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Cerebral vasoreactivity in HeartMate 3 patients
Eric J Stöhr1, Ruiping Ji2, Koichi Akiyama3
1School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom; Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York.
Insights
The HeartMate3 (HM3) continuous-flow left ventricular assist device (CF-LVAD) shows improved cerebrovascular reactivity (CVR) compared to the HeartMate II (HMII). However, CVR remains lower than in healthy individuals, indicating incomplete reversal of cerebral hemodynamic changes.
Area of Science:
- Cardiovascular Science
- Neurology
- Biomedical Engineering
Background:
- Continuous-flow left ventricular assist devices (CF-LVADs) like HeartMate3 (HM3) have reduced stroke rates.
- The impact of non-pulsatile flow and artificial pulse physiology on cerebrovascular function in HM3 patients is not well understood.
- Cerebrovascular metabolic reactivity (CVR) may be affected by CF-LVADs.
Purpose of the Study:
- To compare cerebrovascular metabolic reactivity (CVR) in patients with HeartMate3 (HM3) CF-LVADs versus HeartMate II (HMII) CF-LVADs and heart failure (HF) patients.
- To investigate the effect of HM3's improved hemodynamics and artificial pulse on CVR.
- To assess cerebrovascular function using breath-hold challenges.
Main Methods:
- Ninety participants (24 healthy controls, 30 HF, 15 HMII, 21 HM3) underwent transcranial Doppler ultrasound.
- Cerebral blood flow velocities (MFV, PSV, MinFV) and pulsatility index in the middle cerebral artery (MCA) were measured.
- A 30-second breath-hold challenge was used to assess cerebrovascular metabolic reactivity (CVR).
Main Results:
- HM3 patients demonstrated significantly improved CVR compared to HMII patients after a breath-hold challenge.
- HM3 patients' CVR was similar to HF patients but lower than healthy controls.
- CF-LVAD pump speed was inversely associated with CVR in HMII patients, but not in HM3 patients.
Conclusions:
- The HeartMate3 (HM3) CF-LVAD is associated with improved cerebrovascular reactivity (CVR) compared to the HeartMate II (HMII).
- Despite improvements, CVR in HM3 and HF patients remains lower than in healthy controls, suggesting incomplete reversal of cerebral hemodynamic alterations.
- Further research is needed to understand the mechanisms and long-term effects of altered cerebral hemodynamics in CF-LVAD patients.
Background:
While rates of stroke have declined with the HeartMate3 (HM3) continuous- flow (CF) left ventricular assist device (LVAD), the impact of non-pulsatile flow and artificial pulse physiology on cerebrovascular function is not known. We hypothesized that improved hemodynamics and artificial pulse physiology of HM3 patients would augment cerebrovascular metabolic reactivity (CVR) compared with HeartMate II (HMII) CF-LVAD and heart failure (HF) patients.
Methods:
Mean, peak systolic and diastolic flow velocities (MFV, PSV, MinFV, respectively) and cerebral pulsatility index were determined in the middle cerebral artery (MCA) before and after a 30 sec breath-hold challenge in 90 participants: 24 healthy controls; 30 HF, 15 HMII, and 21 HM3 patients.
Results:
In HM3 patients, breath-holding increased MFV (Δ8 ± 10 cm/sec, p < .0001 vs baseline) to levels similar to HF patients (Δ9 ± 8 cm/sec, p > .05), higher than HMII patients (Δ2 ± 8 cm/sec, p < .01) but lower than healthy controls (Δ13 ± 7 cm/sec, p < .05). CF-LVAD altered the proportion of systolic and diastolic flow responses as reflected by a differential cerebral pulsatility index (p = .03). Baseline MFV was not related to CVR (r2 = 0.0008, p = .81). However, CF-LVAD pump speed was strongly inversely associated with CVR in HM II (r2 = 0.51, p = .003) but not HM3 patients (r2 = 0.01, p = .65).
Conclusions:
Compared with HMII, HM3 patients have a significantly improved CVR. However, CVR remains lower in HM3 and HF patients than in healthy controls, therefore suggesting that changes in cerebral hemodynamics are not reversed by CF-LVAD therapy. Further research on the mechanisms and the long-term impact of altered cerebral hemodynamics in this unique patient population are warranted.
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