Cardiopulmonary Performance Among Heart Failure Patients Before and After Left Ventricular Assist Device Implantation

Cole Buchanan; Collen Buchanan; Maeveen Riordan; Jessica Byrd; Margaret Schulte; Wendy M Kohrt; Amrut V Ambardekar; Larry A Allen; Gene Wolfel; Justin Lawley; Benjamin D Levine; William K Cornwell 3rd

doi:10.1016/j.jchf.2023.06.017

Cardiopulmonary Performance Among Heart Failure Patients Before and After Left Ventricular Assist Device Implantation

JACC Heart Fail. 2024 Jan;12(1):117-129. doi: 10.1016/j.jchf.2023.06.017. Epub 2023 Aug 23.

Affiliations

¹ Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
² Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
³ Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁴ Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Medicine-Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁵ Department of Sport Science, Division of Physiology, University of Innsbruck, Innsbruck, Austria.
⁶ Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, and the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, USA.
⁷ Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Electronic address: william.cornwell@cuanschutz.edu.

PMID: 37632493
DOI: 10.1016/j.jchf.2023.06.017

Abstract

Background: Patients with heart failure with reduced ejection fraction (HFrEF) have persistent impairments in functional capacity after continuous-flow left ventricular assist device (CF-LVAD) implantation.

Objectives: This study aims to characterize longitudinal changes in exercise hemodynamics and functional capacity among patients with HFrEF before and after CF-LVAD implantation.

Methods: Ten patients underwent 3 invasive cardiopulmonary exercise tests on upright cycle ergometry with pulmonary artery catheterization: 1) Visit 1 before CF-LVAD implantation; 2) Visit 2 after device implantation with CF-LVAD pump speed held constant at baseline speed; and 3) Visit 3 with increases in pump speed during exercise (median: 1,050 rpm [IQR: 750-1,150 rpm] and 220 rpm [IQR: 120-220 rpm] for HeartMate 3 and HeartWare VAD, respectively). Hemodynamics and direct Fick cardiac output were monitored using pulmonary artery catheterization. Gas exchange metrics were determined using indirect calorimetry.

Results: Maximal oxygen uptake (Visits 1, 2, and 3: 10.8 ± 2.5 mL/kg/min, 10.7 ± 2.2 mL/kg/min, and 11.5 ± 1.7 mL/kg/min; P = 0.92) did not improve after device implantation. Mean pulmonary arterial and pulmonary capillary wedge pressures increased significantly during submaximal and peak exercise on preimplantation testing (P < 0.01 for rest vs peak exercise) and remained elevated, with minimal change on Visits 2 and 3 regardless of whether pump speed was fixed or increased.

Conclusions: Among patients with HFrEF, cardiovascular hemodynamics and exercise capacity were similar after CF-LVAD implantation, regardless of whether patients exercised at fixed or adjusted pump speeds during exercise. Further research is needed to determine methods by which LVADs may alleviate the HFrEF syndrome after device implantation. (Effect of mechanIcal circulatoRy support ON exercise capacity aMong pAtieNts with heart failure [IRONMAN]; NCT03078972).

Keywords: exercise; heart failure with reduced ejection fraction; hemodynamics; left ventricular assist device.

Publication types

Clinical Study

MeSH terms

Cardiac Output
Exercise Test / methods
Heart Failure* / therapy
Heart-Assist Devices*
Hemodynamics
Humans
Stroke Volume
Ventricular Dysfunction, Left*
Ventricular Function, Left

Associated data

ClinicalTrials.gov/NCT03078972