Beat-to-beat detection of aortic valve opening in HeartWare left ventricular assist device patients.

Clifford, R; Robson, D; Gross, C; Moscato, F; Schima, H; Jansz, P; Macdonald, PS; Hayward, CS

Beat-to-beat detection of aortic valve opening in HeartWare left ventricular assist device patients.

Clifford, R Robson, D Gross, C

Moscato, F

Schima, H Jansz, P Macdonald, PS

Hayward, CS

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Publication Type:: Journal Article
Citation:: Artif Organs, 2019, 43 (5), pp. 458 - 466
Issue Date:: 2019-05

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Field	Value	Language
dc.contributor.author	Clifford, R	en_US
dc.contributor.author	Robson, D	en_US
dc.contributor.author	Gross, C https://orcid.org/0000-0003-1583-5783	en_US
dc.contributor.author	Moscato, F https://orcid.org/0000-0003-0279-6615	en_US
dc.contributor.author	Schima, H	en_US
dc.contributor.author	Jansz, P	en_US
dc.contributor.author	Macdonald, PS https://orcid.org/0000-0001-5378-2825	en_US
dc.contributor.author	Hayward, CS https://orcid.org/0000-0003-4036-1890	en_US
dc.date.accessioned	2020-04-16T02:28:31Z
dc.date.available	2018-10-26	en_US
dc.date.available	2020-04-16T02:28:31Z
dc.date.issued	2019-05	en_US
dc.identifier.citation	Artif Organs, 2019, 43 (5), pp. 458 - 466	en_US
dc.identifier.uri	http://hdl.handle.net/10453/140014
dc.description.abstract	Continuous flow left ventricular assist devices (cfLVADS) result in a significant reduction in aortic valve (AV) opening, which has been associated with several complications. Reliable monitoring of AV opening is needed to determine whether pump speed adjustment may be able to minimize adverse outcomes. We assessed AV status continuously by echocardiography for 4 minutes in 3 states in 18 HeartWare HVAD patients: 2 minutes at rest, and 1 minute each following Valsalva maneuver and supine leg-raising. Using a previously described algorithm, beat-to-beat AV status was compared with the area under the curve of the normalized power spectral density analysis (PSD-AUC) for the corresponding beats of the pump speed waveform. Five thousand five hundred twenty-seven beats were analyzed. AV opening varied between 0% and 100% for the cohort with the median AV opening frequency 21.5%, and median duration of opening of 124 msec (range 0-279). The receiver operating characteristic (ROC) curve area for AV opening by the PSD-AUC algorithm was 0.95 (P < 0.0001). A PSD-AUC cut-off of 0.82 distinguished between an open and closed AV with 86% sensitivity and 93% specificity. Accuracy was similar in regular cardiac rhythm, atrial fibrillation or with frequent ventricular ectopic beats. Valsalva maneuver and leg-raising had no impact on accuracy. The PSD-AUC was strongly predictive of AV opening duration (P < 0.0001). We found that AV status and opening duration can be determined with high accuracy on a beat-to-beat basis irrespective of cardiac rhythm and with low level exercise and changes in filling.	en_US
dc.language	eng	en_US
dc.relation.ispartof	Artif Organs	en_US
dc.relation.isbasedon	10.1111/aor.13381	en_US
dc.subject.classification	Biomedical Engineering	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Aged, 80 and over	en_US
dc.subject.mesh	Aortic Valve	en_US
dc.subject.mesh	Echocardiography	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Heart Ventricles	en_US
dc.subject.mesh	Heart-Assist Devices	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	ROC Curve	en_US
dc.title	Beat-to-beat detection of aortic valve opening in HeartWare left ventricular assist device patients.	en_US
dc.type	Journal Article
utslib.citation.volume	5	en_US
utslib.citation.volume	43	en_US
utslib.location.activity	United States	en_US
utslib.for	0903 Biomedical Engineering	en_US
utslib.for	1103 Clinical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access
pubs.issue	5	en_US
pubs.publication-status	Published	en_US
pubs.volume	43	en_US

Abstract:

Continuous flow left ventricular assist devices (cfLVADS) result in a significant reduction in aortic valve (AV) opening, which has been associated with several complications. Reliable monitoring of AV opening is needed to determine whether pump speed adjustment may be able to minimize adverse outcomes. We assessed AV status continuously by echocardiography for 4 minutes in 3 states in 18 HeartWare HVAD patients: 2 minutes at rest, and 1 minute each following Valsalva maneuver and supine leg-raising. Using a previously described algorithm, beat-to-beat AV status was compared with the area under the curve of the normalized power spectral density analysis (PSD-AUC) for the corresponding beats of the pump speed waveform. Five thousand five hundred twenty-seven beats were analyzed. AV opening varied between 0% and 100% for the cohort with the median AV opening frequency 21.5%, and median duration of opening of 124 msec (range 0-279). The receiver operating characteristic (ROC) curve area for AV opening by the PSD-AUC algorithm was 0.95 (P < 0.0001). A PSD-AUC cut-off of 0.82 distinguished between an open and closed AV with 86% sensitivity and 93% specificity. Accuracy was similar in regular cardiac rhythm, atrial fibrillation or with frequent ventricular ectopic beats. Valsalva maneuver and leg-raising had no impact on accuracy. The PSD-AUC was strongly predictive of AV opening duration (P < 0.0001). We found that AV status and opening duration can be determined with high accuracy on a beat-to-beat basis irrespective of cardiac rhythm and with low level exercise and changes in filling.

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http://hdl.handle.net/10453/140014