{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:40:39Z","timestamp":1792194039055,"version":"4.4.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Hemodynamic ramp (HR) tests can guide the optimization of left ventricular assist device (LVAD) speed and direct medical therapy. We investigated the effects of HR-guided LVAD management.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>\n              This prospective, multicenter, randomized, pilot study compared outcomes in LVAD patients using an HR-guided (HR group) versus a standard transthoracic echocardiography-guided (control group) management strategy. Patients were enrolled and randomized 1 to 3 months post-HVAD implantation and followed for 6 months. Twenty-two patients (57\u00b110 years, 73% male) were randomized to the HR group and 19 patients (51\u00b113 years, 63% male) to the control group. HR group patients had double the number of LVAD speed changes (1.68 versus 0.84 changes\/patient,\n              <jats:italic>P<\/jats:italic>\n              =0.09 with an incidence rate ratio 2.0, 95% CI, 0.9\u20134.7) with twice the magnitude of rotations per minute changes (130 versus 60 rotations per minute\/patient,\n              <jats:italic>P<\/jats:italic>\n              =0.004) during the study. The HR group also had 2-fold greater heart failure medication changes (4.32 versus 2.53 changes\/patient,\n              <jats:italic>P<\/jats:italic>\n              =0.072, incidence rate ratio 1.7 with 95% CI, 0.8\u20133.5) predominantly because of changes in diuretic dose (40 versus 0 mg\/patient,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). The HR group had numerically but not statistically higher event-free survival (62% versus 46%,\n              <jats:italic>P<\/jats:italic>\n              =0.087; hazard ratio, 0.46 with 95% CI, 0.2\u20131.2), with numerically but not statistically lower events per patient-year (\n              <jats:italic>P<\/jats:italic>\n              =0.084). There were no significant differences in the 6-minute walk or Kansas City Cardiomyopathy Questionnaire tests at 6 months.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>In this randomized pilot study of LVAD patient management we demonstrated the feasibility of standardized HR testing at multiple institutions and that a strategy guided by hemodynamics was associated with more LVAD speed and medication adjustments and a nonsignificant reduction in adverse events. A pivotal study to demonstrate the clinical benefit of HR testing is warranted.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT03021239.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.119.006067","type":"journal-article","created":{"date-parts":[[2019,4,4]],"date-time":"2019-04-04T17:45:07Z","timestamp":1554399907000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":88,"title":["Impact of Hemodynamic Ramp Test-Guided HVAD Speed and Medication Adjustments on Clinical Outcomes"],"prefix":"10.1161","volume":"12","author":[{"given":"Nir","family":"Uriel","sequence":"first","affiliation":[{"name":"Division of Cardiology, University of Chicago, IL (N.U., T.I., D.R., J.R., G.K., G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Burkhoff","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Foundation and Division of Cardiology, Columbia University, New York, NY (D.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Rich","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Northwestern University, IL (J.D.R., E.E.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavros G.","family":"Drakos","sequence":"additional","affiliation":[{"name":"Divisions of Cardiology and Surgery, University of Utah, Salt Lake City (S.G.D., C.H.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Teuteberg","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Stanford University, Palo Alto, CA (J.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teruhiko","family":"Imamura","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Chicago, IL (N.U., T.I., D.R., J.R., G.K., G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Rodgers","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Chicago, IL (N.U., T.I., D.R., J.R., G.K., G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayant","family":"Raikhelkar","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Chicago, IL (N.U., T.I., D.R., J.R., G.K., G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther E.","family":"Vorovich","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Northwestern University, IL (J.D.R., E.E.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig H.","family":"Selzman","sequence":"additional","affiliation":[{"name":"Divisions of Cardiology and Surgery, University of Utah, Salt Lake City (S.G.D., C.H.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gene","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Chicago, IL (N.U., T.I., D.R., J.R., G.K., G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Sayer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Chicago, IL (N.U., T.I., D.R., J.R., G.K., G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1809738"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800866"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1602954"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1284"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.028303"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2015.10.001"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.118.005094"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1372"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2012.09.013"},{"key":"e_1_3_3_11_2","unstructured":"INTERMACS Adverse Event Definitions: Adult and Pediatric Patients. 2013. 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