1、Dynamic Testing Before LVAD,Jennifer T.Thibodeau,MD,MSCSProfessor of Medicine,UT Southwestern Medical CenterCatherine Marie Bassett Distinguished Professor of Heart FailureAssociate Clinical Director of Operations,Division of CardiologyMedical Director,Heart FailureMedical Director,ECMO,RV Failure a
2、fter LVAD Portends Poor Prognosis,LaRue SJ,et al.J Heart Lung Transplant 2017;36(4):475-477,Traditional/Static Evaluation of RV Function,RV stroke Work Index(RVSWI)CVP/PCWP ratioPulmonary artery pulsatility index(PAPi)RV Failure Risk Score(RVFRS)aka Michigan Score,RVSWI,RVSWI=(mean PAP-Mean RAP)x SV
3、I=(mean PAP-mean RAP)x(CI/HR),Dec 1991-Dec 1996 100 pts with HM LVADs at Cleveland Clinic11 required RVAD support after LVADHemodynamics at time of LVAD placementNo difference in:RVEF,RAP,LAP,TPG,PVRMean PAP significantly lower in RVAD group(none 40mmHg)If RVSWI 300,did not require RVAD,Fukamachi K,
4、et al.Ann Thorac Surg 1999;68:2181-4,Kormos RL,et al.J Thorac Cardiovasc Surg 2010;139:1316-24,484 pts in the HM2 LVAD BTT clinical trial eval for the occurrence of RVF CVP/PCWP ratio better differentiates patients with concordant high pressures(do okay with LVAD)vs those with intrinsic RV dysfuncti
5、on.CVP/PCWP 0.63=bad,CVP/PCWP Ratio,PAPi,PAPi=(sPAP-dPAP)/RAP132 pts with CF-LVAD at Tufts between 2008-201332 developed RV failurePAPi 1.85=bad,Morine KJ,et al.J Cardiac Fail 2016;22:110-16,PAPi,Morine KJ,et al.J Cardiac Fail 2016;22:110-16,Association of PAPi with RVF was superior to other establi
6、shed hemodynamic determinants of RVF,Post-op increase in PAPi 24 hours after LVAD implantation(after initial decrease)was a good prognostic sign.Recovery of PAPi values=potential indicator of RV recovery,Michigan Score/RVFRS,5 pts=bad,Matthews JC et al.J Am Coll Cardiol 2008;51:2163-72,180-day follo