Table 1
Literature survey of Clinical, Hemodynamic, and Echocardiographic indications of LV distension that potentially trigger the mechanical LV unloading.
| Author, Publication Date, Type, Ref # | Hemodynamic indications | Echocardiographic indications | Recommended LV unloading |
|---|---|---|---|
| Truby et al., 2017, RA, [1] | PAD > 25 | LV blood stasis | TVMA |
| Ezad et al., 2023, RA, [2] | PCWP > 18, or ALPP < 15 | Increased LV dimensions, LV blood stasis, LV thrombus, No AV opening, LVOT VTI < 10 cm | IABP, TVMA |
| Cevasco et al., 2019 RA, [3] | PAD > 25; “an elevated PCWP” | LV distension, LV blood stasis, LV thrombus, hypocontractile LV, No AV Opening | TVMA, Surg Vent |
| Lorusso et al., 2021 GD, [5] | Moderate: CVP 12–16, PCWP 18–25 (moderate); Severe: CVP Above 20, PCWP above 25 | Moderate: AV opening every 3–4 beats, moderate LV/LA distension, moderate Echo Smoke, IVC over 2.5 cm dilated, IVC collapse less than 50%; Severe: AV closed, Severe LV/LA distention, Severe Echo Smoke, IVC over 2.5 cm, no IVC collapse. | IABP, AS, Surg Vent, TVMA |
| Kim et al., 2023, RT, [8] | Minimal ALPP | LV Blood Stasis, No AV Opening, Low ALPP | TSLAV |
| Park et al., 2023, RT, [9] | No Hemodynamic Criteria Described | No or Low AV Opening, congestion score index | TSLAV |
| Cheng et al., 2013, CS, [10] | PCWP > 18 | EF < 20%, Low or No AV Opening, LV Distension, LV Blood Stasis, Echo Smoke | TVMA |
| Hasde et al., 2021, RR, [12] | PAD > 25, PCWP at least 20 | Low or No AV opening | IABP, AS, Surg Vent |
| Thiele et al., 2023, RT, [17] | Lack of ALPP | No AV opening, increase in diameters and volume of LV, LVOT VTI < 10 cm | IABP, TVMA |
| Assmann et al., 2022, GD, [18] | PAD > 25 | LV Dilation | IABP, AS, Surg Vent, TVMA |
| Belohlavek et al., 2021, RA, [19] | ALPP < 15, high LVEDP | High LV Filling Pressures by Doppler Echocardiography | TVMA |
| Donker et al., 2022, Ed, [20] | Increased PAC Pressures; Reduced ALPP | Echo Smoke, Low or No AV opening | TVMA |
| Gaisendrees et al., 2021, RR, [21] | Low ALPP | Echo Smoke, LVEDD at Least 6.8 cm (male), 6.1 (female) | TVMA |
| Lim et al., 2021, RA, [22] | Rising PAP and PCWP, Reduced ALPP | LV Dilation, Echo Smoke, Low or No AV opening | TVMA |
| Lorusso et al., 2022, RR, [23] | CVP 12–16 (moderate), above 20 (severe); ALPP: 8–10 (moderate), less than 8 or pulseless (severe); wedge (PCWP?): 20–25 (moderate), above 25 (severe), Scvo2: 55–45 (moderate), under 45 (severe) | LA/LV distension, Echo Smoke, IVC: 1.5–2.5, above 2.5 for mild, moderate/severe | IABP, TVMA, Surg Vent |
| Lüsebrink et al., 2023, RA, [24] | No ALPP, Elevated PAP or PCWP | Closed AV, LV Blood Stasis | Multiple Discussed |
| Meani et al., 2019, RR, [25] | Moderate PCWP 18–25, CVP 12–16; Severe: CVP > 20, PCWP > 25; Low or No ALPP | Moderate: AV opening every 3–4 beats, moderate LV/LA distension, moderate smoke like effect, IVC over 2.5 cm dilated, IVC collapse less than 50%; Severe: AV closed, LV/LA distention, Severe smoke like effect, IVC over 2.5 cm, no IVC collapse | IABP, TVMA |
