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Left Ventricular Filling Pressures Contribute to Exercise Limitation in Patients with Continuous Flow Left Ventricular Assist Devices
- Source :
- ASAIO Journal. 66:247-252
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- We sought to determine hemodynamic mechanisms of exercise intolerance in a group of patients with the HeartWare ventricular assist device (VAD) compared to a group of heart failure patients. Twenty VAD and 22 heart failure patients underwent symptom-limited active straight leg raising exercise during right heart catheterization with thermodilution (TD), and upright cycling cardiopulmonary stress testing with cardiac output measurement by inert gas rebreathing (IGR) method. The TD and IGR exercise cardiac indexes were higher in VAD compared with heart failure group (both P < 0.05), although there was only a borderline increase in peak exercise oxygen consumption (VO2) (P = 0.06). Baseline and exercise right heart catheterization pressures were not significantly different between the two groups. The only significant independent predictors of peak VO2 in the heart failure group were exercise heart rate and cardiac index (both P < 0.05). In contrast, for the VAD group only, resting pulmonary arterial wedge and pulmonary arterial mean pressures were independently related to peak VO2 (both P < 0.05). Thus, in heart failure, exercise cardiac index is an important limitation to exercise capacity, and VADs increase exercise cardiac index. However, in VAD patients, this only produces limited benefits as increased pulmonary and pulmonary wedge pressures limit increases in exercise capacity.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Stress testing
Biomedical Engineering
Biophysics
Cardiac index
Hemodynamics
Bioengineering
Exercise intolerance
030204 cardiovascular system & hematology
Ventricular Function, Left
Biomaterials
03 medical and health sciences
Oxygen Consumption
0302 clinical medicine
Internal medicine
Heart rate
medicine
Humans
Exercise physiology
Exercise
Aged
Heart Failure
business.industry
General Medicine
Middle Aged
medicine.disease
030228 respiratory system
Heart failure
Ventricular assist device
Cardiology
Female
Heart-Assist Devices
medicine.symptom
business
Subjects
Details
- ISSN :
- 10582916
- Volume :
- 66
- Database :
- OpenAIRE
- Journal :
- ASAIO Journal
- Accession number :
- edsair.doi.dedup.....9c9565e2370f7cce8aa8ec7c7c21fbc6
- Full Text :
- https://doi.org/10.1097/mat.0000000000001073