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• W4224255711 abstract "Purpose Continuous flow left ventricular assist devices (cfLVADs) have an increasingly prominent role in the management of advanced heart failure. Adverse events post-implant are significant burdens, however, may be reduced with optimal patient hemodynamic and device function. Previous studies on cfLVAD flow waveform analysis have shown the slope of the early diastolic portion of the time-series flow waveform, diastolic dQ/dt, provides an estimate of left ventricular (LV) preload. Left ventricular preload sensitivity is important in maintaining optimal LV unloading and thus, optimal support. This study assessed the validity of the relationship between diastolic dQ/dt and LV preload using a mock circulatory loop (MCL). Methods A MCL was run with a HeartWare HVAD at 2800 RPM and repeated at 3200 RPM. Left atrial pressure (LAP; synonymous with LV preload) was decreased through incremental changes in pulmonary vascular resistance by 100 dynes/s/cm5, from 190 to 790 dynes/s/cm5. LAP data was recorded and stored whilst the HVAD flow waveform was digitised using WaveApp (proprietary software). Diastolic dQ/dt was calculated from each flow waveform using a customised MATLAB script. A linear regression model in SPSS was used to analyse the relationship between LAP and diastolic dQ/dt. Receiver operator characteristic (ROC) curves and sensitivity analyses were performed. Results Diastolic dQ/dt was significantly related to MCL-derived LAP (R2 = 0.851, p < 0.001). ROC analysis found the diastolic dQ/dt model has favourable sensitivity and specificity characteristics for discerning LAP ≥ 15 mmHg (AUC = 0.955 (95% CI 0.893-1.000; p = 0.003)). Conclusion This study confirms the value of cfLVAD flow waveform analysis in estimating LV preload using diastolic dQ/dt, consistent with previous clinical studies. These findings contribute to the development of non-invasive, bedside monitoring and optimisation of patient ventricular unloading while supported by LVAD. Continuous flow left ventricular assist devices (cfLVADs) have an increasingly prominent role in the management of advanced heart failure. Adverse events post-implant are significant burdens, however, may be reduced with optimal patient hemodynamic and device function. Previous studies on cfLVAD flow waveform analysis have shown the slope of the early diastolic portion of the time-series flow waveform, diastolic dQ/dt, provides an estimate of left ventricular (LV) preload. Left ventricular preload sensitivity is important in maintaining optimal LV unloading and thus, optimal support. This study assessed the validity of the relationship between diastolic dQ/dt and LV preload using a mock circulatory loop (MCL). A MCL was run with a HeartWare HVAD at 2800 RPM and repeated at 3200 RPM. Left atrial pressure (LAP; synonymous with LV preload) was decreased through incremental changes in pulmonary vascular resistance by 100 dynes/s/cm5, from 190 to 790 dynes/s/cm5. LAP data was recorded and stored whilst the HVAD flow waveform was digitised using WaveApp (proprietary software). Diastolic dQ/dt was calculated from each flow waveform using a customised MATLAB script. A linear regression model in SPSS was used to analyse the relationship between LAP and diastolic dQ/dt. Receiver operator characteristic (ROC) curves and sensitivity analyses were performed. Diastolic dQ/dt was significantly related to MCL-derived LAP (R2 = 0.851, p < 0.001). ROC analysis found the diastolic dQ/dt model has favourable sensitivity and specificity characteristics for discerning LAP ≥ 15 mmHg (AUC = 0.955 (95% CI 0.893-1.000; p = 0.003)). This study confirms the value of cfLVAD flow waveform analysis in estimating LV preload using diastolic dQ/dt, consistent with previous clinical studies. These findings contribute to the development of non-invasive, bedside monitoring and optimisation of patient ventricular unloading while supported by LVAD." @default.
• W4224255711 created "2022-04-26" @default.
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• W4224255711 date "2022-04-01" @default.
• W4224255711 modified "2023-10-15" @default.
• W4224255711 title "Estimation of Left Ventricular Preload Using Left Ventricular Assist Device Flow Waveform Analysis in a Mock Circulatory Loop" @default.
• W4224255711 doi "https://doi.org/10.1016/j.healun.2022.01.1713" @default.
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