Pulse Wave Analysis in Advanced Heart Failure

Pulse waveforms, especially central pressure waveforms, are predictive of cardiovascular
events. Peripheral waveforms have been correlated to central waveforms. Peripheral waveforms
can be easily measured through applanation tonometry. In this study the investigators
hypothesize:

1. That previously established peripheral tonometry techniques would apply to patients
with advanced heart failure, including continuous flow LVADs and facilitate serial
evaluation of central hemodynamics without invasive monitoring.

2. That temporary changes in LVAD speed will be evident in frequency spectrum analysis of
peripheral, non-invasive waveforms.

3. That clinical events involving LVAD will have characteristic frequency spectra.

Inclusion Criteria:

1)18 years of age or older

2)Advanced heart failure as defined by need for IABP or LVAD

3)One or more of the following:

- Current inpatient heart failure treatment with intra-aortic balloon pump (IABP)-IABP
Group

•≤ 1 week post-LVAD implantation with current IABP support-IABP/LVAD Group

•≥ 3 mo post-LVAD placement and scheduled for LVAD speed optimization with
echocardiography.-Post-LVAD Group

- Post-LVAD placement with suspected GI hemorrhage or LVAD thrombosis-LVAD Event Group

4)Voluntary written informed consent before performance of any study-related
procedure not part of normal medical care, with the understanding that consent may be
withdrawn by the subject at any time without prejudice to future medical care.

Exclusion Criteria:

1. Clinical status will not permit pause of IABP (IABP and IABP/LVAD Groups)

2. Unable to undergo echo or oversewn or patched aortic valve (Post-LVAD Group)