Author + information
- Received September 4, 2019
- Revision received October 9, 2019
- Accepted October 10, 2019
- Published online March 30, 2020.
- Noah Moss, MDa,
- Val Rakita, MDa,
- Anuradha Lala, MDa,b,
- Adi Parikh, MDa,
- Julie Roldan, RNa,
- Sumeet S. Mitter, MDa,
- Anelechi Anyanwu, MDc,
- Michelle Campolia,
- Dan Burkhoff, MD, PhDd and
- Donna M. Mancini, MDa,b,∗ ()
- aDivision of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- bInternational Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- cDivision of Cardiothoracic Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
- dCardiovascular Research Foundation, New York, New York
- ↵∗Address for correspondence:
Dr. Donna M. Mancini, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, New York 10029.
Objectives This study sought to characterize the hemodynamic response to exercise in LVAD-supported patients and identify parameters most strongly associated with peak oxygen consumption (VO2).
Background Despite improved survival for heart failure patients afforded by continuous flow left ventricular assist devices (LVADs), peak exercise capacity remains impaired. Mechanisms underlying this reduced functional capacity remain poorly understood.
Methods Patients referred for post-VAD hemodynamic optimization from December 2017 through June 2019 were enrolled. Swan Ganz catheters were inserted and upright incremental bicycle ergometry with respiratory gas analysis was performed. Hemodynamic measurements, mixed venous saturation, and arterial blood pressure were recorded every 3 min during exercise. Linear correlations were performed between peak VO2 (ml/min) and peak Fick cardiac output (CO), peak device flow, the assumed intrinsic CO derived as Fick CO-device flow, peak pressure differential across the LVAD (mean arterial pressure−pulmonary capillary wedge pressure), peak pressure differential across right ventricle (mean pulmonary artery pressure − right atrial pressure) and systemic vascular resistance.
Results Forty-five patients supported by axial flow pumps (n = 12) and centrifugal flow pumps (n = 33) were studied. There were 34 men and 11 women. Age averaged 60 ± 10 years. Peak VO2 averaged 10.6 ± 3.1 ml/kg/min. Fick CO had the greatest correlation with peak VO2 with r = 0.73 (p < 0.0001) followed by intrinsic CO (r = 0.67; p < 0.0001). Multivariate model that best predicted peak VO2 included Fick CO and peak arterial venous oxygen (AVO2) difference.
Conclusions LVAD supported patients have severely impaired peak exercise capacity. The peak Fick cardiac output was the best correlate of peak exercise performance.
This work was supported by the Altman Choudhrie Fund for clinical heart failure research. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 4, 2019.
- Revision received October 9, 2019.
- Accepted October 10, 2019.
- 2020 American College of Cardiology Foundation
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