Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices

Nir Uriel, Gabriel Sayer, Karima Addetia, Savitri Fedson, Gene H. Kim, Daniel Rodgers, Eric Kruse, Keith Collins, Sirtaz Adatya, Nitasha Sarswat, Ulrich P. Jorde, Colleen Juricek, Takeyoshi Ota, Valluvan Jeevanandam, Daniel Burkhoff, Roberto M. Lang

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Objectives: 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.

Original languageEnglish (US)
Pages (from-to)208-217
Number of pages10
JournalJACC: Heart Failure
Volume4
Issue number3
DOIs
StatePublished - Mar 1 2016

Fingerprint

Architectural Accessibility
Heart-Assist Devices
Hemodynamics
Central Venous Pressure
Pulmonary Wedge Pressure
Blood Pressure
High Cardiac Output
Expert Testimony
Cardiac Catheterization
Pulmonary Artery
Echocardiography
Quality of Life
Guidelines
Pressure

Keywords

  • 3D echocardiography
  • Hemodynamics
  • Left ventricular assist device
  • Ramp
  • Unloading

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Uriel, N., Sayer, G., Addetia, K., Fedson, S., Kim, G. H., Rodgers, D., ... Lang, R. M. (2016). Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices. JACC: Heart Failure, 4(3), 208-217. https://doi.org/10.1016/j.jchf.2015.10.001

Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices. / Uriel, Nir; Sayer, Gabriel; Addetia, Karima; Fedson, Savitri; Kim, Gene H.; Rodgers, Daniel; Kruse, Eric; Collins, Keith; Adatya, Sirtaz; Sarswat, Nitasha; Jorde, Ulrich P.; Juricek, Colleen; Ota, Takeyoshi; Jeevanandam, Valluvan; Burkhoff, Daniel; Lang, Roberto M.

In: JACC: Heart Failure, Vol. 4, No. 3, 01.03.2016, p. 208-217.

Research output: Contribution to journalArticle

Uriel, N, Sayer, G, Addetia, K, Fedson, S, Kim, GH, Rodgers, D, Kruse, E, Collins, K, Adatya, S, Sarswat, N, Jorde, UP, Juricek, C, Ota, T, Jeevanandam, V, Burkhoff, D & Lang, RM 2016, 'Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices', JACC: Heart Failure, vol. 4, no. 3, pp. 208-217. https://doi.org/10.1016/j.jchf.2015.10.001
Uriel N, Sayer G, Addetia K, Fedson S, Kim GH, Rodgers D et al. Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices. JACC: Heart Failure. 2016 Mar 1;4(3):208-217. https://doi.org/10.1016/j.jchf.2015.10.001
Uriel, Nir ; Sayer, Gabriel ; Addetia, Karima ; Fedson, Savitri ; Kim, Gene H. ; Rodgers, Daniel ; Kruse, Eric ; Collins, Keith ; Adatya, Sirtaz ; Sarswat, Nitasha ; Jorde, Ulrich P. ; Juricek, Colleen ; Ota, Takeyoshi ; Jeevanandam, Valluvan ; Burkhoff, Daniel ; Lang, Roberto M. / Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices. In: JACC: Heart Failure. 2016 ; Vol. 4, No. 3. pp. 208-217.
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AU - Rodgers, Daniel

AU - Kruse, Eric

AU - Collins, Keith

AU - Adatya, Sirtaz

AU - Sarswat, Nitasha

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KW - Hemodynamics

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KW - Unloading

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