Prognostic impact of echocardiographic optimal profile and echo-guided LVAD speed optimization at six months after LVAD implantation
V A R Thirupathirajan, J Guzman Bofarull, G Gallone, J B Guichard, A Maestro Benedicto, J Ibero, E Karapedi, A Bollas Becerra, K Kiff, M Monteagudo Vela, D Garcia Saez, F Fiorelli, O Dar, A Morley-Smith, F Riesgo GilAbstract
Background
The long-term prognostic significance of achieving an optimal echocardiographic profile and performing echo-guided left ventricular assist device (LVAD) speed optimization after implantation remains incompletely defined.
Purpose
To evaluate whether optimal echocardiographic profile and echo-guided speed optimization at six months after LVAD implantation is associated with improved clinical outcomes.
Methods
We retrospectively analyzed all consecutive patients undergoing durable LVAD implantation at a single center between 2010 and 2025 who survived at least six months post-implant and had an echocardiographic assessment available at six months. Patients were classified as echocardiographically optimized or non-optimized based on predefined criteria at six months: neutral interventricular septal (IVS) position and none or mild mitral regurgitation (MR). Non-optimized patients were further stratified according to whether LVAD speed adjustment was performed. Clinical, laboratory, echocardiographic, cardiopulmonary exercise testing (CPET), and right heart catheterization (RHC) data were compared at six months. The primary endpoint was a composite of heart failure (HF) hospitalization or cardiovascular death. Secondary endpoints included late right ventricular failure (RVF), HF hospitalization, all-cause mortality, and hemocompatibility-related adverse events (HRAEs).
Results
Among 219 patients, 106 (48.4%) were echocardiographically optimized and 113 (51.6%) were non-optimized; 12 non-optimized patients underwent LVAD speed adjustment. Age and sex distribution were similar between groups. Optimized patients had a lower prevalence of more-than-mild aortic and tricuspid regurgitation and smaller left ventricular end-diastolic diameters. Renal and hepatic function, CPET performance, and invasive hemodynamics at six months were comparable between groups (Table). Echocardiographically optimized patients experienced a significantly lower incidence of the primary endpoint (p=0.01), as well as reduced HF hospitalizations (p=0.012), all-cause mortality (p=0.012), and late RVF (p=0.043). Rates of HRAEs did not differ between groups (p=0.56). Among non-optimized patients, LVAD speed adjustment was not associated with improved outcomes (Figure).
Conclusion
Achieving an optimal echocardiographic profile—defined by neutral IVS position and none or mild MR—six months after LVAD implantation is associated with improved survival and reduced HF hospitalization and late RVF. In contrast, late echo-guided LVAD speed adjustment in non-optimized patients does not appear to confer prognostic benefit.
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