Impact of Cardiac Resynchronization Therapy on Left Ventricular Unloading in Patients with Implanted Left Ventricular Assist Devices.

MedStar author(s):
Citation: ASAIO Journal. 65(2):117-122, 2019 02.PMID: 29608492Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cardiac Resynchronization Therapy/mt [Methods] | *Heart Failure/th [Therapy] | *Heart Ventricles/pp [Physiopathology] | *Heart-Assist Devices | Aged | Female | Humans | Male | Middle Aged | Treatment OutcomeYear: 2019Local holdings: Available online from MWHC library: 2000 - present, Available in print through MWHC library: 1999 - 2003ISSN:
  • 1058-2916
Name of journal: ASAIO journal (American Society for Artificial Internal Organs : 1992)Abstract: Cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVADs) are common heart failure therapies; however, little is known regarding the concomitant use of these devices. We aim to evaluate unloading differences in LVAD patients with and without active biventricular pacing. Left ventricular assist device patients with and without CRT prospectively underwent ramp hemodynamic/echocardiographic testing. Patients with >95% biventricular pacing comprised the active CRT pacing group; all others (no device, implantable cardioverter defibrillator only, CRT without biventricular pacing) were categorized into the non-CRT pacing group. Invasive hemodynamics and echocardiographic characteristics (left ventricular end-diastolic/systolic diameter and valvular regurgitation) were measured at baseline and at incremental speed changes. Unloading slopes were calculated using linear regression modeling for individual hemodynamics and echocardiographic characteristics across speeds. Among 62 LVAD patients (age 59.6 +/- 11.4 years, 60% male), 25 had active CRT pacing. There was no significant difference in echocardiographic or hemodynamic characteristics at baseline or final set speeds between CRT groups. Similarly, no significant differences were noted in the unloading characteristics. In LVAD patients, active biventricular pacing is unlikely to improve echocardiographic or hemodynamic characteristics.All authors: Adatya S, Grinstein J, Kim GH, Raikhelkar J, Rodgers D, Sarswat N, Sayer G, Tehrani DM, Uriel NOriginally published: ASAIO Journal. 65(2):117-122, 2019 Feb.Fiscal year: FY2019Digital Object Identifier: Date added to catalog: 2019-03-14
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Journal Article MedStar Authors Catalog Article 29608492 Available 29608492

Available online from MWHC library: 2000 - present, Available in print through MWHC library: 1999 - 2003

Cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVADs) are common heart failure therapies; however, little is known regarding the concomitant use of these devices. We aim to evaluate unloading differences in LVAD patients with and without active biventricular pacing. Left ventricular assist device patients with and without CRT prospectively underwent ramp hemodynamic/echocardiographic testing. Patients with >95% biventricular pacing comprised the active CRT pacing group; all others (no device, implantable cardioverter defibrillator only, CRT without biventricular pacing) were categorized into the non-CRT pacing group. Invasive hemodynamics and echocardiographic characteristics (left ventricular end-diastolic/systolic diameter and valvular regurgitation) were measured at baseline and at incremental speed changes. Unloading slopes were calculated using linear regression modeling for individual hemodynamics and echocardiographic characteristics across speeds. Among 62 LVAD patients (age 59.6 +/- 11.4 years, 60% male), 25 had active CRT pacing. There was no significant difference in echocardiographic or hemodynamic characteristics at baseline or final set speeds between CRT groups. Similarly, no significant differences were noted in the unloading characteristics. In LVAD patients, active biventricular pacing is unlikely to improve echocardiographic or hemodynamic characteristics.

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