The risk of pump thrombosis appears to be highest in the first 6 months after HeartMate II implantation, however the rates of pump thrombosis during longer-term support have not been widely reported. In this analysis we describe the incidence rates of early and late pump thrombosis and risk factors for these events in a large, single center cohort.

Higher pump speeds have recently been associated with reduced rates of pump thrombosis in the HeartMate II LVAD population. Whether pump speed is associated with stroke has not been well established. In this analysis we use a single center cohort to determine the association with discharge speed and all-cause stroke.

It is presently unclear whether pathologic examination of left ventricular assist device (LVAD) cores from the time of implantation changes pre-existing cardiac diagnoses. This analysis used a large single-center database to assess the frequency with which diagnoses were changed and to also determine whether this led to a change in clinical management.

There are limited published data on the outcomes of patients who require temporary mechanical circulatory support (MCS) prior to continuous flow left ventricular assist device (CF-LVAD) placement. The purpose of this analysis was to assess the outcomes of these patients in a contemporary CF-LVAD dataset.

e19504 Background: The use of doxorubicin to treat solid and hematological malignancies is limited by a dose-dependent cardiotoxicity. Predicting individual patient susceptibility to doxorubicin remains difficult. The objective of this study is to determine if a new generation high-sensitivity cardiac troponin T assay (hscTnT) can predict changes in left ventricular ejection fraction (LVEF) secondary to treatment with doxorubicin. Methods: Eighteen patients with breast carcinoma or non-Hodgkin lymphoma were enrolled. Blood samples for hscTnT (detection limit <1 pg/mL) and traditional cardiac troponin T (cTnT, detection limit <0.01 ng/mL) were drawn at baseline and after the last doxorubicin treatment. LVEF was measured by multi gated acquisition scan at the same points in time. Results: Levels of hscTnT but not cTnT increased in all patients and were significantly higher after the last treatment compared to baseline (22.18 ± 4.71 pg/mL vs 2.33 ± 0.66 pg/mL, P=0.0006). Sixty seven percent of the patients had a mean LVEF decline of 6% (95% CI 3 to 9, P<0.01) after receiving a cumulative doxorubicin dose of 240 mg/m2. Baseline hscTnT but not cTnT correlated with the change in LVEF (Spearman correlation -0.54, 95% CI -0.80 to -0.08, P=0.02). Conclusions: High-sensitivity cTnT predicts changes in LVEF in patients treated with an intermediate cumulative dose of doxorubicin. The use of a more sensitive assay provides clinically relevant information. No significant financial relationships to disclose.

OBJECTIVES:We sought to assess and compare the diagnostic accuracy and prognostic value of dobutamine stress echocardiography (DSE), dobutamine SPECT, and adenosine SPECT myocardial perfusion imaging (MPI) in patients with end-stage renal disease (ESRD).BACKGROUND:The optimal stress imaging modality for patients with ESRD has not yet been determined.METHODS:Forty-nine patients with ESRD underwent DSE, dobutamine SPECT MPI, and adenosine SPECT MPI. The primary endpoint of the trial was concordance between stress tests with respect to the presence or absence of ischemia.RESULTS:Agreement on the presence or absence of ischemia between adenosine SPECT MPI and DSE was 69% (kappa = .25, P = NS). Agreement on the presence or absence of ischemia between adenosine and dobutamine SPECT MPI was 77% (kappa = .37, P = <.009). Summed stress scores for adenosine and dobutamine SPECT MPI studies were highly correlated (r = .9, P = <.0001). DSE and SPECT MPI results provided incremental prognostic information when added to clinical variables.CONCLUSIONS:There is moderate concordance between DSE and adenosine SPECT MPI in ESRD patients referred for stress testing. Interobserver agreement was higher for SPECT MPI compared to DSE. Based on these observations, the optimal approach for diagnosing severe coronary artery disease and assessing risk in patients with ESRD has yet to be determined, but appears to warrant further investigation.

Purpose: Newer continuous-flow left ventricular assist devices (LVAD) have the advantage of smaller size and increased durability. Questions remain regarding the safety and effects of long-term nonpulsatile flow, despite some animal and human studies showing that end-organ function is well maintained with pulsatile or axial-flow devices. This study investigated whether centrifugal devices have similar effects on end-organ function.Methods: All patients who underwent LVAD implantation as bridge-to-transplant (BTT) therapy from January 2004 through May 2007 were reviewed. Excluded were patients on biventricular support, destination therapy, temporary support, and patients who died within 30 days after LVAD implantation. The centrifugal device was the VentrAssist (Ventracor Ltd, Sydney, Australia); axial, the HeartMate II; and pulsatile, the HeartMate XVE (Thoratec Corp, Pleasanton, CA).Results: During the study, 10 VentrAssist, 30 HeartMate II, and 18 HeartMate XVE devices were implanted. Among the 3 groups, age, gender, weight, duration of LVAD support, and cause of heart failure were comparable. No significant differences were found between groups with respect to baseline renal function, hepatic function, or hematologic function. At 1 and 3 months of follow-up, renal and hepatic function either improved or remained within normal limits in all groups.Conclusions: Centrifugal, axial, and pulsatile LVADs all provide adequate circulatory support to maintain appropriate end-organ function in patients with end-stage heart failure. The advantages of the newer continuous-flow devices can be safely applied to an increasing number of patients. Long-term studies (>1 year) are needed to assess effects on end-organ function with continuous-flow devices, which may have important implications for use as destination therapy. J Heart, Lung Transplant 2009;28:352-9. Copyright (C) 2009 by the International Society for Heart and Lung Transplantation.

Continuous-flow LVADs are increasingly being used in patients with heart failure as a bridge-to-transplant (BTT). The presence of severe pulmonary hypertension (PH) remains a contraindication to transplant. The efficacy of these newer LVAD designs on LV unloading and PH is less well studied. The objective of this study was to determine if the HeartMate (HM) II, a continuous-flow LVAD, is effective in reversing severe PH prior to heart transplantation.

compared to the control group (0.13 0.10 and 0.13 0.10 vs. 0.34 0.26 g/mm, respectively). As compared to the control group, an increase in contractility of papillary muscles from baseline in response to isoproterenol (10 mol/L) was reduced in complete group (12.3 7.1% vs. 31.1 16.5%, p 0.01), but preserved in partial group (25.1 12% vs. 31.1 16.5%, n.s.). Conclusions: During LV unloading, cardiac contractility was impaired regardless of unloading level. However, during partial LV unloading, -adrenergic response was preserved. These results suggest that appropriate LV loading may contribute to physiological improvement during “bridge to recovery”.