Patient–specific hemodynamic modeling to optimize LVAD speed and right heart health

Background

Left ventricular assist device (LVAD) speed optimization and right heart failure post device implantation are major clinical challenges. Right heart catheterization (RHC)–guided speed titration studies are often performed to optimize LVAD settings, which are unknown and must be optimized for each patient. A virtual hemodynamic model (VHM) that can be tailored to each patient may provide useful guidance and reduce repeated studies.

Methods

We conducted a retrospective analysis on 16 patients implanted with HeartMate 3 (HM3) who underwent RHC speed titration study as an outpatient. A custom-designed VHM was built and customized for each patient based on RHC measurements. VHM predictions were obtained for multiple scenarios: (1) population–based pulmonary system parameters, (2) patient-specific systemic and pulmonary resistance and capacitance parameters, (3) clinical optimization–based patient-specific mean arterial pressure (MAP), and (4) several MAP targets ranging from 70 to 90 mm Hg.

Results

All patients who underwent RHC speed titration had a clinician–guided speed increase, with a median increase of 300 revolutions per minute (rpm). Using each patient’s customized VHM, virtual speed optimization demonstrated congruence with clinician-guided optimization, with a median predicted speed increase of 321 rpm. After virtual optimization, there was a decrease in the pulmonary artery pressure for 13 patients (81.25%), indicating a predicted improvement in pulmonary parameters.

Conclusions

For our cohort of 16 patients, there was an overall congruence between clinician–guided and patient–specific VHM-predicted optimal LVAD speeds. The magnitude of speed change varied depending on individual patient targets. This may provide individualized speed titration goals and lessen the need for repeat invasive studies.