| Nakajima et al., 2021, RR, [26] | ALPP < 20 | Echo Smoke | TVMA |
| Piechura et al., 2020, RR, [27] | ALPP < 10 | LV Dilation or Low or no AV opening | IABP, TVMA |
| Ricarte Bratti et al., 2021, RA, [28] | Elevated LV Filling Pressures, ALPP < 10 | Increased LVEDD, increased E/E’ ratio, Echo Smoke, LV Thrombus, Low or No AV Opening | IABP, AS, TVMA, Surg Vent |
| Alkhouli et al., 2016, CS, [29] | PCWP > 18, “High Left Atrial Pressure” | No Echocardiographic indications were noted | Surgical Vent, AS, TVMA |
| Au et al., 2023, RR, [30] | No Hemodynamic Criteria Described | LVEF < 25% | IABP, TVMA |
| Eliet et al., 2018, RR, [31] | ALPP < 10 | No AV opening, heavy Echo Smoke in LV, LVOT VTI < 5 cm | TVMA |
| Gaudard et al., 2015, RR, [32] | No Hemodynamic Criteria Described | Acute LV dilation/ Echo Smoke in LV/LA | TVMA |
| Hu et al., 2016, CS, [33] | Decreased ALPP | LV Blood Stasis | IABP |
| Karatolios et al., 2016, RR, [34] | No Hemodynamic Criteria Described | Echo Smoke in LV, LV Dilation, Low or No AV opening | TVMA |
| Kim et al., 2021 RR, [35] | ALPP < 10 | No Echocardiographic indications were noted | TVMA |
| Lüsebrink et al., 2020 RA, [36] | Lack of ALPP | Low or No AV opening, LVOT VTI < 10 cm, LV Blood Stasis, Increased LV Dimensions from Previous Exam, severe AR | TVMA |
| Pappalardo et al., 2017, RR, [37] | No Hemodynamic Criteria Described | Stone Heart, LV Thrombus, significant AR | TVMA |
| Rali et al., 2022, RA, [38] | elevated PCWP, low or absent ALPP | No AV opening | IABP, TVMA, AS |
| Saeed et al., 2023, RA, [39] | ALPP < 15, PCWP > 30, PAD > 25 | LV/ Ao Root Thrombus, No AV opening | IABP, TVMA, AS, TSLAV, LV Vent |
Thresholds for defining LVD and indications and triggers for LV mechanical unloading were tabulated according to categories of clinical (or radiographic), hemodynamic, and ECHO findings or parameters. Clinical and radiologic criteria for LVD were placed within the same category for simplicity and to be succinct. Hemodynamic manifestations of LVD were defined as abnormalities with invasive filling pressures and ALPP monitoring. All pressures are reported in mmHg. ECHO criteria for LVD included cardiac ultrasound or pulmonary findings suggestive of pulmonary edema. Several papers stratified their indications and treatments as mild, moderate, and severe. Where applicable this has been included. ALPP: Arterial Line Pulse Pressure; AV: Aortic Valve; AS: Atrial Septostomy; CS: Case Series; CVP: Central Venous Pressure; Ed: Editorial; GD: Guideline Document; IABP: Intra Aortic Balloon Pump; IVC: Inferior Vena Cava; LA: Left Atrium; LV: Left Ventricle; LVD: Left Ventricular Distension; LVOT VTI: Left Ventricular Outflow Tract Velocity Time Integral; PA: Pulmonary Artery; PAC: Pulmonary Artery Catheter; PAD: Pulmonary Artery Diastolic; PCWP: Pulmonary Capillary Wedge Pressure; RA: Review Article; RR: Retrospective Review; RT: Randomized Trial; TSLAV: Transeptal Left Atrial Vent.
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