• Teruhiko Imamura, Gene Kim, Jayant Raikhelkar, Nitasha Sarswat, Sara Kalantari, Bryan Smith, Daniel Rodgers, Ben Chung, Ann Nguyen, Takeyoshi Ota, Tae Song, Colleen Juricek, Valluvan Jeevanandam, Daniel Burkhoff, Gabriel Sayer, and Nir Uriel.
• Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
• J. Card. Fail. 2018 Sep 1; 24 (9): 575-582.

BackgroundDecoupling between diastolic pulmonary arterial pressure (dPAP) and pulmonary arterial wedge pressure (PAWP) is an index of pulmonary vasculature remodeling and provides prognostic information. Furthermore, decoupling may change during incremental left ventricular assist device (LVAD) speed changes.Methods And ResultsIn this prospective study, patients underwent an echocardiographic and hemodynamic ramp test after LVAD implantation and were followed for 1 year. The change in decoupling (dPAP - PAWP) between the lowest and highest LVAD speeds during the ramp test was calculated. Survival and heart failure admission rates were assessed by means of Kaplan-Meier analysis. Eighty-seven patients were enrolled in the study: 54 had a Heartmate II LVAD (60.8 ± 9.3 years of age and 34 male) and 33 had an HVAD LVAD (58.6 ± 13.2 years of age and 20 male). Patients who experienced greater changes in decoupling (Δdecoupling >3 mm Hg) had a persistently elevated dPAP at incremental LVAD speed and had worse 1-year heart failure readmission-free survival compared with the group without significant changes in the degree of decoupling (41% vs 75%; P = .001).ConclusionsAn increase in decoupling between dPAP and PAWP at incremental LVAD speed changes was associated with worse prognosis in LVAD patients.Copyright © 2018 Elsevier Inc. All rights reserved.

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