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Repeated Ramp Tests on Stable LVAD Patients Reveal Patient-Specific Hemodynamic Fingerprint

Imamura, Teruhiko*; Burkhoff, Daniel; Rodgers, Daniel*; Adatya, Sirtaz*; Sarswat, Nitasha*; Kim, Gene*; Raikhelkar, Jayant*; Ota, Takeyoshi; Song, Tae; Juricek, Colleen; Jeevanandam, Valluvan; Sayer, Gabriel*; Uriel, Nir*

doi: 10.1097/MAT.0000000000000705
Adult Circulatory Support

Hemodynamic speed ramp tests are used in left ventricular assist device (LVAD) patients to guide speed adjustment and medical therapies. However, the reproducibility of these tests is unknown. In this prospective study, clinically stable LVAD patients underwent echocardiography and right heart catheterization ramp tests followed by a repeat test within 2 years as per institutional protocol. Sixteen patients (61.8 ± 10.5 years old, 50% male, eight with HeartMate II and eight with HVAD) underwent repeated ramp testing. The first test was performed 187 (42–1857) days from LVAD implant and the second test was performed 278 (126–560) days from the first test. All hemodynamic variables measured at the baseline speed remained statistically unchanged between the first and second ramp test (p > 0.05 for all). Changes in hemodynamic parameters, as assessed by the slopes of their changes over the range of speeds tested, were also the same at the two timepoints (p > 0.05 for all). Stable LVAD patients had similar hemodynamic profiles over the course of years including similar responses to speed changes. This suggests that ramp tests may represent a hemodynamic fingerprint; deviations from a baseline test can aid diagnosis at times of clinical deterioration or device malfunction.

From the *Department of Medicine, University of Chicago Medical Center, Chicago, Illinois

Columbia University Medical Center, and Cardiovascular Research Foundation, New York, New York

Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.

Submitted for consideration April 2017; accepted for publication in revised form September 2017.

Disclosure: The authors have no conflicts of interest to report.

Teruhiko Imamura receives financial funding from Japan Heart Foundation/Bayer Yakuhin Research Grant Abroad and Postdoctoral Fellowship for Research Abroad of Japan Society for the Promotion of Science. Nir Uriel receives consultant fee and grant support from Abbott and Medtronic. Valluvan Jeevanandam receives consultant fee from Abbott. Daniel Burkhoff is a consultant to HeartWare division of Medtronic and receives educational grant support from Abiomed.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Nir Uriel, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL 60637. Email: nuriel@medicine.bsd.uchicago.edu.

Copyright © 2018 by the American Society for Artificial Internal Organs