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Arterial-wave reflections are increased in heart failure patients with a left-ventricular assist device

Richard S Schofield1, Gary L Pierce, Wilmer W Nichols

  • 1Department of Veterans Affairs Medical Center, Gainesville, Florida, USA. schofrs@medicine.ufl.edu

American Journal of Hypertension
|May 29, 2007
PubMed

Insights

Left-ventricular assist device (LVAD) therapy increases central arterial pulse-wave reflections in heart failure patients, raising aortic augmented pressure and augmentation index. This hemodynamic load impacts LVAD management and device longevity.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Hemodynamics

Background:

  • Chronic heart failure (HF) is linked to elevated central arterial pulse-wave reflections, potentially increasing myocardial oxygen demand.
  • Left-ventricular assist device (LVAD) therapy is a common treatment for HF, but its impact on arterial pulse-wave reflections remains unstudied.

Purpose of the Study:

  • To investigate the effects of LVAD support on central arterial pulse-wave reflections in patients with end-stage heart failure.
  • To compare pulse-wave analysis data between LVAD patients, patients on inotropic drugs, and healthy controls.

Main Methods:

  • Central aortic pulse-wave analysis was conducted using the SphygmoCor system.
  • Data were collected from five end-stage HF patients on LVAD support, ten patients on intravenous inotropic drugs, and ten healthy controls.

Main Results:

  • LVAD patients exhibited higher aortic augmented pressure and augmentation index (AI(a)) compared to inotropic and control groups.
  • The AI(a) was significantly higher in LVAD patients (28.2%) versus inotropic patients (7.9%).
  • LVAD patients showed a significantly higher aortic systolic tension time index, indicating increased myocardial oxygen demand.

Conclusions:

  • LVAD support increases central arterial pulse-wave reflection in end-stage HF patients, elevating aortic augmented pressure and AI(a).
  • The elevated AI(a) in LVAD patients compared to healthy controls suggests a significant hemodynamic alteration.
  • Increased arterial wave reflection imposes a hemodynamic load on LVADs, potentially affecting device management and longevity.
Abstract

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