title: Assessment of cardiac function during mechanical circulatory support: the quest for a suitable clinical index.
abstract: A new index to assess left ventricular (LV) function in patients implanted with continuous flow left-ventricular assist devices (LVADs) is proposed. Derived from the pump flow signal, this index is defined as the coefficient (k) of the semilogarithmic relationship between "pseudo-ejection" fraction (pEF) and the volume discharged by the pump in diastole, (V d). pEF is defined as the ratio of the "pseudo-stroke volume" (pSV) to V d. The pseudo-stroke volume is the difference between V d and the volume discharged by the pump in systole (V s), both obtained by integrating pump flow with respect to time in a cardiac cycle. k was compared in-vivo with others two indices: the LV pressure-based index, M(TP), and the pump flow-based index, I(Q). M(TP) is the slope of the linear regression between the "triple-product" and end-diastolic pressure, EDP. The triple-product, TP = LV SP.dP/dt(max). HR, is the product of LV systolic pressure, maximum time-derivative of LV pressure, and heart rate. I(Q) is the slope of the linear regression between maximum time-derivative of pump flow, dQ/dt(max), and pump flow peak-to-peak amplitude variation, Q(P2P). To test the response of k to contractile state changes, contractility was altered through pharmacological interventions. The absolute value of k decreased from 1.354 ± 0.25 (baseline) to 0.685 ± 0.21 after esmolol infusion. The proposed index is sensitive to changes in inotropic state, and has the potential to be used clinically to assess contractile function of patients implanted with VAD.
authors.affiliation: Department of Mathematics, Federal University of Maranhao, Sao Luis, MA 65080-040, Brazil. aferreir@andrew.cmu.edu
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Ferreira
authors.forename: Yajuan
authors.initials: Y
authors.lastname: Wang
authors.forename: John
authors.initials: J
authors.lastname: Gorcsan
authors.forename: James F
authors.initials: JF
authors.lastname: Antaki
mesh_terms: D006305:Health Status Indicators; D006334:Heart Function Tests / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology* / Q000517:prevention & control*