State-of-the-Art-Review
Expanding the Scope of Multimodality Imaging in Durable Mechanical Circulatory Support

https://doi.org/10.1016/j.jcmg.2019.05.035Get rights and content
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Highlights

  • Several advances in LVAS require an updated perspective of multi-modality imaging.

  • Multimodality imaging of LVAS includes echocardiography, CT, and nuclear imaging.

  • As LVAS use increases globally, understanding the roles of the various imaging modalities will be critical.

Abstract

An increasing number of patients transition to advanced-stage heart failure refractory to medical therapy. Left ventricular assist systems (LVAS) provide a bridge to candidates awaiting heart transplantation and extended device durability allows permanent implantation referred to as destination therapy. Noninvasive imaging plays a pivotal role in the optimal management of patients implanted with durable mechanical circulatory support (MCS) devices. Several advances require an updated perspective of multi-modality imaging in contemporary LVAS management. First, there has been substantial evolution of devices such as the introduction of the fully magnetically levitated HeartMate 3 pump (Abbott, Abbott Park, Illinois). Second, imaging beyond the device, of the peripheral system, is increasingly recognized as clinically relevant. Third, U.S. Food and Drug Administration recalls have called attention to LVAS complications beyond pump thrombosis that are amenable to imaging-based diagnosis. Fourth, there is increased availability of multimodality imaging, such as computed tomography and positron emission tomography, at many centers across the world. In this review, the authors provide a practical and contemporary approach to multi-modality imaging of current-generation durable MCS devices. As the use of LVAS and other novel MCS devices increases globally, it is critical for clinicians caring for LVAS patients to understand the roles of various imaging modalities in patient evaluation and management.

Key Words

heart failure
left ventricular assist systems
mechanical circulatory support
multimodality imaging

Abbreviations and acronyms

3D
3-dimensional
18F-FDG
18F-fluorodeoxyglucose
99mTc
Technetium-99m
CT
computed tomography
HF
heart failure
LV
left ventricular
LVAS
left ventricular assist systems
MCS
mechanical circulatory support
MIBG
123I-meta-iodobenzylguanidine
PET
positron emission tomography
RV
right ventricular
SPECT
single-photon emission computed tomography
TEE
transesophageal echocardiography
TTE
transthoracic echocardiography

Cited by (0)

Dr. Vaduganathan is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (NIH/NCATS Award UL 1TR002541), and serves on Advisory Boards for Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, and Boehringer Ingelheim. Dr. Pareek serves on an advisory board for AstraZeneca; and has received speaker honoraria from AstraZeneca, Bayer, and Boehringer Ingelheim. Dr. Estep is a consultant and medical advisor for Abbott and Medtronic. Dr. Mehra is a consultant for Abbott, Medtronic, Janssen (a division of Johnson and Johnson), Stealth Biotherapeutics, Teva (now Mesoblast), NupulseCV, Inc., Portola, Xogenex, Bayer; and is on the Scientific Advisory Board for NupulseCV and FineHeart. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Drs. Almarzooq and Varshney are co-first authors of this paper.