Diastolic plateau – an invasive hemodynamic marker of adverse outcomes among LVAD patients

Introduction: Deep and plateau is a classic invasive hemodynamic marker of right ventricular dysfunction. The purpose of the current analysis was to evaluate the prognostic importance of this sign in left ventricular assist device (LVAD) patients.

Material and Methods: The analysis included all LVAD patients (INTERMACS profile 1-4) who received continuous-flow LVAD (HeartMate 3) at the sheba medical center and underwent hemodynamic studies during follow up post LVAD implantation surgery. Long plateau was defined as the plateau ≥ 55% of diastole. Study end point was defined as the composite of death, heart transplantation, or an increase in furosemide dosage in a 12-month follow-up period post catheterization. Cox regression models were applied.

Results and discussion: The study cohort included 55 LVAD patients (82% males, mean age of 58 years) with 23 outcome events recorded during follow up period. The incidence of study events was significantly higher among patients with plateau ≥ 55% (p=0.004). Patients who reached the study endpoint had longer plateau during diastole (49±29% vs. 32±29%, p = 0.08). In a multivariate model with adjustment for age and INTERMACS score, patients with plateau of more than 55% were 3 times more likely to reach the study endpoint (95% CI 1.15-7.55, p=0.023). In a univariate analysis, INTERMACS score was associated with adverse events. However, there was no association between the depth of the diastolic wave and patients’ outcomes.

Conclusion: Long diastolic plateau during invasive hemodynamic study is associated with adverse outcomes in LVAD patients.