Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices
Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices
复制标题
DOI：
10.1016/j.jchf.2015.10.001
复制
发表时间：
2016-03-01
影响因子：
13
通讯作者：
Lang, Roberto M.
中科院分区：
文献类型：
--
作者：
Uriel, Nir;Sayer, Gabriel;Lang, Roberto M.
结论本研究测试了联合有创血流动力学和超声心动图斜坡试验是否有助于优化患者管理。背景在连续流心室辅助装置（cfLVAD）患者中优化速度和药物治疗的指南主要基于专家意见。（21 HeartMate II [Thoratec，普莱森顿，加州]和14 HVAD [HeartWare International，Fragrance，马萨诸塞州]）进行了右心导管检查（包括中心静脉压[CVP]、肺动脉压、肺毛细血管楔压[PCWP]和血压）和超声心动图的斜坡试验。在多达9个速度设置下记录数据。对于HeartMate II（8，000至12，000 RPM）和HVAD（2，300至3，200 RPM）患者，速度变化以400转/分钟（RPM）为步长，结果只有42.9%的患者在原始RPM设置下具有正常的CVP和PCWP。从最低速度到最高速度，心输出量改善0.16 +/- 0.19 l/min/步（总变化1.28 +/- 1.41 l/min），PCWP降低1.23 +/- 0.85 mm Hg/步（总变化9.9 +/- 6.5 mm Hg）。CVP和收缩压随RPM变化不显著。根据测试结果调整RPM，以使CVP和PCWP尽可能接近正常限值，这在56%的患者中是可行的。对于其余的，结果表明，哪种类型的医疗管理should be pursued.CONCLUSIONS结合使用血流动力学和超声心动图斜坡测试的患者提供了客观的手段，优化RPM，并有可能指导医疗管理。这一策略是否对生活质量或临床结局产生有益影响仍有待检验。（J Am科尔心脏病HF 2016;4：208-17）（C）美国心脏病学会基金会2016年。
OBJECTIVES This study tested whether combined invasive hemodynamic and echocardiographic ramp tests can help optimize patient management.BACKGROUND Guidelines for optimizing speed and medications in continuous flow ventricular assist device (cfLVAD) patients are mainly based on expert opinion.METHODS Thirty-five cfLVAD patients (21 HeartMate II [Thoratec, Pleasanton, California] and 14 HVAD [HeartWare International, Framingham, Massachusetts]) underwent ramp tests with right heart catheterization (including central venous pressure [CVP], pulmonary artery pressure, pulmonary capillary wedge pressure [PCWP], and blood pressure) and echocardiography. Data were recorded at up to 9 speed settings. Speed changes were in steps of 400 revolutions per minute (RPM) for HeartMate II (8,000 to 12,000 RPM) and 100 RPM for HVAD (2,300 to 3,200 RPM) patients.RESULTS Only 42.9% of patients had normal CVPs and PCWPs at their original RPM settings. Going from Lowest to highest speeds, cardiac output improved by 0.16 +/- 0.19 l/min/step (total change 1.28 +/- 1.41 l/min) and PCWP decreased by 1.23 +/- 0.85 mm Hg/step (total change 9.9 +/- 6.5 mm Hg). CVP and systolic blood pressure did not change significantly with RPM. RPM were adjusted based on test results to achieve CVPs and PCWPs as close to normal limits as possible, which was feasible in 56% of patients. For the remainder, results indicated which type of medical management should be pursued.CONCLUSIONS Use of combined hemodynamic and echocardiographic ramp tests in patients provides objective means of optimizing RPM, and has the potential to guide medical management. It remains to be tested whether this strategy has a beneficial impact on quality of life or clinical outcomes. (J Am Coll Cardiol HF 2016;4:208-17) (C) 2016 by the American College of Cardiology Foundation.