Carlo Vignati1, Anna Apostolo1, Gaia Cattadori2, Stefania Farina1, Alberico Del Torto1, Silvia Scuri3, Gino Gerosa4, Tomaso Bottio4, Vincenzo Tarzia4, Jonida Bejko4, Erminio Sisillo1, Flavia Nicoli5, Susanna Sciomer6, Francesco Alamanni7, Stefania Paolillo8, Piergiuseppe Agostoni9. 1. Centro Cardiologico Monzino, IRCCS, Milan, Italy. 2. Centro Cardiologico Monzino, IRCCS, Milan, Italy; Multimedica, IRCCS, Milano, Italy. 3. Artech Srl, Modena, Italy. 4. Cardiac Surgery Unit, Dept. of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. 5. Dept. of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy. 6. Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy. 7. Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dept. of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy. 8. IRCCS SDN, Institute of Research, Naples, Italy. 9. Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dept. of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy. Electronic address: piergiuseppe.agostoni@unimi.it.
Abstract
BACKGROUNDS: Peak exercise cardiac output (CO) increase is associated with an increase of peak oxygen uptake (VO2), provided that arteriovenous O2 difference [Δ(Ca-Cv)O2] does not decrease. At anaerobic threshold, VO2, is related to CO. We tested the hypothesis that, in heart failure (HF) patients with left ventricular assistance device (LVAD), an acute increase of CO obtained through changes in LVAD pump speed is associated with peak exercise and anaerobic threshold VO2 increase. METHODS:Fifteen of 20 patients bearing LVAD (Jarvik 2000) enrolled in the study successfully performed peak exercise evaluation. All patients had severe HF as shown by clinical evaluation, laboratory tests, echocardiography, spirometry with alveolar-capillary diffusion, and maximal cardiopulmonary exercise testing (CPET). CPETs with non-invasive CO measurements at rest and peak exercise were done on 2days at LVAD pump speed set randomly at 2 and 4. RESULTS: Increasing LVAD pump speed from 2 to 4 increased CO from 3.4±0.9 to 3.8±1.0L/min (ΔCO 0.4±0.6L/min, p=0.04) and from 5.3±1.3 to 5.9±1.4L/min (ΔCO 0.6±0.7L/min, p<0.01) at rest and peak exercise, respectively. Similarly, VO2 increased from 788±169 to 841±152mL/min (ΔVO2 52±76mL/min, p=0.01) and from 568±116 to 619±124mL/min (ΔVO2 69±96mL/min, p=0.02) at peak exercise and at anaerobic threshold, respectively. Δ(Ca-Cv)O2 did not change significantly, while ventilatory efficiency improved (VE/VCO2 slope from 39.9±5.4 to 34.9±8.3, ΔVE/VCO2 -5.0±6.4, p<0.01). CONCLUSIONS: In HF, an increase in CO with a higher LVAD pump speed is associated with increased peak VO2, postponed anaerobic threshold, and improved ventilatory efficiency.
RCT Entities:
BACKGROUNDS: Peak exercise cardiac output (CO) increase is associated with an increase of peak oxygen uptake (VO2), provided that arteriovenousO2 difference [Δ(Ca-Cv)O2] does not decrease. At anaerobic threshold, VO2, is related to CO. We tested the hypothesis that, in heart failure (HF) patients with left ventricular assistance device (LVAD), an acute increase of CO obtained through changes in LVAD pump speed is associated with peak exercise and anaerobic threshold VO2 increase. METHODS: Fifteen of 20 patients bearing LVAD (Jarvik 2000) enrolled in the study successfully performed peak exercise evaluation. All patients had severe HF as shown by clinical evaluation, laboratory tests, echocardiography, spirometry with alveolar-capillary diffusion, and maximal cardiopulmonary exercise testing (CPET). CPETs with non-invasive CO measurements at rest and peak exercise were done on 2days at LVAD pump speed set randomly at 2 and 4. RESULTS: Increasing LVAD pump speed from 2 to 4 increased CO from 3.4±0.9 to 3.8±1.0L/min (ΔCO 0.4±0.6L/min, p=0.04) and from 5.3±1.3 to 5.9±1.4L/min (ΔCO 0.6±0.7L/min, p<0.01) at rest and peak exercise, respectively. Similarly, VO2 increased from 788±169 to 841±152mL/min (ΔVO2 52±76mL/min, p=0.01) and from 568±116 to 619±124mL/min (ΔVO2 69±96mL/min, p=0.02) at peak exercise and at anaerobic threshold, respectively. Δ(Ca-Cv)O2 did not change significantly, while ventilatory efficiency improved (VE/VCO2 slope from 39.9±5.4 to 34.9±8.3, ΔVE/VCO2 -5.0±6.4, p<0.01). CONCLUSIONS: In HF, an increase in CO with a higher LVAD pump speed is associated with increased peak VO2, postponed anaerobic threshold, and improved ventilatory efficiency.
Authors: Julien Guihaire; Francois Haddad; Mita Hoppenfeld; Myriam Amsallem; Jeffrey W Christle; Clark Owyang; Khizer Shaikh; Joe L Hsu Journal: Can J Cardiol Date: 2019-11-09 Impact factor: 5.223
Authors: Richard Severin; Ahmad Sabbahi; Cemal Ozemek; Shane Phillips; Ross Arena Journal: Expert Rev Med Devices Date: 2019-09-06 Impact factor: 3.166