A simplified echocardiographic technique for detecting continuous-flow left ventricular assist device malfunction due to pump thrombosis

作者：Estep Jerry D^*; Vivo Rey P; Cordero Reyes Andrea M; Bhimaraj Arvind; Trachtenberg Barry H; Torre Amione Guillermo; Chang Su Min; Elias Barbara; Bruckner Brian A; Suarez Erik E; Loebe Matthias

来源：Journal of Heart and Lung Transplantation, 2014, 33(6): 575-586.

DOI：10.1016/j.healun.2014.01.865

• heart failure
• left ventricular assist device
• thrombosis
• echocardiography
• cardiomyopathy

BACKGROUND: Malfunction of a continuous-flow left ventricular assist device (CF-LVAD) due to device thrombosis is a potentially life-threatening event that currently presents a diagnostic challenge. We aimed to propose a practical echocardiographic assessment to diagnose LVAD malfunction secondary to pump thrombosis.
METHODS: Among 52 patients implanted with a CF-LVAD from a single center who underwent echocardiographic pump speed-change testing, 12 had suspected pump thrombosis as determined by clinical, laboratory, and/or device parameters. Comprehensive echocardiographic evaluation was performed at baseline pump speed and at each 1,000-rpm interval from the low setting of 8,000 rpm to the high setting of 11,000 rpm in 11 of these patients.
RESULTS: Receiver operating characteristic curves and stepwise logistic regression analyses showed that the best diagnostic parameters included changes in the LV end-diastolic diameter (<0.6 cm), aortic valve opening time (<80 msec), and deceleration time of mitral inflow (<70 msec) from lowest to highest pump speed. One parameter was predictive of pump malfunction, with 100% sensitivity and 89% specificity, whereas 2 of 3 parameters increased the sensitivity to 100% and specificity to 95%.
CONCLUSIONS: The 3 echocardiographic variables of measured changes in LV end-diastolic diameter, aortic valve opening time, and deceleration time of mitral inflow between the lowest (8,000 rpm) and highest pump speed settings (11,000 rpm) during echo-guided pump speed-change testing appear highly accurate in diagnosing device malfunction in the setting of pump thrombosis among patients supported with CF-LVAD. Further investigation is warranted to create and validate a prediction score.

• 出版日期2014-6