Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: The Columbia ramp study

Nir Uriel; Kerry A. Morrison; Arthur R. Garan; Tomoko S. Kato; Melana Yuzefpolskaya; Farhana Latif; Susan W. Restaino; Donna M. Mancini; Margaret Flannery; Hiroo Takayama; Ranjit John; Paolo C. Colombo; Yoshifumi Naka; Ulrich P. Jorde

doi:10.1016/j.jacc.2012.07.052

Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: The Columbia ramp study

Nir Uriel, Kerry A. Morrison, Arthur R. Garan, Tomoko S. Kato, Melana Yuzefpolskaya, Farhana Latif, Susan W. Restaino, Donna M. Mancini, Margaret Flannery, Hiroo Takayama, Ranjit John, Paolo C. Colombo, Yoshifumi Naka, Ulrich P. Jorde

Surgery

Research output: Contribution to journal › Article › peer-review

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Abstract

Objectives: This study sought to develop a novel approach to optimizing continuous-flow left ventricular assist device (CF-LVAD) function and diagnosing device malfunctions. Background: In CF-LVAD patients, the dynamic interaction of device speed, left and right ventricular decompression, and valve function can be assessed during an echocardiography-monitored speed ramp test. Methods: We devised a unique ramp test protocol to be routinely used at the time of discharge for speed optimization and/or if device malfunction was suspected. The patient's left ventricular end-diastolic dimension, frequency of aortic valve opening, valvular insufficiency, blood pressure, and CF-LVAD parameters were recorded in increments of 400 rpm from 8,000 rpm to 12,000 rpm. The results of the speed designations were plotted, and linear function slopes for left ventricular end-diastolic dimension, pulsatility index, and power were calculated. Results: Fifty-two ramp tests for 39 patients were prospectively collected and analyzed. Twenty-eight ramp tests were performed for speed optimization, and speed was changed in 17 (61%) with a mean absolute value adjustment of 424 ± 211 rpm. Seventeen patients had ramp tests performed for suspected device thrombosis, and 10 tests were suspicious for device thrombosis; these patients were then treated with intensified anticoagulation and/or device exchange/emergent transplantation. Device thrombosis was confirmed in 8 of 10 cases at the time of emergent device exchange or transplantation. All patients with device thrombosis, but none of the remaining patients had a left ventricular end-diastolic dimension slope >-0.16. Conclusions: Ramp tests facilitate optimal speed changes and device malfunction detection and may be used to monitor the effects of therapeutic interventions and need for surgical intervention in CF-LVAD patients.

Original language	English (US)
Pages (from-to)	1764-1775
Number of pages	12
Journal	Journal of the American College of Cardiology
Volume	60
Issue number	18
DOIs	https://doi.org/10.1016/j.jacc.2012.07.052
State	Published - Oct 30 2012

Bibliographical note

Funding Information:
This study was supported by a gift from Thoratec Corporation to the Trustees of Columbia University supporting a mentored (Dr. Ulrich Jorde) MCSD fellowship at Columbia University. Dr. Jorde is supported by NIH R01-HL 868845-04 . Dr. Uriel is supported by NIH 1 K23 HL 103795-01A1 . Drs. Jorde, Naka, and John are consultants to Thoratec and Heartware; have received honorarium from Thoratec Corporation; and have received research support from Thoratec and Heartware.

Keywords

LVAD
LVEDD
device thrombosis
ramp test

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Uriel, N., Morrison, K. A., Garan, A. R., Kato, T. S., Yuzefpolskaya, M., Latif, F., Restaino, S. W., Mancini, D. M., Flannery, M., Takayama, H., John, R., Colombo, P. C., Naka, Y., & Jorde, U. P. (2012). Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: The Columbia ramp study. Journal of the American College of Cardiology, 60(18), 1764-1775. https://doi.org/10.1016/j.jacc.2012.07.052

Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices : The Columbia ramp study. / Uriel, Nir; Morrison, Kerry A.; Garan, Arthur R. et al.

