patient Selection. Annals of Thoracic Surgery, 77, 133-142. http://dx.doi.org/10.1016/S0003-4975(03)01321-3
[6]
Miller, L.W., Pagani, F.D., Russell, S.D., et al. (2007) Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation. New England Journal of Medicine, 357, 885-896. http://dx.doi.org/10.1056/NEJMoa067758
[7]
Pagani, F.D., Miller, L.W., Russell, S.D., et al. (2009) Extended Mechanical Circulatory Support with a Continuous-Flow Rotary Left Ventricular Assist Device. Journal of the American College of Cardiology, 54, 312-321. http://dx.doi.org/10.1016/j.jacc.2009.03.055
[8]
Najjar, S.S. (2009) Heart Failure with Preserved Ejection Fraction: Failure to Preserve, Failure of Reserve, and Failure on the Compliance Curve. Journal of the American College of Cardiology, 54, 419-421. http://dx.doi.org/10.1016/j.jacc.2009.05.011
[9]
Mornos, C., Cozm, D., Petrescu, L., Ionac, A., Rusinaru, D. and Dragulescu, S.I. (2010) E/(EaxSa) Estimates Left Ventricular End-Diastolic Pressure in Patients with Severe Mitral Regurgitation. Journal of Heart Valve Disease, 19, 576-583.
[10]
Nagueh, S.F., Middleton, K.J., Kopelen, H.A., Zoghbi, W.A. and Quinones, M.A. (1997) Doppler Tissue Imaging: A Noninvasive Technique for Evaluation of Left Ventricular Relaxation and Estimation of Filling Pressures. Journal of the American College of Cardiology, 30, 1527-1533.
[11]
Nishimura, R.A., Housmans, P.R., Hatle, L.K. and Tajik, A.J. (1989) Assessment of Diastolic Function of the Heart: Background and Current Applications of Doppler Echocardiography. Part I. Physiologic and Pathophysiologic Features. Mayo Clinic Proceedings, 64, 71-81. http://dx.doi.org/10.1016/S0025-6196(12)65305-1
[12]
Basnight, M.A., Gonzalez, M.S., Kershenovich, S.C. and Appleton, C.P. (1991) Pulmonary Venous Flow Velocity: Relation to Hemodynamics, Mitral Flow Velocity and Left Atrial Volume and Ejection Fraction. Journal of the American Society of Echocardiography, 4, 547-558. http://dx.doi.org/10.1016/S0894-7317(14)80213-7
[13]
Kato T.S., Chokshi, A., Singh, P., et al. (2011) Effects of Continuous-Flow versus Pulsatile-Flow Left Ventricular Assist Devices on Myocardial Unloading and Remodeling. Circulation: Heart Failure, 4, 546-553. http://dx.doi.org/10.1161/CIRCHEARTFAILURE.111.962142
[14]
Bartoli, C.R., Giridharan, G.A., Litwak, K.N., Sobieski, M., Prabhu, S.D., Slaughter, M.S. and, Koenig, S.C. (2010) Hemodynamic Responses to Continuous versus Pulsatile Mechanical Unloading of the Failing Left Ventricle. ASAIO Journal, 56, 410-416. http://dx.doi.org/10.1097/MAT.0b013e3181e7bf3c
[15]
Wever-Pinzon, O., Stehlik, J., Kfoury, A.G., et al. (2012) Effects of Continuous-Flow Left Ventricular Assist Device Unloading on the Diastolic Function of the Failing Human Heart.[Abstract 19188] American Heart Association Scientific Sessions, Los Angeles. http://circ.ahajournals.org/cgi/content/meeting_abstract/126/21_MeetingAbstracts/A19188
[16]
Drakos, S.G., Wever-Prinzon, O., Selzman, C.H., et al. (2013). Magnitude and Time Course of Changes Induced by Continuous-Flow Left Ventricular Assist Device Unloading in Chronic Heart Failure: Insights Into Cardiac Recovery. Journal of the American College of Cardiology, 61, 1985-1994. http://dx.doi.org/10.1016/j.jacc.2013.01.072
