title: Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois. Electronic address: nuriel@medicine.bsd.uchicago.edu.
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sayer
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Karima
authors.initials: K
authors.lastname: Addetia
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Savitri
authors.initials: S
authors.lastname: Fedson
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Gene H
authors.initials: GH
authors.lastname: Kim
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rodgers
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Eric
authors.initials: E
authors.lastname: Kruse
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Keith
authors.initials: K
authors.lastname: Collins
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Sirtaz
authors.initials: S
authors.lastname: Adatya
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Nitasha
authors.initials: N
authors.lastname: Sarswat
authors.affiliation: Division of Cardiology, Montefiore Medical Center, New York, New York.
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.affiliation: Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Colleen
authors.initials: C
authors.lastname: Juricek
authors.affiliation: Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Ota
authors.affiliation: Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
authors.affiliation: Columbia University Medical Center, New York, New York; HeartWare International Inc., Framingham, Massachusetts.
authors.forename: Daniel
authors.initials: D
authors.lastname: Burkhoff
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
mesh_terms: D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*
keywords: 3D echocardiography; hemodynamics; left ventricular assist device; ramp; unloading