Ultrasound Assessment of Venous and Pulmonary Congestion in Left Ventricular Assist Devices Patients

Abstract

Background: A significant number of (left ventricular assist device) LVAD patients (pts) have hemodynamic-related adverse events requiring right heart catheterization (RHC). Venous and lung ultrasound is an established method for evaluating congestion in heart failure pts. This study aimed to investigate the role of these ultrasound parameters in the hemodynamic assessment of LVAD pts.

Methods: RHC and complete echocardiography were performed on 50 consecutive LVAD pts, 12 of whom were the validation cohort. Pts were stratified based on right atrial pressure (RAP) ≥ 7 mmHg and pulmonary capillary wedge pressure (PCWP) > 15 mmHg.

Results: The median LVAD follow-up time was 400 (209-900) days. Baseline characteristics were similar between high vs. normal RAP groups, except for NYHA class and renal function in the former group. High vs. normal PCWP showed a greater NYHA class and a furosemide dose. All hemodynamic parameters were significantly different in the high RAP group except for cardiac output (CO) and cardiac index (CI). In contrast, in the high PCWP group, no differences in CO, CI, and pulmonary vascular resistances were apparent. The most accurate non-invasive variable for detecting high RAP was renal venous stasis index (RVSI), receiver-operating characteristic curves for areas under the curve (AUC), 0.78 (95% CI, 0.62-0.93). Estimated left atrial pressure (LAP-eRAP) was the most accurate non-invasive value to discriminate high PCWP (AUC 0.85 95% CI 0.73-0.98).

Conclusion: This study found a good correlation between RAP, PWCP, and non-invasive parameters, such as RVSI and LAP-eRAP, suggesting the importance of peripheral venous ultrasound in LVAD patients.

Keywords: Doppler vein signals; POCUS; echocardiography; left ventricular assisted device.