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Trans-aortic Valvular Ejection Fraction for Monitoring Recovery of Patients with Ventricular Systolic Heart Failure

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Abstract

Durable mechanical circulatory support in the form of left ventricular (LV) assist device (LVAD) therapy is increasingly considered in the context of the recovery of native cardiac function. Progressive improvement in LV function may facilitate LVAD explantation and a resultant reduction in device-related risk. However, ascertaining LV recovery remains a challenge. In this study, we investigated the use of trans-aortic valvular flow rate and trans-LVAD flow rate to assess native LV systolic function using a well-established lumped parameter model of the mechanically assisted LV with pre-existing systolic dysfunction. Trans-aortic valvular ejection fraction (TAVEF) was specifically found to characterize the preload-independent contractility of the LV. It demonstrated excellent sensitivity to simulated pharmacodynamic stress tests and volume infusion tests. TAVEF may prove to be useful in the ascertainment of LV recovery in LVAD-supported LVs with pre-existing LV systolic dysfunction.

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Abbreviations

AoV:

Aortic valve

BTR:

Bridge to recovery

CO:

Cardiac output (lpm)

DBP:

Diastolic blood pressure (mmHg)

DP:

Dopamine

E max :

Maximal elastance

EDV:

End-diastolic volume (ml)

ESV:

End-systolic volume (ml)

LVAD:

Left ventricular assist device

LVEF:

Left ventricular ejection fraction

MAP:

Mean arterial pressure (mmHg)

MCS:

Mechanical circulatory support

NYHA:

New York Heart Association

RPM:

Rotations per minute

SBP:

Systolic blood pressure (mmHg)

SNP:

Sodium nitroprusside

SoS:

System of systems

SV:

Stroke volume (ml) (=EDV − ESV)

TBV:

Total blood volume

TAVEF:

Trans-aortic valvular ejection fraction

VAD:

Ventricular assist device

VBE:

Volume in left ventricle before ejection phase

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Funding

The authors acknowledge the Research Grant funded by the US Army Medical Research Acquisition Activity Project Number W81XWH2010387, for the research undertaken as part of this manuscript.

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Author notes

  1. Viswajith Siruvallur Vasudevan

    Present address: Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA

  2. Keshava Rajagopal

    Present address: Department of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA

  3. Jesus E. Rame

    Present address: Thomas Jefferson University Hospital, Philadelphia, PA, USA

Authors and Affiliations

  1. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA

    James F. Antaki

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  1. Viswajith Siruvallur Vasudevan
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  2. Keshava Rajagopal
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Correspondence to James F. Antaki.

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Siruvallur Vasudevan, V., Rajagopal, K., Rame, J.E. et al. Trans-aortic Valvular Ejection Fraction for Monitoring Recovery of Patients with Ventricular Systolic Heart Failure. Ann Biomed Eng 51, 2824–2836 (2023). https://doi.org/10.1007/s10439-023-03345-4

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