title: Slope of the anterior mitral valve leaflet: a new measurement of left ventricular unloading for left ventricular assist devices and systolic dysfunction.
abstract: Left ventricular assist device (LVAD)-supported patients are evaluated routinely with use of transthoracic echocardiography. Values of left ventricular unloading in this unique patient population are needed to evaluate LVAD function and assist in patient follow-up. We introduce a new M-mode measurement, the slope of the anterior mitral valve leaflet (SLAM), and compare its efficacy with that of other standard echocardiographically evaluated values for left ventricular loading, including E/e' and pulmonary artery systolic pressures. Average SLAM values were determined retrospectively for cohorts of random, non-LVAD patients with moderately to severely impaired left ventricular ejection fraction (LVEF) (<0.35, n=60). In addition, pre- and post-LVAD implantation echocardiographic images of 81 patients were reviewed. The average SLAM in patients with an LVEF <0.35 was 11.6 cm/s (95% confidence interval, 10.4-12.8); SLAM had a moderately strong correlation with E/e' in these patients. Implantation of LVADs significantly increased the SLAM from 7.3 ± 2.44 to 14.7 ± 5.01 cm/s (n=42, P <0.0001). The LVAD-supported patients readmitted for exacerbation of congestive heart failure exhibited decreased SLAM from 12 ± 3.93 to 7.3 ± 3.5 cm/s (n=6, P=0.041). In addition, a cutpoint of 10 cm/s distinguished random patients with LVEF <0.35 from those in end-stage congestive heart failure (pre-LVAD) with an 88% sensitivity and a 55% specificity. Evaluating ventricular unloading in LVAD patients remains challenging. Our novel M-mode value correlates with echocardiographic values of left ventricular filling in patients with moderate-to-severe systolic function and dynamically improves with the ventricular unloading of an LVAD.
authors: Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110.
authors: Sara C
authors: SC
authors: Martinez
authors: Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110.
authors: Elisa A
authors: EA
authors: Bradley
authors: Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110.
authors: Eric L
authors: EL
authors: Novak
authors: Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110.
authors: Ravi
authors: R
authors: Rasalingam
authors: Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110.
authors: Ari M
authors: AM
authors: Cedars
authors: Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110.
authors: Gregory A
authors: GA
authors: Ewald
authors: Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110.
authors: Scott C
authors: SC
authors: Silvestry
authors: Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110.
authors: Susan M
authors: SM
authors: Joseph
mesh_terms: D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left
keywords: Echocardiography, Doppler/methods/trends; health status indicators; heart failure/classification/physiopathology/therapy; heart-assist devices; models, theoretical; predictive value of tests; reference values; sensitivity and specificity; severity of illness index; ventricular function/physiology