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Stöhr EJ, Ji R, Mondellini G, Braghieri L, Akiyama K, Castagna F, Pinsino A, Cockcroft JR, Silverman RH, Trocio S, Zatvarska O, Konofagou E, Apostolakis I, Topkara VK, Takayama H, Takeda K, Naka Y, Uriel N, Yuzefpolskaya M, Willey JZ, McDonnell BJ, Colombo PC. Pulsatility and flow patterns across macro- and microcirculatory arteries of continuous-flow left ventricular assist device patients. J Heart Lung Transplant 2023; 42:1223-1232. [PMID: 37098374 PMCID: PMC11078160 DOI: 10.1016/j.healun.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Reduced arterial pulsatility in continuous-flow left ventricular assist devices (CF-LVAD) patients has been implicated in clinical complications. Consequently, recent improvements in clinical outcomes have been attributed to the "artificial pulse" technology inherent to the HeartMate3 (HM3) LVAD. However, the effect of the "artificial pulse" on arterial flow, transmission of pulsatility into the microcirculation and its association with LVAD pump parameters is not known. METHODS The local flow oscillation (pulsatility index, PI) of common carotid arteries (CCAs), middle cerebral arteries (MCAs) and central retinal arteries (CRAs-representing the microcirculation) were quantified by 2D-aligned, angle-corrected Doppler ultrasound in 148 participants: healthy controls, n = 32; heart failure (HF), n = 43; HeartMate II (HMII), n = 32; HM3, n = 41. RESULTS In HM3 patients, 2D-Doppler PI in beats with "artificial pulse" and beats with "continuous-flow" was similar to that of HMII patients across the macro- and microcirculation. Additionally, peak systolic velocity did not differ between HM3 and HMII patients. Transmission of PI into the microcirculation was higher in both HM3 (during the beats with "artificial pulse") and in HMII patients compared with HF patients. LVAD pump speed was inversely associated with microvascular PI in HMII and HM3 (HMII, r2 = 0.51, p < 0.0001; HM3 "continuous-flow," r2 = 0.32, p = 0.0009; HM3 "artificial pulse," r2 = 0.23, p = 0.007), while LVAD pump PI was only associated with microcirculatory PI in HMII patients. CONCLUSIONS The "artificial pulse" of the HM3 is detectable in the macro- and microcirculation but without creating a significant alteration in PI compared with HMII patients. Increased transmission of pulsatility and the association between pump speed and PI in the microcirculation indicate that the future clinical care of HM3 patients may involve individualized pump settings according to the microcirculatory PI in specific end-organs.
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Affiliation(s)
- Eric J Stöhr
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK; Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York.
| | - Ruiping Ji
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Giulio Mondellini
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York; Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Koichi Akiyama
- Department of Medicine, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, New York; Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Francesco Castagna
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York; Cardiology Division, Montefiore Medical Center, New York, New York
| | - Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - John R Cockcroft
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK; Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ronald H Silverman
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Samuel Trocio
- Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Oksana Zatvarska
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Elisa Konofagou
- Department of Biomedical Engineering, Columbia University Irving Medical Center, New York, New York
| | - Iason Apostolakis
- Department of Biomedical Engineering, Columbia University Irving Medical Center, New York, New York
| | - Veli K Topkara
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Hiroo Takayama
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Koji Takeda
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Yoshifumi Naka
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Joshua Z Willey
- Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Barry J McDonnell
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
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Stöhr E, Castagna F, Pearson J, Watkeys L, Trocio S, Zatvarska O, Crimmins T, Pinsino A, Colombo P, Yuzefpolskaya M, Garan R, Topkara V, Takayama H, Takeda K, Naka Y, Cockcroft J, Willey J, McDonnell B. 4.4 MIDDLE CEREBRAL ARTERY PULSATILITY IN HEART FAILURE AND PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES. Artery Res 2017. [DOI: 10.1016/j.artres.2017.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
OBJECTIVE Carotid distensibility (CD) is a measure of carotid artery elasticity that has been introduced as a risk factor for cardiovascular disease. Information regarding reproducibility of sonographic CD measures is limited. The objective of this study was to evaluate the inter-reader reliability of sonographic measurements of common carotid artery (CCA) diameters and derived metrics of CD. METHODS Two independent readers (R1 and R2) measured the systolic diameter (SD) and diastolic diameter (DD) for the right CCA from the B/M-mode sonographic registrations among 118 subjects. The derived CD metrics (strain, elastic modulus [E], stiffness [beta], and CD) were calculated. The inter-reader type 3 intraclass correlation coefficients (ICC3,1) for carotid diameters were calculated. RESULTS The mean SDs +/- standard deviation were 7.15 +/- 1.43 mm for R1 and 7.24 +/- 1.43 mm for R2. The mean DDs were 6.71 +/- 1.36 mm for R1 and 6.68 +/- 1.41 mm for R2. The mean differences of SD and DD between R1 and R2 were 0.08 +/- 0.40 mm (paired t test, P = .04) and 0.03 +/- 0.43 mm (paired t test, P = .46), respectively. Inter-reader type 3 intraclass correlation coefficients were 0.96 for SD and 0.95 for DD. We observed a significant association of demographics with carotid diameters but not with derived CD metrics or risk factors. CONCLUSIONS Our results suggest good reproducibility of CCA diameters measured with B/M-mode sonography. However, very small changes in linear measurements of carotid diameters can have big effects on estimates of arterial mechanical properties such as strain and Young's modulus. The standard boundary identification methods may not be precise and reproducible enough for use in a clinical setting.
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Affiliation(s)
- Elisa Cuadrado Godia
- Department of Neurology, Division of Stroke, Columbia University and Mailman School of Public Health, New York, New York, USA
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