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Reverse Ramp Testing in Left Ventricular Assist Device Support and Myocardial Recovery

Holzhauser, Luise; Lang, Roberto; Raikhelkar, Jayant; Sayer, Gabriel; Uriel, Nir

doi: 10.1097/MAT.0000000000001010
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Mechanical unloading with left ventricular assist device (LVAD) support can lead to clinically meaningful reversal of stress-related compensatory mechanisms. However, true assessment of left ventricular ejection fraction (LVEF) is not possible, whereas the left ventricle is unloaded by LVAD therapy making identification of patients with myocardial recovery even more challenging. We introduce our new protocol, the “reverse ramp test” for HeartWare HVAD, HeartMate II, and HeartMate 3. The reverse ramp is transthoracic echo (TTE) and right heart catheterization (RHC)-based protocol with LVAD turn down steps to minimal support allowing for a more accurate assessment of myocardial function.

From the Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois.

Submitted for consideration December 2018; accepted for publication in revised form March 2019.

Disclosure: Gabriel Sayer is a consultant to Medtronic. Nir Uriel is a consultant and received both grant support and honorarium from Abbott and Medtronic.

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 (

Correspondence: Nir Uriel, Division of Cardiology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637. Email:

Copyright © 2019 by the American Society for Artificial Internal Organs