TY - JOUR
T1 - Right ventricular function and cardiopulmonary performance among patients with heart failure supported by durable mechanical circulatory support devices
AU - Tran, Tomio
AU - Muralidhar, Akshay
AU - Hunter, Kendall
AU - Buchanan, Cullen
AU - Coe, Greg
AU - Hieda, Michinari
AU - Tompkins, Christine
AU - Zipse, Matthew
AU - Spotts, Melanie J.
AU - Laing, Stephanie G.
AU - Fosmark, Kristina
AU - Hoffman, Jordan
AU - Ambardekar, Amrut V.
AU - Wolfel, Eugene E.
AU - Lawley, Justin
AU - Levine, Benjamin
AU - Kohrt, Wendy M.
AU - Pal, Jay
AU - Cornwell, William K.
N1 - Funding Information:
W.K.C. III has received funding by the National Institutes of Health /National Heart, Lung, and Blood Institute Mentored Patient-Oriented Research Career Development Award ( #1K23HLI32048-01 ) as well as the National Institutes of Health /National Center for Advancing Translational Sciences (#UL1TR002535), Susie and Kurt Lochmiller Distinguished Heart Transplant Fund, the Clinical Translational Science Institute at the University of Colorado Anschutz Medical Campus , and Medtronic Inc . M.H. has been supported by an American Heart Association post-doctoral fellowship grant (18POST33960092) and the Harry S. Moss Heart Trust. J.P. has received funding by Medtronic Inc . and is a consultant for Medtronic Inc. W.K.C. III has received research funding from Medtronic Inc., is a consultant for Medtronic Inc., and serves on a steering committee sponsored by Medtronic Inc. The remaining authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2020 International Society for Heart and Lung Transplantation
PY - 2021/2
Y1 - 2021/2
N2 - BACKGROUND: Patients with continuous-flow left ventricular assist devices (CF-LVADs) experience limitations in functional capacity and frequently, right ventricular (RV) dysfunction. We sought to characterize RV function in the context of global cardiopulmonary performance during exercise in this population. METHODS: A total of 26 patients with CF-LVAD (aged 58 ± 11 years, 23 males) completed a hemodynamic assessment with either conductance catheters (Group 1, n = 13) inserted into the right ventricle to generate RV pressure‒volume loops or traditional Swan‒Ganz catheters (Group 2, n = 13) during invasive cardiopulmonary exercise testing. Hemodynamics were collected at rest, 2 sub-maximal levels of exercise, and peak effort. Breath-by-breath gas exchange parameters were collected by indirect calorimetry. Group 1 participants also completed an invasive ramp test during supine rest to determine the impact of varying levels of CF-LVAD support on RV function. RESULTS: In Group 1, pump speed modulations minimally influenced RV function. During upright exercise, there were modest increases in RV contractility during sub-maximal exercise, but there were no appreciable increases at peak effort. Ventricular‒arterial coupling was preserved throughout the exercise. In Group 2, there were large increases in pulmonary arterial, left-sided filling, and right-sided filling pressures during sub-maximal and peak exercises. Among all participants, the cardiac output‒oxygen uptake relationship was preserved at 5.8:1. Ventilatory efficiency was severely abnormal at 42.3 ± 11.6. CONCLUSIONS: Patients with CF-LVAD suffer from limited RV contractile reserve; marked elevations in pulmonary, left-sided filling, and right-sided filling pressures during exercise; and severe ventilatory inefficiency. These findings explain mechanisms for persistent reductions in functional capacity in this patient population.
AB - BACKGROUND: Patients with continuous-flow left ventricular assist devices (CF-LVADs) experience limitations in functional capacity and frequently, right ventricular (RV) dysfunction. We sought to characterize RV function in the context of global cardiopulmonary performance during exercise in this population. METHODS: A total of 26 patients with CF-LVAD (aged 58 ± 11 years, 23 males) completed a hemodynamic assessment with either conductance catheters (Group 1, n = 13) inserted into the right ventricle to generate RV pressure‒volume loops or traditional Swan‒Ganz catheters (Group 2, n = 13) during invasive cardiopulmonary exercise testing. Hemodynamics were collected at rest, 2 sub-maximal levels of exercise, and peak effort. Breath-by-breath gas exchange parameters were collected by indirect calorimetry. Group 1 participants also completed an invasive ramp test during supine rest to determine the impact of varying levels of CF-LVAD support on RV function. RESULTS: In Group 1, pump speed modulations minimally influenced RV function. During upright exercise, there were modest increases in RV contractility during sub-maximal exercise, but there were no appreciable increases at peak effort. Ventricular‒arterial coupling was preserved throughout the exercise. In Group 2, there were large increases in pulmonary arterial, left-sided filling, and right-sided filling pressures during sub-maximal and peak exercises. Among all participants, the cardiac output‒oxygen uptake relationship was preserved at 5.8:1. Ventilatory efficiency was severely abnormal at 42.3 ± 11.6. CONCLUSIONS: Patients with CF-LVAD suffer from limited RV contractile reserve; marked elevations in pulmonary, left-sided filling, and right-sided filling pressures during exercise; and severe ventilatory inefficiency. These findings explain mechanisms for persistent reductions in functional capacity in this patient population.
UR - http://www.scopus.com/inward/record.url?scp=85097448175&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85097448175&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2020.11.009
DO - 10.1016/j.healun.2020.11.009
M3 - Article
C2 - 33281029
AN - SCOPUS:85097448175
SN - 1053-2498
VL - 40
SP - 128
EP - 137
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 2
ER -