Accelerometer Detects Pump Thrombosis and Thromboembolic Events in an In vitro HVAD Circuit
Accelerometer Detects Pump Thrombosis and Thromboembolic Events in an In vitro HVAD Circuit
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DOI：
10.1097/mat.0000000000000699
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发表时间：
2018-09-01
期刊：
影响因子：
4.2
通讯作者：
Halvorsen, Per S.
中科院分区：
文献类型：
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作者：
Schalit, Itai;Espinoza, Andreas;Halvorsen, Per S.
泵血栓形成和中风是左心室辅助装置 (LVAD) 支持的严重并发症。本研究的目的是测试加速度计通过实时分析泵振动来检测泵血栓形成和血栓栓塞事件 (TE) 的能力。将加速度计传感器连接到 HeartWare HVAD 上，并在三个体外实验中进行测试，每个实验使用不同的泵。每个实验包括 0.2-1.0 mL 的血栓注射和控制干预：泵速变化、后负荷增加、前负荷减少和盐水推注。根据加速度计信号计算频谱图，并使用三次谐波幅度来测试该方法的灵敏度和特异性。将三次谐波振幅与泵能耗进行比较。加速度信号质量很高。在血栓栓塞干预期间，加速度计三次谐波发生了显着变化。三次谐波检测血栓栓塞事件的灵敏度/特异性高于 LVAD 能量消耗：分别为 92%/94% 与 72%/58%。总共 60% 的血栓栓塞事件导致三次谐波振幅变化延长，这表明叶轮上存在血栓质量残留。我们的结论是，有强有力的证据支持使用加速度计实时连续 LVAD 监测血栓栓塞事件和泵血栓形成的可行性。需要进一步的体内研究来证实这些有希望的发现。
Pump thrombosis and stroke are serious complications of left ventricular assist device (LVAD) support. The aim of this study was to test the ability of an accelerometer to detect pump thrombosis and thromboembolic events (TEs) using real-time analysis of pump vibrations. An accelerometer sensor was attached to a HeartWare HVAD and tested in three in vitro experiments using different pumps for each experiment. Each experiment included thrombi injections sized 0.2-1.0 mL and control interventions: pump speed change, afterload increase, preload decrease, and saline bolus injections. A spectrogram was calculated from the accelerometer signal, and the third harmonic amplitude was used to test the sensitivity and specificity of the method. The third harmonic amplitude was compared with the pump energy consumption. The acceleration signals were of high quality. A significant change was identified in the accelerometer third harmonic during the thromboembolic interventions. The third harmonic detected thromboembolic events with higher sensitivity/specificity than LVAD energy consumption: 92%/94% vs. 72%/58%, respectively. A total of 60% of thromboembolic events led to a prolonged third harmonic amplitude change, which is indicative of thrombus mass residue on the impeller. We concluded that there is strong evidence to support the feasibility of real-time continuous LVAD monitoring for thromboembolic events and pump thrombosis using an accelerometer. Further in vivo studies are needed to confirm these promising findings.