{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T11:23:17Z","timestamp":1740136997580,"version":"3.37.3"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T00:00:00Z","timestamp":1600300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T00:00:00Z","timestamp":1600300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Artif Organs"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Aortic insufficiency (AI) is an important adverse event in patients with continuous-flow (CF) left ventricular assist device (LVAD) support. AI is often progressive, resulting in elevated 2-year morbidity and mortality. The effectiveness of echocardiographic ramp studies in patients with AI has been unclear. Here, we describe a patient with a CF-LVAD implant who underwent aortic valve replacement (AVR), following assessment of AI using a hemodynamic ramp test with simultaneous echocardiography and right heart catheterization (RHC). The patient was a 21-year-old man with cardiogenic shock due to acute myocarditis, who underwent HeartWare CF-LVAD (HVAD) implantation. Heart failure persisted despite increased doses of diuretics and inotrope, as well as an increased HVAD pump rate. HVAD monitoring revealed a correlation between increased HVAD pump rate and flow at each speed step. A hemodynamic ramp test with simultaneous transthoracic echocardiography and RHC revealed a significant discrepancy between HVAD pump flow and cardiac output (CO) at each speed step; moreover, pulmonary capillary wedge pressure remained high. Therefore, the patient underwent AVR. Subsequently, his low CO symptoms disappeared and inotropes were successfully discontinued. A postoperative hemodynamic ramp test revealed that AVR had successfully closed the loop of blood flow and reduced the discrepancy between HVAD pump flow and CO, thereby increasing CO. The patient was then discharged uneventfully. In conclusion, a hemodynamic ramp test with simultaneous echocardiography and RHC was useful for the evaluation of the causal relationship between AI and low CO, and for selection of surgical treatment for AI in a patient with CF-LVAD.<\/jats:p>","DOI":"10.1007\/s10047-020-01210-y","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T14:06:27Z","timestamp":1600351587000},"page":"265-268","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical potential of hemodynamic ramp test by simultaneous echocardiography and right heart catheterization for aortic insufficiency in a patient with continuous-flow left ventricular assist device"],"prefix":"10.1007","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0939-4125","authenticated-orcid":false,"given":"Yasumori","family":"Sujino","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kensuke","family":"Kuroda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Yoshitake","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuichiro","family":"Yagi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiji","family":"Anegawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Mochizuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiichiro","family":"Iwasaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seiko","family":"Nakajima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masanobu","family":"Yanase","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satsuki","family":"Fukushima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyuki","family":"Fujita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junjiro","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norihide","family":"Fukushima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,9,17]]},"reference":[{"key":"1210_CR1","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.healun.2014.09.045","volume":"34","author":"J Cowger","year":"2015","unstructured":"Cowger J, Rao V, Massey T, Sun B, May-Newman K, Jorde U, Estep JD. Comprehensive review and suggested strategies for the detection and management of aortic insufficiency in patients with a continuous-flow left ventricular assist device. J Heart Lung Transplant. 2015;34:149\u201357.","journal-title":"J Heart Lung Transplant"},{"key":"1210_CR2","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1016\/j.athoracsur.2011.04.115","volume":"92","author":"K Toda","year":"2011","unstructured":"Toda K, Fujita T, Domae K, Shimahara Y, Kobayashi J, Nakatani T. Late aortic insufficiency related to poor prognosis during left ventricular assist device support. Ann Thorac Surg. 2011;92:929\u201334.","journal-title":"Ann Thorac Surg"},{"key":"1210_CR3","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1016\/j.healun.2010.06.006","volume":"29","author":"R John","year":"2010","unstructured":"John R, Mantz K, Eckman P, Rose A, May-Newman K. Aortic valve pathophysiology during left ventricular assist device support. J Heart Lung Transplant. 2010;29:1321\u20139.","journal-title":"J Heart Lung Transplant"},{"key":"1210_CR4","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.healun.2016.07.018","volume":"36","author":"CT Holley","year":"2017","unstructured":"Holley CT, Fitzpatrick M, Roy SS, Alraies MC, Cogswell R, Souslian L, Eckman P, John R. Aortic insufficiency in continuous-flow left ventricular assist device support patients is common but does not impact long-term mortality. J Heart Lung Transplant. 2017;36:91\u20136.","journal-title":"J Heart Lung Transplant"},{"key":"1210_CR5","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.cardfail.2017.04.012","volume":"23","author":"G Sayer","year":"2017","unstructured":"Sayer G, Sarswat N, Kim GH, Adatya S, Medvedofsky D, Rodgers D, Kruse E, Ota T, Jeevanandam V, Lang R, Uriel N. The hemodynamic effects of aortic insufficiency in patients supported with continuous-flow left ventricular assist devices. J Card Fail. 2017;23:545\u201351.","journal-title":"J Card Fail"},{"key":"1210_CR6","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1016\/j.cardfail.2015.06.010","volume":"21","author":"N Uriel","year":"2015","unstructured":"Uriel N, Levin AP, Sayer GT, Mody KP, Thomas SS, Adatya S, Yuzefpolskaya M, Garan AR, Breskin A, Takayama H, Colombo PC, Naka Y, Burkhoff D, Jorde UP. Left ventricular decompression during speed optimization ramps in patients supported by continuous-flow left ventricular assist devices: device-specific performance characteristics and impact on diagnostic algorithms. J Card Fail. 2015;21:785\u201391.","journal-title":"J Card Fail"},{"key":"1210_CR7","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1097\/MAT.0000000000000557","volume":"63","author":"JD Rich","year":"2017","unstructured":"Rich JD, Burkhoff D. HVAD flow waveform morphologies: theoretical foundation and implications for clinical practice. ASAIO J. 2017;63:526\u201335.","journal-title":"ASAIO J"},{"key":"1210_CR8","doi-asserted-by":"publisher","first-page":"1764","DOI":"10.1016\/j.jacc.2012.07.052","volume":"60","author":"N Uriel","year":"2012","unstructured":"Uriel N, Morrison KA, Garan AR, Kato TS, Yuzefpolskaya M, Latif F, Restaino SW, Mancini DM, Flannery M, Takayama H, John R, Colombo PC, Naka Y, Jorde UP. Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: the Columbia ramp study. J Am Col Cardiol. 2012;60:1764\u201375.","journal-title":"J Am Col Cardiol"}],"container-title":["Journal of Artificial Organs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10047-020-01210-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10047-020-01210-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10047-020-01210-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T00:47:18Z","timestamp":1631839638000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10047-020-01210-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,17]]},"references-count":8,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["1210"],"URL":"https:\/\/doi.org\/10.1007\/s10047-020-01210-y","relation":{},"ISSN":["1434-7229","1619-0904"],"issn-type":[{"type":"print","value":"1434-7229"},{"type":"electronic","value":"1619-0904"}],"subject":[],"published":{"date-parts":[[2020,9,17]]},"assertion":[{"value":"2 April 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 September 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"There is no conflict of interests related to this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}