Echo-guided left ventricular assist device speed optimisation for exercise maximisation
Maciej Stapor1, Adam Pilat2, Andrzej Gackowski3
1Department of Interventional Cardiology, John Paul II Hospital, Krakow, Malopolska, Poland m.stapor@szpitaljp2.krakow.pl.
Heart (British Cardiac Society)
|March 22, 2022
Summary
Optimizing left ventricular assist device (LVAD) speed based on aortic valve opening (AVO) during exercise tests significantly improves patient exercise tolerance. This dynamic adjustment enhances peak oxygen consumption and workload capacity in LVAD patients.
Area of Science:
- Cardiovascular Engineering
- Medical Device Technology
- Exercise Physiology
Background:
- Current left ventricular assist devices (LVADs) lack automated speed adjustment, operating at fixed rates.
- Physiological optimization of LVAD function during exercise remains a challenge.
Purpose of the Study:
- To evaluate the feasibility and impact of dynamic LVAD speed adjustment guided by aortic valve opening (AVO) during cardiopulmonary exercise tests (CPETs).
Main Methods:
- A prospective crossover study involving 22 patients with third-generation LVADs.
- LVAD speed was dynamically adjusted during CPETs to maintain periodic AVO.
- Comparison between fixed-speed and dynamically adjusted speed protocols.
Main Results:
- Exertional AVO assessment was feasible in all participants.
- Dynamic speed adjustment safely increased LVAD speed from 2900 to 3440 RPM (p<0.001).
- Peak oxygen consumption increased by 15% (p<0.001), maximum workload by 9% (p=0.028), and perceived exertion decreased (p=0.005).
Conclusions:
- Transthoracic echocardiography for AVO assessment is viable during CPETs in LVAD patients.
- Dynamic, echo-guided LVAD speed adjustment based on AVO improves exercise tolerance.
- This approach enhances peak oxygen consumption and maximum workload in patients with LVADs.
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