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    Assessing Cerebrovascular Hemodynamics Using Transcranial Doppler in Patients with Mechanical Circulatory Support Devices

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    Author
    Melmed, Kara R
    Schlick, Konrad H
    Rinsky, Brenda
    Dumitrascu, Oana M
    Volod, Oksana
    Nezhad, Mani
    Padrick, Matthew M
    Runyan, Carmelita
    Arabia, Francisco A
    Moriguchi, Jaime D
    Lyden, Patrick D
    Song, Shlee S
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    Affiliation
    Banner Univ Arizona, Dept Surg & Med
    Issue Date
    2020-05
    Keywords
    Transcranial Doppler ultrasound
    heart failure
    high-intensity transient signal
    Left ventricular assist device
    Stroke
    
    Metadata
    Show full item record
    Publisher
    WILEY
    Citation
    Melmed, K.R., Schlick, K.H., Rinsky, B., Dumitrascu, O.M., Volod, O., Nezhad, M., Padrick, M.M., Runyan, C., Arabia, F.A., Moriguchi, J.D., Lyden, P.D. and Song, S.S. (2020), Assessing Cerebrovascular Hemodynamics Using Transcranial Doppler in Patients with Mechanical Circulatory Support Devices. Journal of Neuroimaging, 30: 297-302. doi:10.1111/jon.12694
    Journal
    JOURNAL OF NEUROIMAGING
    Rights
    © 2020 by the American Society of Neuroimaging.
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    BACKGROUND AND PURPOSE Mechanical circulatory support (MCS) devices are commonly used in heart failure patients. These devices carry risk for presumably embolic and additionally hemorrhagic stroke. Alterations in blood flow play a key role in stroke pathophysiology, and we aimed to learn more about hemodynamic compromise. In this study, we used transcranial Doppler (TCD) ultrasound to define hemodynamics of commonly used nonpulsatile MCS devices, as well as pulsatile devices, with special attention to the total artificial heart (TAH). METHODS From 2/2013 through 12/2016, we prospectively enrolled patients with MCS who underwent TCD imaging. We analyzed TCD parameters, including peak systolic velocity, end-diastolic velocity, pulsatility indices (PIs), and number of high-intensity transient signals. Waveform morphologies were compared between various MCS devices. RESULTS We performed 132 TCD studies in 86 MCS patients. Waveforms in patients supported by venoarterial-extracorporeal membrane oxygenation demonstrated continuous flow without clear systolic peaks with an average (+/- SD) PI of .43 (+/-.2). PIs were low in patients with continuous-flow left ventricular assist devices with a mean PI of .32 (+/-.13). Impella patients had morphologically distinct pulsatile waveforms and a higher mean PI of .65 (+/-.24). In intra-arterial balloon pump patients, mean PI was 1.01 (+/-.16) and diastolic upstrokes were pronounced. In TAH patients, mean middle cerebral artery velocity of 79.69 (+/- 32.33) cm/seconds and PI of .74 (+/-.14) approached normal values. CONCLUSION TCD can detect characteristic waveforms in patients supported by various MCS devices. These device-specific TCD patterns are recognizable and reproducible.
    Note
    12 month embargo; published online: 10 February 2020
    ISSN
    1051-2284
    EISSN
    1552-6569
    PubMed ID
    32037621
    DOI
    10.1111/jon.12694
    Version
    Final accepted manuscript
    ae974a485f413a2113503eed53cd6c53
    10.1111/jon.12694
    Scopus Count
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    UA Faculty Publications

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