In: Journal of the American College of Cardiology, Vol. 60, No. 18, 30.10.2012, p. 1764-1775.

Research output: Contribution to journal › Article › peer-review

Uriel, N, Morrison, KA, Garan, AR, Kato, TS, Yuzefpolskaya, M, Latif, F, Restaino, SW, Mancini, DM, Flannery, M, Takayama, H, John, R, Colombo, PC, Naka, Y & Jorde, UP 2012, 'Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: The Columbia ramp study', Journal of the American College of Cardiology, vol. 60, no. 18, pp. 1764-1775. https://doi.org/10.1016/j.jacc.2012.07.052

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title = "Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: The Columbia ramp study",

abstract = "Objectives: This study sought to develop a novel approach to optimizing continuous-flow left ventricular assist device (CF-LVAD) function and diagnosing device malfunctions. Background: In CF-LVAD patients, the dynamic interaction of device speed, left and right ventricular decompression, and valve function can be assessed during an echocardiography-monitored speed ramp test. Methods: We devised a unique ramp test protocol to be routinely used at the time of discharge for speed optimization and/or if device malfunction was suspected. The patient's left ventricular end-diastolic dimension, frequency of aortic valve opening, valvular insufficiency, blood pressure, and CF-LVAD parameters were recorded in increments of 400 rpm from 8,000 rpm to 12,000 rpm. The results of the speed designations were plotted, and linear function slopes for left ventricular end-diastolic dimension, pulsatility index, and power were calculated. Results: Fifty-two ramp tests for 39 patients were prospectively collected and analyzed. Twenty-eight ramp tests were performed for speed optimization, and speed was changed in 17 (61%) with a mean absolute value adjustment of 424 ± 211 rpm. Seventeen patients had ramp tests performed for suspected device thrombosis, and 10 tests were suspicious for device thrombosis; these patients were then treated with intensified anticoagulation and/or device exchange/emergent transplantation. Device thrombosis was confirmed in 8 of 10 cases at the time of emergent device exchange or transplantation. All patients with device thrombosis, but none of the remaining patients had a left ventricular end-diastolic dimension slope >-0.16. Conclusions: Ramp tests facilitate optimal speed changes and device malfunction detection and may be used to monitor the effects of therapeutic interventions and need for surgical intervention in CF-LVAD patients.",

keywords = "LVAD, LVEDD, device thrombosis, ramp test",

author = "Nir Uriel and Morrison, {Kerry A.} and Garan, {Arthur R.} and Kato, {Tomoko S.} and Melana Yuzefpolskaya and Farhana Latif and Restaino, {Susan W.} and Mancini, {Donna M.} and Margaret Flannery and Hiroo Takayama and Ranjit John and Colombo, {Paolo C.} and Yoshifumi Naka and Jorde, {Ulrich P.}",

note = "Funding Information: This study was supported by a gift from Thoratec Corporation to the Trustees of Columbia University supporting a mentored (Dr. Ulrich Jorde) MCSD fellowship at Columbia University. Dr. Jorde is supported by NIH R01-HL 868845-04 . Dr. Uriel is supported by NIH 1 K23 HL 103795-01A1 . Drs. Jorde, Naka, and John are consultants to Thoratec and Heartware; have received honorarium from Thoratec Corporation; and have received research support from Thoratec and Heartware. ",

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doi = "10.1016/j.jacc.2012.07.052",

language = "English (US)",

volume = "60",

pages = "1764--1775",

journal = "Journal of the American College of Cardiology.",

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T1 - Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices

T2 - The Columbia ramp study

AU - Uriel, Nir

AU - Morrison, Kerry A.

AU - Garan, Arthur R.

AU - Kato, Tomoko S.

AU - Yuzefpolskaya, Melana

AU - Latif, Farhana

AU - Restaino, Susan W.

AU - Mancini, Donna M.

AU - Flannery, Margaret

AU - Takayama, Hiroo

AU - John, Ranjit

AU - Colombo, Paolo C.

AU - Naka, Yoshifumi

AU - Jorde, Ulrich P.

