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Correction of High Afterload Improves Low Cardiac Output in Patients Supported on Left Ventricular Assist Device

Andrew N Rosenbaum1, Alfredo L Clavell1,2, John M Stulak3

  • 1From the Department of Cardiovascular Diseases.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|April 1, 2020
PubMed

Insights

High afterload is common in patients with left ventricular assist devices (LVADs). Nitrates can improve cardiac output in hypertensive LVAD patients, suggesting vasodilator therapy benefits.

Area of Science:

  • Cardiovascular Medicine
  • Medical Devices
  • Hemodynamics

Background:

  • Limited data exists on invasive afterload assessment in left ventricular assist device (LVAD) patients.
  • Understanding afterload's influence on cardiac output is crucial for LVAD therapy optimization.

Purpose of the Study:

  • To invasively assess afterload and its impact on cardiac output in LVAD patients.
  • To evaluate the effectiveness of speed optimization and vasodilator therapy in managing high afterload.

Main Methods:

  • Simultaneous left/right heart catheterization ramp studies were performed on 31 LVAD patients (2015-2018).
  • Hemodynamic parameters, including mean aortic pressure (MAP) and cardiac index (CI), were analyzed.
  • Patients with hypertension received nitrate therapy for evaluation.

Main Results:

  • Elevated baseline mean central aortic pressure (MAP) was observed (87 ± 13 mm Hg).
  • No direct association was found between MAP and cardiac index (CI) (r = 0.11, p = 0.20).
  • High afterload (MAP > 90 mm Hg) was associated with poor response to speed optimization.
  • Nitrate therapy in hypertensive patients improved biventricular filling pressures and increased CI by 22% (p = 0.04).

Conclusions:

  • High afterload is prevalent in LVAD patients and negatively impacts cardiac output response.
  • Nitrates effectively ameliorate high afterload, improving cardiac function in hypertensive LVAD patients.
  • Findings support further research into chronic vasodilator therapy for managing afterload in LVAD support.

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