Faculty Collaboration Database

Determinants of Improvement in Cardiopulmonary Exercise Testing After Left Ventricular Assist Device Implantation. ASAIO J 2018;64(5):610-615

Date

10/19/2017

Pubmed ID

29045277

DOI

10.1097/MAT.0000000000000693

Scopus ID

2-s2.0-85052840902 (requires institutional sign-in at Scopus site)   26 Citations

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.

Author List

Rosenbaum AN, Dunlay SM, Pereira NL, Allison TG, Maltais S, Stulak JM, Joyce LD, Kushwaha SS

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Cardiac Output
Exercise
Exercise Test
Female
Heart Failure
Heart-Assist Devices
Hemodynamics
Humans
Male
Middle Aged
Oxygen Consumption
Ventricular Function, Left
Ventricular Function, Right