Faculty Collaboration Database

Role of echocardiography in patients with intravascular hemolysis due to suspected continuous-flow LVAD thrombosis. JACC Cardiovasc Imaging 2013 Nov;6(11):1129-40

Date

10/08/2013

Pubmed ID

24094831

DOI

10.1016/j.jcmg.2013.06.006

Scopus ID

2-s2.0-84888027409 (requires institutional sign-in at Scopus site)   43 Citations

Abstract

OBJECTIVES: This study sought to characterize the echocardiographic findings of patients presenting with intravascular hemolysis (IVH) due to suspected continuous-flow left ventricular assist device (LVAD) pump thrombosis.

BACKGROUND: LVAD patients who develop pump thrombosis often present with IVH. Echocardiography may be able to detect device dysfunction in this setting.

METHODS: Continuous-flow LVAD patients presenting with IVH due to suspected pump thrombosis were identified. Patients underwent echocardiography with cannula Doppler flow velocity interrogation. Findings were compared with baseline and follow-up studies, and with 49 stable LVAD control patients.

RESULTS: Of 145 patients, 14 (10%) had IVH due to suspected pump thrombosis. The mean age was 55 ± 15 years, 93% were men, and 50% received LVAD as destination therapy. Mean duration between implantation and IVH was 231 ± 218 days. Eleven (79%) patients presented with hemoglobinuria, 9 (64%) with jaundice, and 5 (36%) with acute heart failure. Reduced cannula diastolic flow velocity and increased systolic/diastolic (S/D) flow velocity ratio were the only echocardiographic parameters significantly different from controls (outflow cannula 0.3 ± 0.2 m/s vs. 0.8 ± 0.3 m/s, p = 0.03, and 5.9 ± 2.8 vs. 1.7 ± 0.7, p < 0.01, respectively), and were worse for IVH patients with acute heart failure compared with those without (outflow cannula 0.2 ± 0.1 m/s vs. 0.5 ± 0.2 m/s, p = 0.04, and 7.2 ± 3.3 vs. 5.3 ± 2.0, p = 0.02, respectively). Outflow cannula diastolic flow velocity and S/D flow velocity ratio changed significantly from baseline (p = 0.01 and p < 0.01, respectively) in IVH patients, whereas systolic flow velocity did not change (p = 0.59). Odds ratios for outflow cannula diastolic flow velocity and S/D flow velocity ratio for predicting IVH were 0.60 (95% confidence interval [CI]: 0.51 to 0.73), p = 0.02, and 2.45 (95% CI: 2.37 to 2.52) p < 0.01, respectively. Corresponding inflow cannula values were similarly significant. Pump thrombosis was confirmed in 7 (50%) patients after LVAD retrieval.

CONCLUSIONS: Reduced cannula diastolic flow velocity and increased S/D flow velocity ratio identified continuous-flow LVAD dysfunction in patients with IVH due to suspected pump thrombosis better than other echocardiographic parameters.

Author List

Fine NM, Topilsky Y, Oh JK, Hasin T, Kushwaha SS, Daly RC, Joyce LD, Stulak JM, Pereira NL, Boilson BA, Clavell AL, Edwards BS, Park SJ

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Blood Flow Velocity
Coronary Circulation
Echocardiography, Doppler, Color
Echocardiography, Doppler, Pulsed
Female
Heart Failure
Heart-Assist Devices
Hemolysis
Humans
Male
Middle Aged
Predictive Value of Tests
Prosthesis Failure
Regional Blood Flow
Retrospective Studies
Stroke Volume
Thrombosis
Time Factors
Ventricular Function, Left