Effect of exercise and pump speed modulation on invasive hemodynamics in patients with centrifugal continuous-flow left ventricular assist devices

Muthiah, K; Robson, D; Prichard, R; Walker, R; Gupta, S; Keogh, AM; Macdonald, PS; Woodard, J; Kotlyar, E; Dhital, K; Granger, E; Jansz, P; Spratt, P; Hayward, CS

Effect of exercise and pump speed modulation on invasive hemodynamics in patients with centrifugal continuous-flow left ventricular assist devices

Muthiah, K Robson, D Prichard, R

Walker, R Gupta, S Keogh, AM Macdonald, PS Woodard, J Kotlyar, E Dhital, K Granger, E Jansz, P Spratt, P Hayward, CS

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Publication Type:: Journal Article
Citation:: Journal of Heart and Lung Transplantation, 2015, 34 (4), pp. 522 - 529
Issue Date:: 2015-04-01

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Field	Value	Language
dc.contributor.author	Muthiah, K	en_US
dc.contributor.author	Robson, D	en_US
dc.contributor.author	Prichard, R https://orcid.org/0000-0001-8057-6605	en_US
dc.contributor.author	Walker, R	en_US
dc.contributor.author	Gupta, S	en_US
dc.contributor.author	Keogh, AM	en_US
dc.contributor.author	Macdonald, PS	en_US
dc.contributor.author	Woodard, J	en_US
dc.contributor.author	Kotlyar, E	en_US
dc.contributor.author	Dhital, K	en_US
dc.contributor.author	Granger, E	en_US
dc.contributor.author	Jansz, P	en_US
dc.contributor.author	Spratt, P	en_US
dc.contributor.author	Hayward, CS	en_US
dc.date.available	2014-11-04	en_US
dc.date.issued	2015-04-01	en_US
dc.identifier.citation	Journal of Heart and Lung Transplantation, 2015, 34 (4), pp. 522 - 529	en_US
dc.identifier.issn	1053-2498	en_US
dc.identifier.uri	http://hdl.handle.net/10453/118646
dc.description.abstract	© 2015 Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. All rights reserved. Background Continuous-flow left ventricular assist devices (CF-LVADs) improve functional capacity in patients with end-stage heart failure. Pump output can be increased by increased pump speed as well as changes in loading conditions. Methods The effect of exercise on invasive hemodynamics was studied in two study protocols. The first examined exercise at fixed pump speed (n = 8) and the second with progressive pump speed increase (n = 11). Patients underwent simultaneous right-heart catheterization, mixed venous saturation, echocardiography and mean arterial pressure monitoring. Before exercise, a ramp speed study was performed in all patients. Patients then undertook symptom-limited supine bicycle exercise. Results Upward titration of pump speed at rest (by 11.6 ± 8.6% from baseline) increased pump flow from 5.3 ± 1.0 to 6.3 ± 1.0 liters/min (18.9% increase, p < 0.001) and decreased pulmonary capillary wedge pressure (PCWP; 13.6 ± 5.4 to 8.9 ± 4.1 mm Hg, p < 0.001). Exercise increased pump flow to a similar extent as pump speed change alone (to 6.2 ± 1.0 liters/min, p < 0.001), but resulted in increased right- and left-heart filling pressures (right atrial pressure [RAP]: 16.6 ± 7.5 mm Hg, p < 0.001; PCWP 24.8 ± 6.7 mm Hg, p < 0.001). Concomitant pump speed increase with exercise enhanced the pump flow increase (to 7.0 ± 1.4 liters/min, p < 0.001) in Protocol 2, but did not alleviate the increase in pre-load (RAP: 20.5 ± 8.0 mm Hg, p = 0.07; PCWP: 26.8 ± 12.7 mm Hg; p = 0.47). Serum lactate and NT-proBNP levels increased significantly with exercise. Conclusions Pump flow increases with up-titration of pump speed and with exercise. Although increased pump speed decreases filling pressures at rest, the benefit is not seen with exercise despite concurrent up-titration of pump speed.	en_US
dc.relation.ispartof	Journal of Heart and Lung Transplantation	en_US
dc.relation.isbasedon	10.1016/j.healun.2014.11.004	en_US
dc.subject.classification	Surgery	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Exercise	en_US
dc.subject.mesh	Heart-Assist Devices	en_US
dc.subject.mesh	Prosthesis Design	en_US
dc.subject.mesh	Adolescent	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Heart Failure	en_US
dc.subject.mesh	Hemodynamics	en_US
dc.subject.mesh	Young Adult	en_US
dc.title	Effect of exercise and pump speed modulation on invasive hemodynamics in patients with centrifugal continuous-flow left ventricular assist devices	en_US
dc.type	Journal Article
utslib.citation.volume	4	en_US
utslib.citation.volume	34	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1102 Cardiorespiratory Medicine and Haematology	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access
pubs.issue	4	en_US
pubs.publication-status	Published	en_US
pubs.volume	34	en_US

Abstract:

© 2015 Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. All rights reserved. Background Continuous-flow left ventricular assist devices (CF-LVADs) improve functional capacity in patients with end-stage heart failure. Pump output can be increased by increased pump speed as well as changes in loading conditions. Methods The effect of exercise on invasive hemodynamics was studied in two study protocols. The first examined exercise at fixed pump speed (n = 8) and the second with progressive pump speed increase (n = 11). Patients underwent simultaneous right-heart catheterization, mixed venous saturation, echocardiography and mean arterial pressure monitoring. Before exercise, a ramp speed study was performed in all patients. Patients then undertook symptom-limited supine bicycle exercise. Results Upward titration of pump speed at rest (by 11.6 ± 8.6% from baseline) increased pump flow from 5.3 ± 1.0 to 6.3 ± 1.0 liters/min (18.9% increase, p < 0.001) and decreased pulmonary capillary wedge pressure (PCWP; 13.6 ± 5.4 to 8.9 ± 4.1 mm Hg, p < 0.001). Exercise increased pump flow to a similar extent as pump speed change alone (to 6.2 ± 1.0 liters/min, p < 0.001), but resulted in increased right- and left-heart filling pressures (right atrial pressure [RAP]: 16.6 ± 7.5 mm Hg, p < 0.001; PCWP 24.8 ± 6.7 mm Hg, p < 0.001). Concomitant pump speed increase with exercise enhanced the pump flow increase (to 7.0 ± 1.4 liters/min, p < 0.001) in Protocol 2, but did not alleviate the increase in pre-load (RAP: 20.5 ± 8.0 mm Hg, p = 0.07; PCWP: 26.8 ± 12.7 mm Hg; p = 0.47). Serum lactate and NT-proBNP levels increased significantly with exercise. Conclusions Pump flow increases with up-titration of pump speed and with exercise. Although increased pump speed decreases filling pressures at rest, the benefit is not seen with exercise despite concurrent up-titration of pump speed.

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http://hdl.handle.net/10453/118646