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Estimation of Central Venous Pressure by Pacemaker Lead Impedances in Left Ventricular Assist Device Patients

Imamura, Teruhiko*; Moss, Joshua D.*; Flatley, Erin*; Rodgers, Daniel*; Kim, Gene*; Raikhelkar, Jayant*; Sarswat, Nitasha*; Kalantari, Sara*; Nguyen, Ann*; Juricek, Colleen; Burkhoff, Daniel; Song, Tae; Ota, Takeyoshi; Jeevanandam, Valluvan; Sayer, Gabriel*; Uriel, Nir*

doi: 10.1097/MAT.0000000000000966
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Volume status assessment in left ventricular assist device (LVAD) patients remains challenging. Cardiac resynchronization therapy (CRT) devices are common in LVAD patients, and the impedance across the CRT leads may be associated with hemodynamics and serve as a tool for noninvasive estimation of volume status. Ninety-one sets of measurements including cardiac filling pressures and lead impedances were prospectively obtained during ramp tests from 11 LVAD patients (65.5 ± 9.7 years old; nine male) with CRT devices. Right atrial (RA), right ventricular (RV), and left ventricular (LV) lead impedances were all significantly associated with central venous pressure (CVP) (p < 0.05). We derived the following equation: estimated CVP = 47.90–(0.086 × RA lead impedance) + (0.013 × RV lead impedance)–(0.020 × LV lead impedance). The estimated CVP had a significant correlation (r = 0.795) and good agreement with the measured CVP (mean difference –0.14 ± 1.77 mmHg). Applying the above equation on the validation cohort of twenty-one patients also maintained a strong association with measured CVP (r = 0.705). In conclusion, we have derived a novel equation to estimate CVP using lead impedance measurements. This finding may allow noninvasive monitoring of volume status in LVAD patients.

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

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

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

Submitted for consideration October 2018; accepted for publication in revised form January 2019.

Disclosure: Dr. Imamura receives financial support from Postdoctoral Fellowship for Research Abroad of Japan Society for the Promotion of Science; Dr. Uriel receives grant support from Abbott and Medtronic; Dr. Sayer has received consulting fees from Medtronic; Dr. Jeevanandam receives consultant fee from Abbott. Dr. Burkhoff receives consultant fee from Medtronic, Corvia Medical, Sensible Medical, Impulse Dynamics, Cardiac Implants, and educational grant support from Abiomed. The other authors have no conflicts of interest to report.

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 © 2019 by the American Society for Artificial Internal Organs