Use of Left Ventricular Assist Device Hemodynamic Ramp Studies to Assess Heart Recovery and Device Complications

Purpose Studies have shown that hemodynamic measurements taken during Left Ventricular Assist Device (LVAD) ramp studies can be used to optimize LVAD speed and improve clinical outcomes. However, this method has not been validated in a large dataset to determine its utility in evaluating heart recovery and other device complications. Methods 470 patients, encompassing 3 LVAD types, were retrospectively analyzed at a single institution from 2015 to 2020 and 53 ramp studies were identified. Standardized measurements including right atrial (RA), mean pulmonary artery (PA), and pulmonary capillary wedge (PCW) pressure, as well as cardiac index (CI) were taken at speeds +/- 20% of manufacturer recommended set speed for HM2, HM3, and HVAD devices. Ramp study results were considered positive if they showed greater than 20% PCWP decompression from highest to lowest speed. Studies that did not show decompression were further stratified into the following categories: heart recovery, outflow graft obstruction, pump thrombosis, suction, or unable to determine. Results Analysis of 53 LVAD ramp studies showed baseline characteristics of: mean age 60.1 +/- 10, 15.1% women, 56.6% ischemic cardiomyopathy, 71.7% on destination therapy, 76% with a hospitalization within the prior 6 months, average NYHA class 2.5 +/- 0.7 and INTERMACS 5.9 +/- 1. 39 of 53 (73.5%) showed expected PCWP decompression (greater than 20%). Of those that did not decompress, 5 were determined to have heart recovery, 2 had outflow graft obstruction, 2 had pump thrombosis, 1 had suction events, and 6 had unknown etiology. Ramp study had a sensitivity of 83%, specificity of 78%, positive predictive value of 3.79, and negative predictive value of 0.21 (Figure 1A). Hemodynamic trends in subjects with decompression were similar across LVAD types (Fig. 1B). Conclusion Hemodynamic ramp studies are a valuable tool evaluate clinical changes amongst LVAD patients. Further prospective studies may validate this tool to help guide clinical management. Studies have shown that hemodynamic measurements taken during Left Ventricular Assist Device (LVAD) ramp studies can be used to optimize LVAD speed and improve clinical outcomes. However, this method has not been validated in a large dataset to determine its utility in evaluating heart recovery and other device complications. 470 patients, encompassing 3 LVAD types, were retrospectively analyzed at a single institution from 2015 to 2020 and 53 ramp studies were identified. Standardized measurements including right atrial (RA), mean pulmonary artery (PA), and pulmonary capillary wedge (PCW) pressure, as well as cardiac index (CI) were taken at speeds +/- 20% of manufacturer recommended set speed for HM2, HM3, and HVAD devices. Ramp study results were considered positive if they showed greater than 20% PCWP decompression from highest to lowest speed. Studies that did not show decompression were further stratified into the following categories: heart recovery, outflow graft obstruction, pump thrombosis, suction, or unable to determine. Analysis of 53 LVAD ramp studies showed baseline characteristics of: mean age 60.1 +/- 10, 15.1% women, 56.6% ischemic cardiomyopathy, 71.7% on destination therapy, 76% with a hospitalization within the prior 6 months, average NYHA class 2.5 +/- 0.7 and INTERMACS 5.9 +/- 1. 39 of 53 (73.5%) showed expected PCWP decompression (greater than 20%). Of those that did not decompress, 5 were determined to have heart recovery, 2 had outflow graft obstruction, 2 had pump thrombosis, 1 had suction events, and 6 had unknown etiology. Ramp study had a sensitivity of 83%, specificity of 78%, positive predictive value of 3.79, and negative predictive value of 0.21 (Figure 1A). Hemodynamic trends in subjects with decompression were similar across LVAD types (Fig. 1B). Hemodynamic ramp studies are a valuable tool evaluate clinical changes amongst LVAD patients. Further prospective studies may validate this tool to help guide clinical management.