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The impact of acute reduction of continuous-flow left ventricular assist device support on cardiac and exercise performance

Lookup NU author(s): Dr Djordje Jakovljevic

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Abstract

Objective: The use of the HeartMate II continuous-flow left ventricular assist device (LVAD) improves survival, quality of life, and functional capacity of patients with advanced heart failure. However, no study so far has shown the benefits of these devices in terms of cardiac function during peak exercise. The present study assessed cardiac and exercise performance in patients implanted with the HeartMate II LVAD under two settings (i) optimal device support and (ii) reduced device support. Methods: Twelve patients implanted with a HeartMate II LVAD performed a graded cardiopulmonary exercise test with respiratory gas exchange and noninvasive (rebreathing) haemodynamic measurements. Following a four hour resting period, patients performed an additional cardiopulmonary exercise test with reduced LVAD support (pump speed was reduced from optimal 9,000-9,600 to 6,000 revs/min). Results: In response to reduced HeartMate II LVAD support, resting cardiac power output and cardiac output decreased by 21% and 13% respectively. Also at reduced device support, peak exercise cardiac power output was 39% lower (1.40±0.50 vs 2.31±0.58 watts; p<0.05), peak cardiac output 30% lower (8.6±2.5 vs 12.2±2.1 l.min-1; p<0.05), and mean blood pressure 13% lower (74.3±15.4 vs 85.4±14.9 vs mmHg; p<0.05). Exercise capacity was also diminished with 23% lower peak oxygen consumption (14.1±5.3 vs 18.2±4.5 ml.kg-1.min-1; p<0.05) and an 18% shorter exercise duration (516±119 vs 628±192 seconds; p<0.05). Conclusion: We have shown for the first time that the HeartMate II LVAD can confer not only resting but also peak cardiac functional benefits to patients with end-stage heart failure thus producing an improved exercise capacity.


Publication metadata

Author(s): Jakovljevic DG, George RS, Nunan D, Donovan G, Bougard RS, Yacoub MH, Birks EJ, Brodie DA

Publication type: Article

Publication status: Published

Journal: Heart

Year: 2010

Volume: 96

Issue: 17

Pages: 1390-1395

Print publication date: 18/07/2010

ISSN (print): 1355-6037

ISSN (electronic): 1468-201X

Publisher: BMJ Group

URL: http://dx.doi.org/10.1136/hrt.2010.193698

DOI: 10.1136/hrt.2010.193698


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