BACKGROUND: The HeartMate3 (HM3) is a Conformitee Europeenne mark-approved left Ventricular (LV) assist device (LVAD) with fully-magnetically levitated rotor and features consisting of wide range operational speeds, wide flow paths and artificial pulse. We performed a hemodynamic-echocardiographic speed optimization evaluation in HM3 implanted patients to achieve optimal LV- and right-ventricular (RV) shape. METHODS: Sixteen HM3 patients underwent pump speed ramp-tests with right-heart catheterization. Three-dimensional echocardiographic (3DE) LV and RV datasets (Philips) were acquired, and volumetric (TomTec) and shape (custom software) analyses were performed (LV: sphericity, conicity; RV: septal and free-wall curvatures). Data were recorded at up to 13 speed settings. Speed changes were in 100 RPM steps, starting at 4600 RPM ramping up to 6200 RPM. RESULTS: 3DE was feasible in 50% of the patients. Mean original speed was 5306 +/- 148-rpm. LV end-diastolic diameter (-0.15 +/- 0.09cm/100rpm) and volumes (EDV: 269 +/- 109mL to 175 +/- 90mL, ESV: 234 +/- 111mL to 146 +/- 81mL) progressively decreased as the shape became less spherical and more conical, while RV volumes initially remained stable, but at higher speeds increased (EDV: from 148 +/- 64mL to 181 +/- 92 mL, ESV: 113 +/- 63 mL to 130 +/- 69 mL). On average, the RV septum became less convex (bulging towards the LV) at the highest speeds. CONCLUSION: LV- and RV-shape changes were noted in HM3 supported patients. While a LV volumetric decrease and shape improvement was consistently noted, RV volumes grew in response to increase in speed above a certain point. A next concern would be whether understanding of morphological and function changes in LV and RV during LVAD speed change assessed by using 3DE helps optimize LVAD speed settings and improve clinical outcomes. .
- Uriel, N.
- Medvedofsky, D.
- Imamura, T.
- Maly, J.
- Kruse, E.
- Ivak, P.
- Sood, P.
- Lang, R. M.
- Maffessanti, F.
- Berliner, D.
- Bauersachs, J.
- Haverich, A.
- Zelizko, M.
- Netuka, I.
- Schmitto, J. D.
Keywords
- Conicity
- Echocardiography
- Hvad
- HeartMate 3
- Ramp test
- Sphericity