Evaluation of left ventricular relaxation in rotary blood pump recipients using the pump flow waveform: a simulation study.
ABSTRACT In heart failure, diastolic dysfunction is responsible for about 50% of the cases, with higher prevalence in women and elderly persons and contributing similarly to mortality as systolic dysfunction. Whereas the cardiac systolic diagnostics in ventricular assist device patients from pump parameters have been investigated by several groups, the diastolic behavior has been barely discussed. This study focuses on the determination of ventricular relaxation during early diastole in rotary blood pump (RBP) recipients. In conventional cardiology, relaxation is usually evaluated by the minimum rate and the time constant of left ventricular pressure decrease, dP/dt(min) and τ(P) . Two new analogous indices derived from the pump flow waveform were investigated in this study: the minimum rate and the time constant of pump flow decrease, dQ/dt(min) and τ(Q) . The correspondence between the indices was investigated in a numerical simulation of the assisted circulation for different ventricular relaxation states (τ(P) ranging from 24 to 68 ms) and two RBP models characterized by linear and nonlinear pressure-flow characteristics. dQ/dt(min) and τ(Q) always correlated with the dP/dt(min) and τ(P) , respectively (r>0.97). These relationships were influenced by the nonlinear pump characteristics during partial support and by the pump speed during full support. To minimize these influences, simulation results suggest the evaluation of dQ/dt(min) and τ(Q) at a pump speed that corresponds to the borderline between partial and full support. In conclusion, at least in simulation, relaxation can be derived from pump data. This noninvasively accessible information could contribute to a continuous estimation of the remaining cardiac function and its eventual recovery.
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ABSTRACT: Monitoring of cardiac rhythms is of major importance in the treatment of heart failure patients with left ventricular assist devices (LVADs) implanted. A continuous surveillance of these rhythms could improve out-of-hospital care in these patients. The aim of this study was to investigate cardiac rhythms using available pump data only. Datasets (n = 141) obtained in the normal ward, in the intensive care unit, and during bicycle ergometry were analyzed in 11 recipients of a continuous flow LVAD (59.1 ± 9.7 years; male 82%). Tachograms and arrhythmic patterns derived from the pump flow waveform, and a simultaneously recorded ECG were compared, as well as heart rate variability parameters such as: the average heart beat duration (RR interval), the standard deviation of the beat duration (SDNN), the root-mean-square of the difference of successive beat durations (RMSSD), and the number of pairs of adjacent beat duration differing by >50 ms divided by the number of all beats (pNN50). A very good agreement of cardiac rhythm parameters from the pump flow compared with ECG was found. Tachycardia, atrial fibrillation, and extrasystoles could be accurately identified from the tachograms derived from the pump flow. Also, Bland-Altman analysis comparing pump flow with ECG indicated a very small difference in average RR interval of 0.3 ± 1.0 ms, in SSDN of 0.5 ± 2.7 ms, in RMSSD of 1.0 ± 5.6 ms, and in pNN50 of 0.3 ± 1.0%. Continuous monitoring of cardiac rhythms from available pump data is possible. It has the potential to reduce the out-of-hospital diagnostic burden and to permit a more efficient adjustment of the level of mechanical support.Artificial Organs 08/2013; · 1.87 Impact Factor
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ABSTRACT: In this editor's review, articles published in 2012 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ replacement, recovery, and regeneration. As the official journal of the International Federation for Artificial Organs, the International Faculty for Artificial Organs, and the International Society for Rotary Blood Pumps, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ replacement, recovery, and regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide such meaningful suggestions to the author's work whether eventually accepted or rejected, and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers, the quality expected from such a journal could not be possible. We also express our special thanks to our publisher, Wiley Periodicals, for their expert attention and support in the production and marketing of Artificial Organs. We look forward to recording further advances in the coming years.Artificial Organs 03/2013; 37(3):324-49. · 1.87 Impact Factor
Conference Paper: Development of pressure estimation for external rotary blood pump[Show abstract] [Hide abstract]
ABSTRACT: The improvement of heart function are the important consideration for heart failure patient with rotary blood pump (RBP). The capable of function evaluation depend on good monitoring system, which facilitate the physician for diagnosis. In this study, pressure estimation from measured flow rate for the patients with external RBP support is implemented with the non-invasive technique for cardiac function assessment. Measured flow rate from our mock circulation experiment at difference rotational speeds were used to apply with a notable RBP models. Our purpose is to find the optimal parameter values for pressure estimation from our RBP prototype. MUPD-VAD02 that is the external rotary blood pump for pediatric patients was used in this study. The suitable model for our pump prototype is the linear pressure - flow characteristics relationship with speed dependent resistant (Rp), which appeared linear correlations between estimated and measured pressure in a slope of 0.96 (R2 = 0.9603). In conclusion, the parameters and modified RBP model for pressure estimation of MUPD-VAD02 is developed.Biomedical Engineering International Conference (BMEiCON), 2013 6th; 01/2013