Heart failure & cardiomyopathies
Pressure-Dimension Index and Left Ventricular Sphericity Index Following HeartMate II and HeartMate 3 implantation
Authors' conclusion
The design of HM3 offered better geometrical preservation of the LV and enabled normal PDI values, leading to improved RV function, as indicated by better RVFAC, TAPSE, and TASV values.
Study context
- Population
- Patients implanted with HeartMate II or HeartMate 3, 2012–2020, with echocardiography pre-operatively, at 6 and 12 months post-operativelymean follow-up 24 ± 7 months
- Participants
- 46 patients
- Exposure
- HM3 vs HMII LVAD
- HM3n = 24
- HMIIn = 22reference
- Outcome
- Changes in left ventricle (LV) and right ventricle (RV) geometry and performance (echocardiography)
- Follow-up
- 12 months post-operatively
Main finding
As reported in the abstract
RV and LV echocardiographic parameters
| Group | Value | RV fractional area change (RVFAC) | Tricuspid annular plane systolic excursion (TAPSE) | Tricuspid annular systolic velocity (TASV) | LV sphericity index (LVSI) |
|---|---|---|---|---|---|
| HM3 | 35 ± 12 % | 35 ± 12% | 13.9 ± 1.9 mm | 11.5 ± 2.7 mm/s | 0.8 ± 0.2 |
| HMII | 26 ± 16 % | 26 ± 16% | 12.0 ± 2.1 mm | 9.9 ± 1.5 mm/s | 1.2 ± 0.4 |
Value
HM335 ± 12 %
HMII26 ± 16 %
RV fractional area change (RVFAC)
HM335 ± 12%
HMII26 ± 16%
Tricuspid annular plane systolic excursion (TAPSE)
HM313.9 ± 1.9 mm
HMII12.0 ± 2.1 mm
Tricuspid annular systolic velocity (TASV)
HM311.5 ± 2.7 mm/s
HMII9.9 ± 1.5 mm/s
LV sphericity index (LVSI)
HM30.8 ± 0.2
HMII1.2 ± 0.4
- HM3 vs HMII: P = 0.039 — RVFAC
- HM3 vs HMII: P = 0.002 — TAPSE
- HM3 vs HMII: P = 0.020 — TASV
- HMII vs HM3: P = 0.001 — LVSI higher with HMII
Observational data: associations, not effects.
Further findings
Pre-operative pressure-dimension index (PDI) as predictor of post-operative right ventricular failure (RVF)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Pre-operative PDIOnly predictor in univariate and multivariate analyses | 3.84 (1.53–18.16) | P = 0.022 | |
| 0.050.21520Odds ratio (log scale) |
| Outcome | P value |
|---|---|
| 2-year survival · log-rank; better with HM3 | P = 0.042 |
- Pre-operative PDI as predictor of post-operative RVF — AUC for pre-operative PDI
- 0.912
LV end-diastolic diameter (LVEDD), pre-operative vs 12 months post-operatively
- HMII: 6.4 ± 1.4 cm vs 5.7 ± 0.9 cm
- P = 0.040
- HM3: 6.7 ± 1.3 cm vs 5.5 ± 0.9 cm
- P < 0.01
PDI in HM3, baseline vs 12 months · 12 months post-operatively
- 3.4 ± 1.4 mmHg/cm² vs 2.0 ± 0.8 mmHg/cm²
- P < 0.001
Original publication
Pressure-Dimension Index and Left Ventricular Sphericity Index Following HeartMate II and HeartMate 3 implantation. ESC Heart Fail. Published 5 June 2024. doi:10.
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