title: Cardiac Index Declines During Long-Term Left Ventricular Device Support.
abstract: To investigate longitudinal trends in valvular and ventricular function with long-term left ventricular assist device (LVAD) therapy, we analyzed hemodynamic and echocardiographic data of patients with at least 2 years of continuous LVAD support. All 130 patients who underwent HeartMate II implantation at our institution between 2005 and 2012 were reviewed. Twenty patients had hemodynamic and echocardiographic evaluations in both the early (0-6 months) and late (2-3 years) postoperative period. Patients on inotropic therapy or temporary mechanical support were excluded. The average times of early and late hemodynamic evaluations were 59 ± 41 days and 889 ± 160 days, respectively. Cardiac index (CI) declined by an average of 0.4 L/min/m2(P = 0.04) with concomitant increase in pulmonary capillary wedge pressure (PCWP; P = 0.02). The right atrial pressure to PCWP (RAP:PCWP) ratio decreased during LVAD support suggesting improvement in right ventricular function. While there was an increase in degree of aortic insufficiency (AI) at the late follow-up period (P = 0.008), dichotomization by median decline in CI (-0.4 L/min/m2) indicated no difference in prevalence of AI among the groups. CI declined in patients with HeartMate II after 2 years of continuous support. An increase in preload and afterload was observed in those with the greatest decline in CI.
authors.affiliation: Osler Medical Residency, Department of Medicine.
authors.forename: Rohan J
authors.initials: RJ
authors.lastname: Kalathiya
authors.affiliation: Division of Cardiology, Department of Medicine.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Houston
authors.affiliation: Osler Medical Residency, Department of Medicine.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Chaisson
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Grimm
authors.affiliation: Division of Cardiology, Department of Medicine.
authors.forename: Gerin R
authors.initials: GR
authors.lastname: Stevens
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Sciortino
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Glenn J R
authors.initials: GJ
authors.lastname: Whitman
authors.affiliation: Division of Cardiology, Department of Medicine.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
authors.affiliation: Division of Cardiology, Department of Medicine.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Tedford
mesh_terms: D000328:Adult; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology* / Q000601:surgery; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation
keywords: Left ventricular assist device-Hemodynamics-Cardiac index-HeartMate