Exercise capacity in ventricular assist device patients: clinical relevance of pump speed and power

Fresiello, Libera; Buys, Roselien; Timmermans, Philippe; Vandersmissen, Katrien; Jacobs, Steven; Droogné, Walter; Ferrari, Gianfranco; Rega, Filip; Meyns, Bart

doi:10.1093/ejcts/ezw147

Cited by 26 publications

(39 citation statements)

References 14 publications

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“…C. AV open at peak exercise (Response type 1 with AV open): This category will include the most patients and benefits with speed increase will most probably result in outcomes similar to previous studies [23][24][25][26][27]36].…”

Section: Plos Onementioning

confidence: 97%

“…The parameter Q MEAN is calculated over the whole cardiac cycle and therefore an indicator for overall hemodynamic changes rather than particular cardiovascular impairments. Generally, due to the instantaneous increase in preload with dynamic exercises a sudden increase of Q MEAN can be observed [4,32,[34][35][36]. However Q MEAN can increase to a different extent according to the residual ventricular contractility, LVAD speed setting as well as other parameters.…”

Section: Plos One Plos Onementioning

confidence: 99%

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Hemodynamic exercise responses with a continuous-flow left ventricular assist device: Comparison of patients’ response and cardiorespiratory simulations

et al. 2020

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Background Left ventricular assist devices (LVADs) are an established treatment for end stage heart failure patients. As LVADs do not currently respond to exercise demands, attention is also directed towards improvements in exercise capacity and resulting quality of life. The aim of this study was to explore hemodynamic responses observed during maximal exercise tests to infer underlying patient status and therefore investigate possible diagnostics from LVAD derived data and advance the development of physiologically adaptive LVAD controllers. Methods High resolution continuous LVAD flow waveforms were recorded from 14 LVAD patients and evaluated at rest and during maximum bicycle exercise tests (n = 24). Responses to exercise were analyzed in terms of an increase (") or decrease (#) in minimum (Q MIN), mean (Q MEAN), maximum flow (Q MAX) and flow pulsatility (Q P2P). To interpret clinical data, a cardiorespiratory numerical simulator was used that reproduced patients' hemodynamics at rest and exercise. Different cardiovascular scenarios including chronotropic and inotropic responses, peripheral vasodilation, and aortic valve pathologies were simulated systematically and compared to the patients' responses. Results Different patients' responses to exercise were observed. The most common response was a positive change of ΔQ MIN " and ΔQ P2P " from rest to exercise (70% of exercise tests). Two

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Section: Plos Onementioning

confidence: 97%

Section: Plos One Plos Onementioning

confidence: 99%

Hemodynamic exercise responses with a continuous-flow left ventricular assist device: Comparison of patients’ response and cardiorespiratory simulations

et al. 2020

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“…Dependencies between low LVAD speed (below baseline value) and reduced exercise capacities were found in the previous clinical studies . However, other studies investigating the effects of an LVAD speed increase under exertion, reported moderate to no improvements in terms of exercise capacity or TCO . Given the large patient diversity in terms of cardiovascular impairments, the benefits of an increased LVAD speed during exercise are still unclear.…”

Section: Introductionmentioning

confidence: 82%

“…3,4,9 Noor et al 6 observed that patients with a residual LV contractility are able to better accommodate an increase in TCO, resulting in higher exercise capacities. Fresiello et al 8 reported that LVAD power increased less at peak exertion in patients with better exercise capacity, indicating a possible increase in TCO mostly at the expenses of the LV. In addition, Gross et al 3 reported the importance of the cardiac response during exercise by observing correlations of peak oxygen consumption with HR and AV status, whereas Q LVAD showed no correlation.…”

Section: Evolution Of Tco In Different Exercise Profilesmentioning

confidence: 99%

“…5,6 However, other studies investigating the effects of an LVAD speed increase under exertion, reported moderate to no improvements in terms of exercise capacity or TCO. [7][8][9][10][11][12][13] Given the large patient diversity in terms of cardiovascular impairments, the benefits of an increased LVAD speed during exercise are still unclear.…”

Section: Introductionmentioning

confidence: 99%

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LVAD speed increase during exercise, which patients would benefit the most? A simulation study

et al. 2019

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Patients supported with a left ventricular assist device (LVAD) have impaired cardiovascular adaptations during exercise, resulting in reduced total cardiac output and exercise intolerance. The aim of this study is to report associations among these impaired cardiovascular parameters and exercise hemodynamics, and to identify in which conditions an LVAD speed increase can provide substantial benefits to exercise. A cardiorespiratory simulator was used to reproduce the average hemodynamics of LVAD patients at exercise. Then, a sensitivity study was conducted where cardiovascular parameters were changed individually ±20% of their baseline value at exercise (heart rate, left/right ventricular contractility, total peripheral resistance, and valve pathologies). Simulations were performed at a baseline LVAD speed of 2700 rpm and repeated at 3500 rpm to evaluate the benefits of a higher LVAD support on hemodynamics. Total cardiac output (TCO) was mostly impaired by a poor left ventricular contractility or vasodilation at exercise (−0.6 L/min), followed by a poor chronotropic response (−0.3 L/min) and by a poor right ventricular contractility (−0.2 L/min). LVAD speed increase better unloads the left ventricle and improves total cardiac output in all the simulated conditions. The most substantial benefits from LVAD speed increase were observed in case of poor left ventricular contractility (TCO + 1.6 L/min) and vascular dysfunction (TCO + 1.4 L/min) followed by lower heart rate (TCO + 1.3 L/min) and impaired right ventricular contractility (TCO + 1.1 L/min). Despite the presence of the LVAD, exercise hemodynamic is strongly depending on the ability of the cardiovascular system to adapt to exercise. A poor left ventricular inotropic response and a poor vascular function can strongly impair cardiac output at exercise. In these conditions, LVAD speed increase can be an effective strategy to augment total cardiac output and unload the left ventricle. These results evidence the need to design a physiological LVAD speed controller, tailored on specific patient’s needs.

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Current Limitations and Characteristics of Next‐Generation Ventricular Assist Devices

Kaku,

Naka,

Burkhoff

2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Exercise capacity in ventricular assist device patients: clinical relevance of pump speed and power

Abstract: Although VAD speed increase provided an additional pump flow of 1.6 l/min at peak exercise, no significant objective and subjective benefits on patients' exercise performance were observed. Finally, VAD power could be a useful parameter to monitor patients during exercise.

Cited by 26 publications

References 14 publications

Hemodynamic exercise responses with a continuous-flow left ventricular assist device: Comparison of patients’ response and cardiorespiratory simulations

Hemodynamic exercise responses with a continuous-flow left ventricular assist device: Comparison of patients’ response and cardiorespiratory simulations

LVAD speed increase during exercise, which patients would benefit the most? A simulation study

Current Limitations and Characteristics of Next‐Generation Ventricular Assist Devices

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