HVAD Flow Waveform Estimates Left Ventricular Filling Pressure: HVAD Waveform and PCWP

Teruhiko Imamura, Nikhil Narang, Daniel Rodgers, Daisuke Nitta, Jonathan Grinstein, Takeo Fujino, Gene Kim, Ann Nguyen, Valluvan Jeevanandam, Gabriel Sayer, Nir Uriel

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Background: HVAD left ventricular assist device flow waveforms provides graphical real-time information linking device performance with invasive hemodynamics. Previous studies have demonstrated a good correlation between the slopes of the ventricular filling phase slope (VFPS) and directly measured pulmonary capillary wedge pressure (PCWP). We aimed to validate the utility of VFPS to estimate PCWP and predict clinical outcomes. Methods: In this prospective blinded study, screenshots from the HVAD monitor and simultaneous invasive hemodynamic measurements were obtained. Each screenshot was digitized and the VFPS was calculated by 2 independent reviewers who were blinded to the hemodynamic results. The equation PCWP = 7.053 +1.365 × (VFPS) was derived from a previously published dataset and the estimated PCWP was correlated to the actually measured PCWP. Results: One hundred thirty-one sets of simultaneous measurements (VFPS and PCWP) were obtained from 27 HVAD patients (mean age 55 years, 47% male). A previously proposed cutoff of VFPS ≥5.8 L/min/s predicted PCWP ≥ 18 mmHg with 91.5% sensitivity and 95.2% specificity with the area under curve of 0.987. The estimated PCWP significantly correlated with measured PCWP (R2 = 0.65, P < .001) and showed acceptable agreement with measured PCWP. Patients with VFPS ≥ 5.8 L/min/s experienced significantly higher heart failure readmission rates than those without (0.24 vs 0.05 events/y, P < .001). Conclusions: VFPS of the HVAD flow waveform is a novel noninvasive parameter that can estimate PCWP.

Original languageEnglish
Pages (from-to)342-348
Number of pages7
JournalJournal of Cardiac Failure
Volume26
Issue number4
DOIs
Publication statusPublished - Apr 2020
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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