Microembolic Signal Monitoring in Patients with Left Ventricular Assist Devices HeartMate 3 and HeartWare - Association with Antithrombotic Treatment and Cerebrovascular Events.

BACKGROUND: In patients with left ventricular assist devices (LVADs) ischemic and hemorrhagic stroke are dreaded complications. Predictive markers for these events are lacking. This study aimed to investigate the prevalence and predictive value of microembolic signals (MES) for stroke, detected by Transcranial Doppler sonography (TCD) in patients with HeartMate 3 (HM 3) or HeartWare (HW).

METHODS: A thirty-minute bilateral TCD monitoring of the middle cerebral artery (MCA) was performed in 62 outpatients with LVAD (HM 3 N=31, HW N=31) and 31 healthy controls. Prevalence and quantity of MES were investigated regarding clinical and laboratory parameters. Cerebrovascular events (CVE) were recorded on follow-up at 90 and 180 days.

RESULTS: MES were detected in six patients with HM 3, three patients with HW, and three controls. Within the LVAD groups, patients on monotherapy with vitamin-K-antagonist (VKA) without antiplatelet therapy were at risk for a higher count of MES (negative binomial regression: VKA: 1; VKA + ASA: Exp(B)=0.005, 95%CI 0.001 - 0.044; VKA + clopidogrel: Exp(B)=0.012, 95%CI 0.002 - 0.056). There was no association between the presence of MES and CVE or death on follow-up (p>0.05).

CONCLUSION: For the first time, the prevalence of MES was prospectively investigated in a notable outpatient cohort of patients with HM 3 and HW. Despite optimized properties of the latest LVAD devices, MES remain detectable depending on antithrombotic therapy. No association between MES and CVE could be detected.