AimsWhile echocardiography remains essential within haemodynamic monitoring of durable mechanical circulatory support, previous echocardiographic guidelines are missing scientific evidence for the novel HeartMate 3™ (HM3) system. Accordingly, this review aims to summarize available echocardiographic evidence including HM3.Methods and resultsThis systematic review adhered to the PRISMA 2020 guidelines. Searches were conducted during August 2023 across PubMed, Embase, and Google Scholar using specific echocardiographic terms combined with system identifiers. Study quality was assessed using the Newcastle–Ottawa Scale (NOS) for cohort studies and Critical Appraisal Instrument (PCAI) for cross‐sectional studies. Nine studies met the inclusion criteria, of which eight cohort studies and one cross‐sectional study. Aortic regurgitation (AR) prevalence at approximately 12 months of support exhibited heterogenicity (33.5% (Δ 33%)) in a limited number of studies (n = 3). Several studies (n = 5) demonstrated an increasing prevalence and severity of AR during HM3 support, generating moderate to high level of evidence. One AR study showed a higher cumulative incidence of death and heart failure (HF) readmission compared with those without significant AR, hazard ratio 3.42 (95% CI 1.48–8.76). A second study showed that a worsening AR group had significantly lower survival‐free from HF readmission (59% vs. 89%, P = 0.023) with a hazard ratio of 5.18 (95% CI 1.07–25.0), while a third study did not reveal any differences in cardiac‐related hospitalizations in the 12 months follow‐up or non‐cardiac‐related hospitalization. Mitral regurgitation (MR) prevalence at approximately 12 months of support exhibited good consistency 15.0% (Δ 0.8%) in both included studies, which did not reveal any significant pattern of changing prevalence over time. Tricuspid regurgitation (TR) prevalence at approximately 12 months of support exhibited fair consistency 28.5% (Δ 8.3%) in a limited number of studies (n = 2); both studies showed a statistically un‐confirmed trend of increased TR prevalence over time. The evidence of general prevalence of right ventricular dysfunction (RVD) was insufficient due to lack of studies.ConclusionsThere are few methodologically consistent studies with focus on long‐term haemodynamic effects. Aortic regurgitation still seems to be a prevalent and potentially significant finding. The available evidence concerning right heart function is limited despite clinical relevance and potential prognostic value. Potential interventricular and haemodynamic interplay are identified as a white field for future research.

中文翻译：

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HeartMate 3™ 治疗背景下的超声心动图血流动力学监测：系统评价

目标虽然超声心动图在持久机械循环支持的血流动力学监测中仍然至关重要，但之前的超声心动图指南缺少新型 HeartMate 3™ (HM3) 系统的科学证据。因此，本综述旨在总结包括 HM3 在内的可用超声心动图证据。方法和结果本系统综述遵循 PRISMA 2020 指南。 2023 年 8 月，使用特定的超声心动图术语与系统标识符相结合，在 PubMed、Embase 和 Google Scholar 上进行了搜索。研究质量使用纽卡斯尔-渥太华量表（NOS）进行队列研究，使用批判性评估工具（PCAI）进行横断面研究。九项研究符合纳入标准，其中八项队列研究和一项横断面研究。在有限数量的研究中，大约 12 个月支持时的主动脉瓣反流 (AR) 患病率表现出异质性 (33.5% (Δ 33%))（n= 3）。多项研究（n= 5) 证明在 HM3 支持期间 AR 的患病率和严重程度不断增加，产生了中等到高水平的证据。一项 AR 研究显示，与没有显着 AR 的患者相比，死亡和心力衰竭 (HF) 再入院的累积发生率更高，风险比 3.42 (95% CI 1.48–8.76)。第二项研究表明，病情恶化的 AR 组的无心衰再入院生存率显着较低（59% vs. 89%，磷= 0.023），风险比为 5.18（95% CI 1.07-25.0），而第三项研究没有揭示 12 个月随访中心脏相关住院或非心脏相关住院的任何差异。在两项纳入的研究中，大约 12 个月支持时的二尖瓣反流 (MR) 患病率表现出良好的一致性，为 15.0% (Δ 0.8%)，这没有揭示随时间推移患病率发生任何显着变化的模式。在有限数量的研究中，大约 12 个月支持时的三尖瓣反流 (TR) 患病率表现出 28.5% (Δ 8.3%) 的相当一致性（n= 2);这两项研究都显示了随着时间的推移 TR 患病率增加的趋势，但未经统计学证实。由于缺乏研究，右心室功能障碍（RVD）普遍患病率的证据不足。结论很少有方法学上一致的研究关注长期血流动力学影响。主动脉瓣关闭不全似乎仍然是一个普遍且具有潜在意义的发现。尽管具有临床相关性和潜在的预后价值，但有关右心功能的现有证据仍然有限。潜在的心室间和血液动力学相互作用被认为是未来研究的空白领域。