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Assessment of Left-Sided Hemodynamics With Exercise in Patients With Continuous Flow Left Ventricular Assist Device
Sara S Inglis1,2, Sarah D Schettle3, Mauricio A Villavicencio3
1Deparment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Left heart catheterization (LHC) with exercise reveals improved left ventricular (LV) systolic and diastolic responses in patients with LVAD support. Understanding LV-LVAD interactions can enhance exercise tolerance through speed modulation.
Area of Science:
- Cardiology
- Medical Devices
- Exercise Physiology
Background:
- Left ventricular assist devices (LVADs) support patients with advanced heart failure.
- Assessing cardiac response to exercise in LVAD patients is crucial for management.
- Left heart catheterization (LHC) provides detailed hemodynamic data during activity.
Purpose of the Study:
- To evaluate left ventricular (LV) systolic and diastolic responses to exercise in LVAD patients.
- To compare these responses between patients undergoing hemodynamic optimization versus those considered for device weaning.
- To explore the relationship between LV-LVAD interaction and exercise capacity.
Main Methods:
- Retrospective review of adult patients undergoing LHC with exercise (June 2017-June 2023).
- Patients divided into hemodynamic optimization (Optim) and weaning consideration (Wean) cohorts.
- Analysis of LV systolic and diastolic parameters, including LV systolic work index (LVSWI) and LV end-diastolic pressure (LVEDP).
Main Results:
- Eight patients included (88% male, median age 57).
- The Wean cohort showed a more rapid increase in LVSWI over exercise levels compared to the Optim cohort (p=0.044).
- LVSWI rose more quickly at lower LVEDP in the Wean group (p=0.0026), with a trend towards higher pulse power index.
Conclusions:
- Patients with favorable remodeling on LVAD support demonstrate enhanced LV systolic and diastolic responses to exercise.
- Higher systemic pulsatility was observed in these patients.
- Further understanding of LV-LVAD interactions during activity may guide strategies for improving exercise tolerance via LVAD speed modulation.
Background:
Addition of left heart catheterization (LHC) to exercise protocols allows for a unique focus on parameters of systolic and diastolic responses to increased activity in patients with left ventricular assist device (LVAD) support.
Methods:
A retrospective review was conducted of all consecutive adult patients who underwent LHC with exercise for any indication from June 2017 to June 2023. For all patients, the relationship between exercise and parameters of LV systolic and diastolic response was assessed. Patients were divided into two cohorts based on the indication for testing: hemodynamic optimization (Optim, n = 5) or weaning consideration (Wean, n = 3).
Results:
Eight patients (88% male, median age 57 years (IQR 44, 65)) were included. LVEF was 45% (IQR 45, 56) in Wean and 25% (IQR 20, 42) in Optim. LV systolic work index (LVSWI) increased more rapidly over levels of exercise in Wean vs. Optim (slope 46.3 vs. -0.625; p = 0.044) and LVSWI rose more quickly at lower levels of LV end diastolic pressure (LVEDP) in Wean vs. Optim (slope 219.5 vs. -2.008; p = 0.0026). Pulse power index was higher in Wean patients at baseline (0.046 (IQR 0.04, 0.07) vs. 0.016 (IQR 0.001, 0.04); p = 0.14) and peak exercise (0.12 (IQR 0.12, 0.12) vs. 0.06 (IQR 0.03, 0.1); p = 0.29).
Conclusions:
Patients with favorable remodeling on LVAD support have significantly improved LV systolic and diastolic responses to exercise and a trend of higher systemic pulsatility. Improving our understanding of LV-LVAD interactions with activity may aid in future efforts to improve exercise tolerance through speed modulation.
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