Dynamic Testing before LVAD.pptx

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