scholarly journals Slope of the Anterior Mitral Valve Leaflet: A New Measurement of Left Ventricular Unloading for Left Ventricular Assist Devices and Systolic Dysfunction

2014 ◽  
Vol 41 (3) ◽  
pp. 262-272 ◽  
Author(s):  
Sara C. Martinez ◽  
Elisa A. Bradley ◽  
Eric L. Novak ◽  
Ravi Rasalingam ◽  
Ari M. Cedars ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Mitral Valve ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Valve Leaflet ◽  
Mitral Valve Leaflet ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Left ventricular assist device (LVAD)-supported patients are evaluated routinely with use of transthoracic echocardiography. Values of left ventricular unloading in this unique patient population are needed to evaluate LVAD function and assist in patient follow-up. We introduce a new M-mode measurement, the slope of the anterior mitral valve leaflet (SLAM), and compare its efficacy with that of other standard echocardiographically evaluated values for left ventricular loading, including E/e′ and pulmonary artery systolic pressures. Average SLAM values were determined retrospectively for cohorts of random, non-LVAD patients with moderately to severely impaired left ventricular ejection fraction (LVEF) (<0.35, n=60). In addition, pre- and post-LVAD implantation echocardiographic images of 81 patients were reviewed. The average SLAM in patients with an LVEF <0.35 was 11.6 cm/s (95% confidence interval, 10.4–12.8); SLAM had a moderately strong correlation with E/e′ in these patients. Implantation of LVADs significantly increased the SLAM from 7.3 ± 2.44 to 14.7 ± 5.01 cm/s (n=42, P <0.0001). The LVAD-supported patients readmitted for exacerbation of congestive heart failure exhibited decreased SLAM from 12 ± 3.93 to 7.3 ± 3.5 cm/s (n=6, P=0.041). In addition, a cutpoint of 10 cm/s distinguished random patients with LVEF <0.35 from those in end-stage congestive heart failure (pre-LVAD) with an 88% sensitivity and a 55% specificity. Evaluating ventricular unloading in LVAD patients remains challenging. Our novel M-mode value correlates with echocardiographic values of left ventricular filling in patients with moderate-to-severe systolic function and dynamically improves with the ventricular unloading of an LVAD.

Abstract 12: Heart Failure Medications Prescribed at Discharge for Patients With Left Ventricular Assist Devices

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Jacqueline Baras Shreibati ◽  
Shubin Sheng ◽  
Gregg C Fonarow ◽  
Adam D DeVore ◽  
Clyde W Yancy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Beta Blocker ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Ventricular Assist ◽  
Aldosterone Antagonist ◽  
Factors Associated ◽  
Left Ventricular Assist ◽  
Lvad Support

Background: The longitudinal success of the heart failure (HF) patient with a left ventricular assist device (LVAD) depends on medications to maintain the device, such as antithrombotic agents to prevent pump thrombosis and antihypertensives to reduce stroke risk. However, the role of traditional, evidence-based HF medications for patients with concurrent LVAD support is not well known. This study aimed to determine use, temporal trends, and factors associated with prescription of HF medications at discharge among patients with advanced HF with and without LVADs, and to examine patient and hospital-level factors associated with HF medication prescription among LVAD recipients. Methods: We conducted a retrospective, observational analysis of 4,580 advanced HF patients from 215 hospitals participating in the Get With The Guidelines-Heart Failure registry from January 2009 to March 2015. We examined patterns of HF medication use at hospital discharge among patients with an in-hospital (n=258) or prior (n=326) LVAD implant, and those with advanced HF without an LVAD, as defined by a reduced left ventricular ejection fraction and intravenous inotrope or vasopressin antagonist receipt (n=3,996). Results: For beta-blocker and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACE/ARB), discharge prescriptions were 58.9% and 53.5% for new LVAD recipients, 62.9% and 51.4% for prior LVAD recipients, and 78.7% and 60.7% for patients without LVAD support, respectively (p<0.0001 and p=0.0005). There was no significant difference in aldosterone antagonist use among the three groups (p=0.23) but its use quadrupled among LVAD patients during the study period (p<0.0001, see figure). Approximately 54% of new and prior LVAD patients and 66% of patients without an LVAD were discharged on two of the three HF medications (p<0.0001). In the multivariable analysis of LVAD patients, patient age was inversely associated with beta-blocker, ACE/ARB, and aldosterone antagonist use. Conclusion: Traditional HF therapies are commonly prescribed to LVAD recipients, although less frequently than to advanced HF patients without LVAD support. Aldosterone antagonists are prescribed increasingly to LVAD patients. Further research is needed on the optimal medical regimen for patients with LVADs.

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