title: Hematologic markers better predict left ventricular assist device thrombosis than echocardiographic or pump parameters.
abstract: BACKGROUND
  Left ventricular assist device (LVAD) thrombosis is a life-threatening complication that remains a major clinical problem. Consensus diagnostic criteria do not exist. We investigated whether hematologic, echocardiographic, or pump parameters reliably change during LVAD thrombosis.
  
  
  METHODS
  A retrospective analysis of 20 consecutive cases of continuous-flow LVAD thrombosis (Thoratec HeartMate II n = 16, HeartWare HVAD n = 4) was performed. Hematologic markers (lactate dehydrogenase, plasma-free hemoglobin, hemoglobin, creatinine), echocardiographic parameters (left ventricular end-systolic and end-diastolic diameter, mitral regurgitation, aortic insufficiency, inflow-cannula velocity), and pump characteristics (speed, power, estimated flow, pulsatility index) were analyzed with one-way repeated measures ANOVA with Tukey post-test or paired Student t-tests.
  
  
  RESULTS
  Lactate dehydrogenase and plasma-free hemoglobin were significantly (p < 0.05) elevated at admission for LVAD thrombosis. Hemoglobin and creatinine were not significantly different at admission but changed significantly after admission. Left ventricular end-systolic and end-diastolic diameter, mitral regurgitation, aortic insufficiency, inflow-cannula velocity, LVAD speed, power consumption, estimated flow, and pulsatility index were not significantly different at admission for LVAD thrombosis.
  
  
  CONCLUSIONS
  Hematological markers of hemolysis, but not echocardiographic or pump parameters, reliably changed during LVAD thrombosis. Markers of hemolysis are the best early predictors of LVAD thrombosis.
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States.
authors.forename: Carlo R
authors.initials: CR
authors.lastname: Bartoli
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, United States.
authors.forename: Amaninderapal S
authors.initials: AS
authors.lastname: Ghotra
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, United States.
authors.forename: Ajay R
authors.initials: AR
authors.lastname: Pachika
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, United States.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Birks
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, United States.
authors.forename: Kelly C
authors.initials: KC
authors.lastname: McCants
mesh_terms: D015415:Biomarkers / Q000097:blood; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013927:Thrombosis / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology
chemical_list: D015415:Biomarkers