title: Pump Speed Optimization in Stable Patients with a Left Ventricular Assist Device.
abstract: Optimal left ventricular assist device (LVAD) functioning and preservation of right ventricular (RV) function are major survival determinants in destination therapy (DT)-LVAD recipients. Currently, the indication for routine pump speed optimization in stable patients and its effect on RV function at follow-up remain underexplored. Hemodynamically stable patients (N = 17, age 61 [interquartile range {IQR} 51-66] years; 13 [77%] male) underwent a routine speed ramp test. Echocardiographic images were obtained at incremental speed settings to determine optimal pump speed. In 8 patients (47%), LVAD speed could be optimized. In these patients, RV fractional area change (26% [IQR 23-31] to 35% [IQR 27-45], p = 0.04) and RV longitudinal peak systolic strain (-13% [IQR -16 to -9] to -17% [IQR -18 to -11], p = 0.02) at 3 months follow-up improved without RV dilatation. Furthermore, N-terminal pro-brain natriuretic peptide level decreased (3,162 [IQR 1,336-4,487] ng/L to 2,294 [IQR 1,157-3,810] ng/L, p = 0.02). No significant follow-up changes were found in patients without indication for speed adjustment. In conclusion, routine evaluation of optimal LVAD speed reveals the potential of speed optimization in a substantial proportion of stable LVAD-DT patients and can improve RV function.
authors.affiliation: From the *Department of Cardiology, LUMC, Leiden, The Netherlands; †Department of Cardiothoracic Surgery, LUMC, Leiden, The Netherlands; ‡Department of Medical Statistics and Bioinformatics, LUMC, Leiden, The Netherlands; and §Mathematical Institute, Leiden University, Leiden, The Netherlands.
authors.forename: Lotte E
authors.initials: LE
authors.lastname: Couperus
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Mand J H
authors.initials: MJH
authors.lastname: Khidir
authors.forename: Marijke P M
authors.initials: MPM
authors.lastname: Vester
authors.forename: Meindert
authors.initials: M
authors.lastname: Palmen
authors.forename: Marta
authors.initials: M
authors.lastname: Fiocco
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.forename: Laurens F
authors.initials: LF
authors.lastname: Tops
authors.forename: Robert J M
authors.initials: RJM
authors.lastname: Klautz
authors.forename: Harriëtte F
authors.initials: HF
authors.lastname: Verwey
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Saskia L M A
authors.initials: SLMA
authors.lastname: Beeres
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D016278:Ventricular Function, Right