Determinants of improvement in cardiopulmonary exercise testing after left ventricular assist device implantation

Andrew N. Rosenbaum, Shannon M Dunlay, Naveen Luke Pereira, Thomas G. Allison, Simon Maltais, John M. Stulak, Lyle D. Joyce, Sudhir S. Kushwaha

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Although improvement in cardiac output and hemodynamic parameters is routinely demonstrated in patients implanted with continuous-flow left ventricular assist devices (CF-LVADs), improvement in exercise capacity is inconsistently seen. Our purpose was to determine whether native cardiac factors, LVAD factors, or comorbid factors were associated with lack of improvement. Review of all patients undergoing preimplant cardiopulmonary exercise testing (CPET) and CPET on LVAD therapy at one institution was performed between 2007 and 2014 (n = 49). Comprehensive assessment of echocardiographic parameters, right heart catheterization data, medications, and comorbid illness was undertaken. There was no mean improvement in peak oxygen consumption (VO2; 11.8–12.4 ml/kg/min; p = 0.26), although exercise time (5.1 [46% predicted] to 5.8 min [56% predicted]; p = 0.02) and nadir of the ratio of minute ventilation to carbon dioxide production slope (VE/VCO2; 39–36; p = 0.001) improved. Factors most strongly associated with improvement in VO2 were Heartmate II pulsatility index (PI; R = 0.48; p = 0.001), power (R = −0.40; p = 0.009), pump flow (R = −0.40; p = 0.008), and pump speed (R = −0.32; p = 0.04). Peak heart rate (HR) was also associated with improvement in VO2 (R = 0.41; p = 0.004). Left ventricular ejection fraction (LVEF; R = 0.004; p = 0.77), right ventricular (RV) function (R = 0.22; p = 0.28), and aortic valve opening (R = 0.20; p = 0.57) were not associated with improvement in VO2. Our data suggest that less reliance on LVAD support was modestly associated with improvement in exercise capacity. Further studies should seek to determine the optimal level of device support prospectively in relation to exercise capacity. ASAIO Journal 2018; 64:610–615.

Original languageEnglish (US)
Pages (from-to)610-615
Number of pages6
JournalASAIO Journal
Volume64
Issue number5
DOIs
StatePublished - Jan 1 2018

Fingerprint

Left ventricular assist devices
Heart-Assist Devices
Pumps
Exercise
Hemodynamics
Testing
Carbon Dioxide
Ventilation
Carbon dioxide
Oxygen
Right Ventricular Function
Cardiac Catheterization
Aortic Valve
Oxygen Consumption
Cardiac Output
Stroke Volume
Heart Rate
Equipment and Supplies

Keywords

  • Cardiopulmonary exercise testing
  • Left ventricular assist device
  • LVAD support
  • Optimization

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

Cite this

Determinants of improvement in cardiopulmonary exercise testing after left ventricular assist device implantation. / Rosenbaum, Andrew N.; Dunlay, Shannon M; Pereira, Naveen Luke; Allison, Thomas G.; Maltais, Simon; Stulak, John M.; Joyce, Lyle D.; Kushwaha, Sudhir S.

In: ASAIO Journal, Vol. 64, No. 5, 01.01.2018, p. 610-615.

Research output: Contribution to journalArticle

Rosenbaum, Andrew N. ; Dunlay, Shannon M ; Pereira, Naveen Luke ; Allison, Thomas G. ; Maltais, Simon ; Stulak, John M. ; Joyce, Lyle D. ; Kushwaha, Sudhir S. / Determinants of improvement in cardiopulmonary exercise testing after left ventricular assist device implantation. In: ASAIO Journal. 2018 ; Vol. 64, No. 5. pp. 610-615.
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