HVAD 血流波形估计左心室充盈压。
HVAD Flow Waveform Estimates Left Ventricular Filling Pressure.
机构信息
Department of Medicine, University of Chicago Medical Center, Chicago, Illinois; Second Department of Medicine, University of Toyama, Toyama, Japan.
Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois.
出版信息
J Card Fail. 2020 Apr;26(4):342-348. doi: 10.1016/j.cardfail.2020.01.012. Epub 2020 Jan 23.
BACKGROUND
HVAD left ventricular assist device flow waveforms provides graphical real-time information linking device performance with invasive hemodynamics. Previous studies have demonstrated a good correlation between the slopes of the ventricular filling phase slope (VFPS) and directly measured pulmonary capillary wedge pressure (PCWP). We aimed to validate the utility of VFPS to estimate PCWP and predict clinical outcomes.
METHODS
In this prospective blinded study, screenshots from the HVAD monitor and simultaneous invasive hemodynamic measurements were obtained. Each screenshot was digitized and the VFPS was calculated by 2 independent reviewers who were blinded to the hemodynamic results. The equation PCWP = 7.053 +1.365 × (VFPS) was derived from a previously published dataset and the estimated PCWP was correlated to the actually measured PCWP.
RESULTS
One hundred thirty-one sets of simultaneous measurements (VFPS and PCWP) were obtained from 27 HVAD patients (mean age 55 years, 47% male). A previously proposed cutoff of VFPS ≥5.8 L/min/s predicted PCWP ≥ 18 mmHg with 91.5% sensitivity and 95.2% specificity with the area under curve of 0.987. The estimated PCWP significantly correlated with measured PCWP (R = 0.65, P < .001) and showed acceptable agreement with measured PCWP. Patients with VFPS ≥ 5.8 L/min/s experienced significantly higher heart failure readmission rates than those without (0.24 vs 0.05 events/y, P < .001).
CONCLUSIONS
VFPS of the HVAD flow waveform is a novel noninvasive parameter that can estimate PCWP.
背景
HVAD 左心室辅助装置的血流波形提供了将设备性能与侵入性血液动力学联系起来的图形实时信息。先前的研究表明，心室充盈相斜率 (VFPS) 的斜率与直接测量的肺毛细血管楔压 (PCWP) 之间存在良好的相关性。我们旨在验证 VFPS 估计 PCWP 和预测临床结果的效用。
方法
在这项前瞻性、盲法研究中，从 HVAD 监测仪和同时进行的侵入性血液动力学测量中获取屏幕截图。每个屏幕截图都被数字化，VFPS 由 2 位独立的审阅者计算，他们对血液动力学结果是盲目的。从之前发表的数据集推导出 PCWP=7.053+1.365×(VFPS)的方程，并将估计的 PCWP 与实际测量的 PCWP 相关联。
结果
从 27 名 HVAD 患者中获得了 131 组同时测量值（VFPS 和 PCWP）（平均年龄 55 岁，47%为男性）。之前提出的 VFPS≥5.8 L/min/s 的截定点预测 PCWP≥18mmHg 的敏感性为 91.5%，特异性为 95.2%，曲线下面积为 0.987。估计的 PCWP 与实际测量的 PCWP 显著相关（R=0.65，P<.001），且与实际测量的 PCWP 具有良好的一致性。VFPS≥5.8 L/min/s 的患者心力衰竭再入院率明显高于无 VFPS≥5.8 L/min/s 的患者（0.24 比 0.05 次/年，P<.001）。
结论
HVAD 血流波形的 VFPS 是一种新的无创参数，可以估计 PCWP。
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