N1 - Funding Information: This study was supported by a gift from Thoratec Corporation to the Trustees of Columbia University supporting a mentored (Dr. Ulrich Jorde) MCSD fellowship at Columbia University. Dr. Jorde is supported by NIH R01-HL 868845-04 . Dr. Uriel is supported by NIH 1 K23 HL 103795-01A1 . Drs. Jorde, Naka, and John are consultants to Thoratec and Heartware; have received honorarium from Thoratec Corporation; and have received research support from Thoratec and Heartware.

PY - 2012/10/30

Y1 - 2012/10/30

N2 - Objectives: This study sought to develop a novel approach to optimizing continuous-flow left ventricular assist device (CF-LVAD) function and diagnosing device malfunctions. Background: In CF-LVAD patients, the dynamic interaction of device speed, left and right ventricular decompression, and valve function can be assessed during an echocardiography-monitored speed ramp test. Methods: We devised a unique ramp test protocol to be routinely used at the time of discharge for speed optimization and/or if device malfunction was suspected. The patient's left ventricular end-diastolic dimension, frequency of aortic valve opening, valvular insufficiency, blood pressure, and CF-LVAD parameters were recorded in increments of 400 rpm from 8,000 rpm to 12,000 rpm. The results of the speed designations were plotted, and linear function slopes for left ventricular end-diastolic dimension, pulsatility index, and power were calculated. Results: Fifty-two ramp tests for 39 patients were prospectively collected and analyzed. Twenty-eight ramp tests were performed for speed optimization, and speed was changed in 17 (61%) with a mean absolute value adjustment of 424 ± 211 rpm. Seventeen patients had ramp tests performed for suspected device thrombosis, and 10 tests were suspicious for device thrombosis; these patients were then treated with intensified anticoagulation and/or device exchange/emergent transplantation. Device thrombosis was confirmed in 8 of 10 cases at the time of emergent device exchange or transplantation. All patients with device thrombosis, but none of the remaining patients had a left ventricular end-diastolic dimension slope >-0.16. Conclusions: Ramp tests facilitate optimal speed changes and device malfunction detection and may be used to monitor the effects of therapeutic interventions and need for surgical intervention in CF-LVAD patients.

AB - Objectives: This study sought to develop a novel approach to optimizing continuous-flow left ventricular assist device (CF-LVAD) function and diagnosing device malfunctions. Background: In CF-LVAD patients, the dynamic interaction of device speed, left and right ventricular decompression, and valve function can be assessed during an echocardiography-monitored speed ramp test. Methods: We devised a unique ramp test protocol to be routinely used at the time of discharge for speed optimization and/or if device malfunction was suspected. The patient's left ventricular end-diastolic dimension, frequency of aortic valve opening, valvular insufficiency, blood pressure, and CF-LVAD parameters were recorded in increments of 400 rpm from 8,000 rpm to 12,000 rpm. The results of the speed designations were plotted, and linear function slopes for left ventricular end-diastolic dimension, pulsatility index, and power were calculated. Results: Fifty-two ramp tests for 39 patients were prospectively collected and analyzed. Twenty-eight ramp tests were performed for speed optimization, and speed was changed in 17 (61%) with a mean absolute value adjustment of 424 ± 211 rpm. Seventeen patients had ramp tests performed for suspected device thrombosis, and 10 tests were suspicious for device thrombosis; these patients were then treated with intensified anticoagulation and/or device exchange/emergent transplantation. Device thrombosis was confirmed in 8 of 10 cases at the time of emergent device exchange or transplantation. All patients with device thrombosis, but none of the remaining patients had a left ventricular end-diastolic dimension slope >-0.16. Conclusions: Ramp tests facilitate optimal speed changes and device malfunction detection and may be used to monitor the effects of therapeutic interventions and need for surgical intervention in CF-LVAD patients.

KW - LVAD

KW - LVEDD

KW - device thrombosis

KW - ramp test

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Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: The Columbia ramp study

Abstract

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Keywords

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