Role of echocardiography in patients with intravascular hemolysis due to suspected continuous-flow LVAD thrombosis

Nowell M. Fine, Yan Topilsky, Jae Kuen Oh, Tal Hasin, Sudhir S. Kushwaha, Richard C. Daly, Lyle D. Joyce, John M. Stulak, Naveen Luke Pereira, Barry A. Boilson, Alfredo L. Clavell, Brooks Sayre Edwards, Soon J. Park

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Abstract

Objectives This study sought to characterize the echocardiographic findings of patients presenting with intravascular hemolysis (IVH) due to suspected continuous-flow left ventricular assist device (LVAD) pump thrombosis. Background LVAD patients who develop pump thrombosis often present with IVH. Echocardiography may be able to detect device dysfunction in this setting. Methods Continuous-flow LVAD patients presenting with IVH due to suspected pump thrombosis were identified. Patients underwent echocardiography with cannula Doppler flow velocity interrogation. Findings were compared with baseline and follow-up studies, and with 49 stable LVAD control patients. Results Of 145 patients, 14 (10%) had IVH due to suspected pump thrombosis. The mean age was 55 ± 15 years, 93% were men, and 50% received LVAD as destination therapy. Mean duration between implantation and IVH was 231 ± 218 days. Eleven (79%) patients presented with hemoglobinuria, 9 (64%) with jaundice, and 5 (36%) with acute heart failure. Reduced cannula diastolic flow velocity and increased systolic/diastolic (S/D) flow velocity ratio were the only echocardiographic parameters significantly different from controls (outflow cannula 0.3 ± 0.2 m/s vs. 0.8 ± 0.3 m/s, p = 0.03, and 5.9 ± 2.8 vs. 1.7 ± 0.7, p < 0.01, respectively), and were worse for IVH patients with acute heart failure compared with those without (outflow cannula 0.2 ± 0.1 m/s vs. 0.5 ± 0.2 m/s, p = 0.04, and 7.2 ± 3.3 vs. 5.3 ± 2.0, p = 0.02, respectively). Outflow cannula diastolic flow velocity and S/D flow velocity ratio changed significantly from baseline (p = 0.01 and p < 0.01, respectively) in IVH patients, whereas systolic flow velocity did not change (p = 0.59). Odds ratios for outflow cannula diastolic flow velocity and S/D flow velocity ratio for predicting IVH were 0.60 (95% confidence interval [CI]: 0.51 to 0.73), p = 0.02, and 2.45 (95% CI: 2.37 to 2.52) p < 0.01, respectively. Corresponding inflow cannula values were similarly significant. Pump thrombosis was confirmed in 7 (50%) patients after LVAD retrieval. Conclusions Reduced cannula diastolic flow velocity and increased S/D flow velocity ratio identified continuous-flow LVAD dysfunction in patients with IVH due to suspected pump thrombosis better than other echocardiographic parameters.

Original languageEnglish (US)
Pages (from-to)1129-1140
Number of pages12
JournalJACC: Cardiovascular Imaging
Volume6
Issue number11
DOIs
StatePublished - Nov 2013

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Keywords

  • echocardiography
  • intravascular hemolysis
  • left ventricular assist device
  • pump thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Fine, N. M., Topilsky, Y., Oh, J. K., Hasin, T., Kushwaha, S. S., Daly, R. C., Joyce, L. D., Stulak, J. M., Pereira, N. L., Boilson, B. A., Clavell, A. L., Edwards, B. S., & Park, S. J. (2013). Role of echocardiography in patients with intravascular hemolysis due to suspected continuous-flow LVAD thrombosis. JACC: Cardiovascular Imaging, 6(11), 1129-1140. https://doi.org/10.1016/j.jcmg.2013.06.006