Contrast-Enhanced Ultrasound of Muscle Perfusion May Indicate Patient Response to Left Ventricular Assist Device Therapy.
PURPOSE
Left ventricular assist device (LVAD) support is associated with peripheral vascular abnormalities beyond those associated with heart failure (HF). These abnormalities are associated with persistent functional impairments that adversely impact quality of life (QoL). Methods for measuring peripheral vascular function in this population are needed.


METHODS
This pilot study investigated the use of contrast-enhanced ultrasound (CEUS) using standardized protocols to estimate changes in peripheral (quadriceps) muscle perfusion among patients with HF (INTERMACS profile 3) undergoing LVAD implantation (n = 7). Patients were then stratified by those who did ("responders", n = 4) and did not ("nonresponders", n = 3) report QoL improvement with LVAD support.


RESULTS
Serial measurements obtained preoperatively and 3 months following LVAD implantation showed no significant change (P > .23) in muscle perfusion by all CEUS-based measures at rest or with an exercise stimulus for the overall population. Responders exhibited improved muscle perfusion at rest (P = .043) and decreased time to peak contrast enhancement (P = .010) at 3 months compared with baseline, suggesting improved delivery of blood to the extremities post-LVAD. Nonresponders showed unchanged resting muscle perfusion (P > .99), time to peak contrast enhancement (P = .59), and response to exercise stimulus (P > .99) following LVAD therapy.


CONCLUSION
Our findings suggest that CEUS evaluation is a promising noninvasive, quantitative modality for real-time assessment of peripheral vasculature and muscle perfusion as an indication of treatment response in LVAD recipients and that this modality may capture perfusion measures important to QoL following LVAD implantation.
['Delaney|Lauren J|LJ|https://orcid.org/0000-0001-6794-9550', 'Fitzgerald|Kathleen|K|', 'Stanczak|Maria|M|', 'Machado|Priscilla|P|', 'Entwistle|John W C|JWC|', 'Forsberg|Flemming|F|https://orcid.org/0000-0003-2215-1371', 'Reeves|Gordon R|GR|']
D006333:Heart Failure D006353:Heart-Assist Devices D006801:Humans D009132:Muscles D010477:Perfusion D010865:Pilot Projects D011788:Quality of Life
contrast-enhanced ultrasound LVAD heart failure quality of life skeletal muscle perfusion