Peripheral Vascular Reactivity in Patients With Pulsatile vs Axial Flow Left Ventricular Assist Device Support

Amir, Offer; Radovančević, Branislav; Delgado, Reynolds M.; Kar, Biswajit; Radovancevic, Rajko; Henderson, Maria; Cohn, William E.; Smart, Frank W.

doi:10.1016/j.healun.2005.11.439

Cited by 96 publications

(63 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For example, reduced pulsatility at the same mean flow leads to reduced shear stress, which may reduce nitric oxide (NO) production and impair endothelial function. 17 Not only will reduced NO decrease endothelial vasodilation, but it also has been shown to increase sympathetic activity in humans. 18 Third, humoral factors (ie, angiotensin II, aldosterone, etc.)…”

Section: Mechanisms For Sympathetic Activation With Nonpulsatile Flowmentioning

confidence: 99%

Sympathetic Neural and Hemodynamic Responses to Upright Tilt in Patients With Pulsatile and Nonpulsatile Left Ventricular Assist Devices

Markham

Palmer

et al. 2013

Circ: Heart Failure

100

View full text Add to dashboard Cite

Background— Left ventricular assist devices (LVADs) are now widely accepted as an option for patients with advanced heart failure. First-generation devices were pulsatile, but they had poor longevity and durability. Newer generation devices are nonpulsatile and more durable, but remain associated with an increased risk of stroke and hypertension. Moreover, little is understood about the physiological effects of the chronic absence of pulsatile flow in humans. Methods and Results— We evaluated patients with pulsatile (n=6) and nonpulsatile (n=11) LVADs and healthy controls (n=9) during head-up tilt while measuring hemodynamics and muscle sympathetic nerve activity. Patients with nonpulsatile devices had markedly elevated supine and upright muscle sympathetic nerve activity (mean±SD, 43±15 supine and 60±21 bursts/min at 60° head-up tilt) compared with patients with pulsatile devices (24±7 and 35±8 bursts/min; P <0.01) and controls (11±6 and 31±6 bursts/min; P <0.01); however, muscle sympathetic nerve activity was not different between patients with pulsatile flow and controls ( P =0.34). Heart rate, mean arterial pressure, and total peripheral resistance were greater, whereas cardiac output was smaller, in LVAD patients compared with controls in both supine and upright postures. However, these hemodynamic variables were not significantly different between patients with pulsatile and nonpulsatile flow. Conclusions— Heart failure patients with continuous, nonpulsatile LVADs have marked sympathetic activation, which is likely due, at least in part, to baroreceptor unloading. We speculate that such chronic sympathetic activation may contribute to, or worsen end-organ diseases, and reduce the possibility of ventricular recovery. Strategies to provide some degree of arterial pulsatility, even in continuous flow LVADs may be necessary to achieve optimal outcomes in these patients.

show abstract

Section: Mechanisms For Sympathetic Activation With Nonpulsatile Flowmentioning

confidence: 99%

Sympathetic Neural and Hemodynamic Responses to Upright Tilt in Patients With Pulsatile and Nonpulsatile Left Ventricular Assist Devices

Markham

Palmer

et al. 2013

Circ: Heart Failure

100

View full text Add to dashboard Cite

show abstract

“…Moreover in the above mentioned work [5] only 1 out of 10 axial LVAD was of the kind implanted in our patient.…”

Section: Discussionmentioning

confidence: 95%

“…[5] with FMD measured in 10 patients with pulsatile flow LVAD and in 10 patients with axial flow LVAD; they assessed that only pulsatile flow LVAD patients showed normal endothelial function while axial LVAD patients had a significantly reduced endothelial function.…”

Section: Discussionmentioning

confidence: 99%

Flow mediated dilation in patient with Berlin Heart Incor left ventricle assist device

Genta

Colajanni

Sbarra

et al. 2016

Monaldi Arch Chest Dis

View full text Add to dashboard Cite

Endothelial function measured with brachial ultrasound (BU) is a validated prognostic factor in heart failure patients. LVAD (left ventricle assist device) application is a promising surgical technique to treat refractory heart failure patients both as a bridge to heart transplantation or as destination therapy. Clinical recovery in such patients may be associated to normal endothelial function measured by BU but, as recently reported, only in pulsatile flow LVAD patients. The present paper report a case of normal endothelial function even in a axial LVAD patient.

show abstract

“…49 Clinical studies are limited but suggestive of worsening endothelial function with CF-LVADs utilizing flow-mediated vasodilation 50 and reactive hyperemia index. 16 In some studies, endothelial cell-derived microparticlessmall cell vesicles shed during cell activation and apoptosis-were documented in the peripheral blood, suggesting inflammation and cell damage.…”

Section: Endothelial Functionmentioning

confidence: 99%

Physiological Impact of Continuous Flow on End-Organ Function: Clinical Implications in the Current Era of Left Ventricular Assist Devices

Bhimaraj¹,

Uribe²,

Suarez

2015

Methodist DeBakey Cardiovascular Journal

View full text Add to dashboard Cite

Peripheral Vascular Reactivity in Patients With Pulsatile vs Axial Flow Left Ventricular Assist Device Support

Cited by 96 publications

References 26 publications

Sympathetic Neural and Hemodynamic Responses to Upright Tilt in Patients With Pulsatile and Nonpulsatile Left Ventricular Assist Devices

Sympathetic Neural and Hemodynamic Responses to Upright Tilt in Patients With Pulsatile and Nonpulsatile Left Ventricular Assist Devices

Flow mediated dilation in patient with Berlin Heart Incor left ventricle assist device

Physiological Impact of Continuous Flow on End-Organ Function: Clinical Implications in the Current Era of Left Ventricular Assist Devices

Contact Info

Product

Resources

About