Slope of the anterior mitral valve leaflet: A new measurement of left ventricular unloading for left ventricular assist devices and systolic dysfunction

Sara C. Martinez, Elisa A. Bradley, Eric L. Novak, Ravi Rasalingam, Ari M. Cedars, Gregory A. Ewald, Scott C. Silvestry, Susan M. Joseph

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Left ventricular assist device (LVAD)-supported patients are evaluated routinely with use of transthoracic echocardiography. Values of left ventricular unloading in this unique patient population are needed to evaluate LVAD function and assist in patient follow-up. We introduce a new M-mode measurement, the slope of the anterior mitral valve leaflet (SLAM), and compare its efficacy with that of other standard echocardiographically evaluated values for left ventricular loading, including E/e′ and pulmonary artery systolic pressures. Average SLAM values were determined retrospectively for cohorts of random, non-LVAD patients with moderately to severely impaired left ventricular ejection fraction (LVEF) (<0.35, n=60). In addition, pre- and post-LVAD implantation echocardiographic images of 81 patients were reviewed. The average SLAM in patients with an LVEF <0.35 was 11.6 cm/s (95% confidence interval, 10.4-12.8); SLAM had a moderately strong correlation with E/e′ in these patients. Implantation of LVADs significantly increased the SLAM from 7.3 ± 2.44 to 14.7 ± 5.01 cm/s (n=42, P <0.0001). The LVAD-supported patients readmitted for exacerbation of congestive heart failure exhibited decreased SLAM from 12 ± 3.93 to 7.3 ± 3.5 cm/s (n=6, P=0.041). In addition, a cutpoint of 10 cm/s distinguished random patients with LVEF <0.35 from those in end-stage congestive heart failure (pre-LVAD) with an 88% sensitivity and a 55% specificity. Evaluating ventricular unloading in LVAD patients remains challenging. Our novel Mmode value correlates with echocardiographic values of left ventricular filling in patients with moderate-to-severe systolic function and dynamically improves with the ventricular unloading of an LVAD.

Original languageEnglish
Pages (from-to)262-272
Number of pages11
JournalTexas Heart Institute journal
Volume41
Issue number3
DOIs
StatePublished - Jun 2014

Keywords

  • Echocardiography, Doppler/methods/trends
  • Health status indicators
  • Heart failure/classification/physiopathology/therapy
  • Heart-assist devices
  • Models, theoretical
  • Predictive value of tests
  • Reference values
  • Sensitivity and specificity
  • Severity of illness index
  • Ventricular function/physiology

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