Relationship between pump speed and exercise capacity during HeartMate II left ventricular assist device support: influence of residual left ventricular function

Eur J Heart Fail. 2012 Jun;14(6):613-20. doi: 10.1093/eurjhf/hfs042. Epub 2012 Apr 14.

Abstract

Aims: Patients treated with a Thoratec HeartMate II left ventricular assist device (LVAD) are supported at a fixed pump speed. It is uncertain whether pump speed has a significant effect on exercise capacity. We investigated the relationship between pump speed and exercise capacity and the influence of residual LV function

Methods and results: We exercised 30 patients 6 months after HeartMate II implantation at clinical pump speed (typically 9000 r.p.m.) and again at the lowest speed available (6000 r.p.m.). Overall, peak oxygen uptake (pkVO(2)) positively correlated with LV ejection fraction (LVEF) both at the clinical pump speed (r = 0.41, P = 0.03) and after pump speed reduction (r = 0.50, P = 0.01). We divided the patients into two groups; those with higher LVEF (LVEF ≥40%) and those with lower LVEF (LVEF <40%) at the time of exercise testing. The response to speed change was different between the two groups. In the higher LVEF group, the impact of LVAD pump speed reduction was minimal (pkVO(2) 21.4 ± 4.8 mL/kg/min vs. 20.8 ± 5.5 mL/kg/min, P = 0.38). In the lower LVEF group, the pkVO(2) was lower at both speeds; 17.2 ± 5.3 and 14.7 ± 5.9 mL/kg/min, respectively. In the lower LVEF group, the pkVO(2) decreased by 2.5 mL/kg/min (P = 0.02) with speed reduction.

Conclusions: HeartMate II patients with lower residual LV function had a lower pkVO(2) and were more sensitive to pump speed reduction. This suggests that modulation of LVAD speed during exercise could be of benefit to this group of patients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Pressure
  • Echocardiography
  • Exercise Test
  • Exercise Tolerance*
  • Female
  • Heart Failure / diagnostic imaging
  • Heart Failure / drug therapy
  • Heart Failure / therapy*
  • Heart Rate
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / pathology*
  • Heart-Assist Devices*
  • Humans
  • Male
  • Middle Aged
  • Oxygen Consumption
  • Statistics as Topic
  • Stroke Volume
  • Time Factors
  • Ventricular Function, Left*
  • Young Adult