Continuous assessment of cardiac function during rotary blood pump support: A contractility index derived from pump flow

Department of Biomedical Engineering and Physics, Medical University of Vienna, Vienna, Austria.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation (Impact Factor: 6.65). 09/2009; 29(1):37-44. DOI: 10.1016/j.healun.2009.05.032
Source: PubMed

ABSTRACT The clinical application of rotary blood pumps (RBPs) for bridge-to-recovery and destination therapy has focused interest on the remaining contractile function of the heart and its course. This study reports a method to determine contractility that uses readily measured variables of the RBP.
The proposed index (I(Q)) is defined as the slope of a linear regression between the maximum derivative of the pump flow and its peak-to-peak value. I(Q) was compared with the maximal derivative of ventricular pressure (dP/dt(max)) vs end-diastolic volume (EDV) and the pre-load-recruitable stroke work. All indices were evaluated using computer simulations and animal experiments. For in vivo studies, a MicroMed-DeBakey ventricular assist device (VAD) was implanted in 7 healthy sheep. Ventricular contractility was examined under normal conditions and after pharmacologic intervention. For the computer simulation, variations of ventricular contractility, ventricular pre-load and after-load, and pump speeds were studied.
In vivo and computer simulations showed the I(Q) index to be sensitive to changes of cardiac contractility, similar to other classic indices. For reduced cardiac contractility, it decreased to 9.3 +/- 3.9 (s(-1)) vs 15.3 +/- 4.0 (s(-1)) in the control condition (in vivo experiments). The I(Q) index was only marginally influenced by pre-load and after-load changes: a variation of 7.0% +/- 8.9% and 1.3% +/- 7.1%, respectively, was observed in computer simulations.
The I(Q) index, which can be derived from pump data only, is a useful parameter for continuous monitoring of the cardiac contractility in patients with RBP support.

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    • "Moreover, they claimed that the inflow cannula pressure monitoring was useful not only for the suction detection but also for synchronization with the natural heartbeat. Also, to continuously monitor the cardiac function and contractility in patients supported by RBPs, Naiyanetr et al (2010) have proposed a novel index (I Q ) which is defined as the slope of a linear regression between the maximum derivative of the pump flow and its peak-to-peak value. In vivo and simulation studies showed that the I Q index to be sensitive to changes in cardiac contractility. "
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    ABSTRACT: From the moment of creation to the moment of death, the heart works tirelessly to circulate blood, being a critical organ to sustain life. As a non-stopping pumping machine, it operates continuously to pump blood through our bodies to supply all cells with oxygen and necessary nutrients. When the heart fails, the supplement of blood to the body's organs to meet metabolic demands will deteriorate. The treatment of the participating causes is the ideal approach to treat heart failure (HF). As this often cannot be done effectively, the medical management of HF is a difficult challenge. Implantable rotary blood pumps (IRBPs) have the potential to become a viable long-term treatment option for bridging to heart transplantation or destination therapy. This increases the potential for the patients to leave the hospital and resume normal lives. Control of IRBPs is one of the most important design goals in providing long-term alternative treatment for HF patients. Over the years, many control algorithms including invasive and non-invasive techniques have been developed in the hope of physiologically and adaptively controlling left ventricular assist devices and thus avoiding such undesired pumping states as left ventricular collapse caused by suction. In this paper, we aim to provide a comprehensive review of the developments of control systems and techniques that have been applied to control IRBPs.
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    ABSTRACT: A new cardiac contractility index derived from pump flow (IQ) has been developed for rotary blood pumps (RBPs) recipients, to determine preservation and eventual recovery of the remaining cardiac function. Pulse flow indices were used for comparison with IQ during pump speed changes. Pump flow was recorded in animal experiments and clinically in RBP recipients (MicroMed DeBakey LVAD®) at different pump speeds. IQ was derived from the maximal derivative of pump flow versus QP2P relationship (dQ/dtmax vs. QP2P) during speed variations. IQ was compared to classical indices. Further, simple currently used parameters such as peak to peak of pump flow (QP2P) and pulsation index (PI = QP2P divided by mean pump flow) were calculated. IQ was speed-independent for both pumps, and correlated well in animal experiments with classical invasively measured contractility index. Simple parameters (QP2P and PI) depended on speed and could be used only for estimation of percentage of support, but not for characterization of cardiac contractility. In conclusion the cardiac contractility index IQ can be derived from pump flow (IQ) only. It allows easy and noninvasive continuous access to cardiac function. KeywordsCardiac contractility index-Rotary blood pump-Cardiac recovery-Pulsitility index and LVAD
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    ABSTRACT: The ventricular performance is dependent on the drainage effect of rotary blood pumps (RBPs) and the performance of RBPs is affected by the ventricular pulsation. In this study, the interaction between the ventricle and RBPs was examined using the pressure-volume (P-V) diagram of the ventricle and dynamic head pressure-bypass flow (H-Q) curves (H, head pressure: arterial pressure minus ventricular pressure vs. Q, bypass flow) of the RBPs. We first investigated the relationships in a mock loop with a passive fill ventricle, followed by validation in ex vivo animal experiments. An apical drainage cannula with a micro-pressure sensor was especially fabricated to obtain ventricular pressure, while three pairs of ultrasonic crystals placed on the heart wall were used to derive ventricular volume. The mock loop-configured ventricular apical-descending aorta bypass revealed that the external work of the ventricle expressed by the area inside the P-V diagrams (EW(Heart) ) correlated strongly with the area inside dynamic H-Q curves (EW(VAD)), with the coefficients of correlation being R² = 0.869 ∼ 0.961. The results in the mock loop were verified in the ex vivo studies using three Shiba goats (10-25 kg in body weight), showing the correlation coefficients of R² = 0.802 ∼ 0.817. The linear regression analysis indicated that the increase in the bypass flow reduced pulsatility in the ventricle expressed in EW(Heart) as well as in EW(VAD) . Experimental results, both mock loop and animal studies, showed that the interaction between cardiac external work and H-Q performance of RBPs can be expressed by the relationships "EW(Heart) versus EW(VAD) ." The pulsatile nature of the native heart can be expressed in the area underneath the H-Q curves of RBPs EW(VAD) during left heart bypass indicating the status of the level of assistance by RBPs and the native heart function.
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