title: A simplified echocardiographic technique for detecting continuous-flow left ventricular assist device malfunction due to pump thrombosis.
abstract: BACKGROUND
  Malfunction of a continuous-flow left ventricular assist device (CF-LVAD) due to device thrombosis is a potentially life-threatening event that currently presents a diagnostic challenge. We aimed to propose a practical echocardiographic assessment to diagnose LVAD malfunction secondary to pump thrombosis.
  
  
  METHODS
  Among 52 patients implanted with a CF-LVAD from a single center who underwent echocardiographic pump speed-change testing, 12 had suspected pump thrombosis as determined by clinical, laboratory, and/or device parameters. Comprehensive echocardiographic evaluation was performed at baseline pump speed and at each 1,000-rpm interval from the low setting of 8,000 rpm to the high setting of 11,000 rpm in 11 of these patients.
  
  
  RESULTS
  Receiver operating characteristic curves and stepwise logistic regression analyses showed that the best diagnostic parameters included changes in the LV end-diastolic diameter (<0.6 cm), aortic valve opening time (<80 msec), and deceleration time of mitral inflow (<70 msec) from lowest to highest pump speed. One parameter was predictive of pump malfunction, with 100% sensitivity and 89% specificity, whereas 2 of 3 parameters increased the sensitivity to 100% and specificity to 95%.
  
  
  CONCLUSIONS
  The 3 echocardiographic variables of measured changes in LV end-diastolic diameter, aortic valve opening time, and deceleration time of mitral inflow between the lowest (8,000 rpm) and highest pump speed settings (11,000 rpm) during echo-guided pump speed-change testing appear highly accurate in diagnosing device malfunction in the setting of pump thrombosis among patients supported with CF-LVAD. Further investigation is warranted to create and validate a prediction score.
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas. Electronic address: jestep@houstonmethodist.org.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Estep
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Mechanical and Circulatory Support and Heart Transplantation Program, UCLA Ahmanson Cardiomyopathy Center, UCLA, Los Angeles, California.
authors.forename: Rey P
authors.initials: RP
authors.lastname: Vivo
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Cordero-Reyes
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Arvind
authors.initials: A
authors.lastname: Bhimaraj
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Barry H
authors.initials: BH
authors.lastname: Trachtenberg
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Cátedra de Cardiologia y Medicina Vascular, Tecnológico de Monterrey, Monterrey, Nuevo León, México.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Su Min
authors.initials: SM
authors.lastname: Chang
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Barbara
authors.initials: B
authors.lastname: Elias
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Bruckner
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Erik E
authors.initials: EE
authors.lastname: Suarez
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Matthias
authors.initials: M
authors.lastname: Loebe
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000502:physiology; D004452:Echocardiography / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D013927:Thrombosis / Q000175:diagnosis* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology
keywords: cardiomyopathy; echocardiography; heart failure; left ventricular assist device; thrombosis