Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 1361-1371 |
| Number of pages | 11 |
| Journal | Journal of Heart and Lung Transplantation |
| Volume | 37 |
| Issue number | 11 |
| DOIs | |
| Publication status | E-pub ahead of print - Sep 5 2018 |
Keywords
- cardiac output
- CPET
- exercise
- lung diffusion
- LVAD
- muscle oxygenation
- adult
- apnea hypopnea index
- Article
- assisted ventilation
- cardiac index
- cardiopulmonary exercise test
- cardiorespiratory fitness
- clinical article
- clinical protocol
- controlled study
- electroencephalography
- female
- forced expiratory volume
- heart output
- human
- lung gas exchange
- lung hemodynamics
- male
- near infrared spectroscopy
- oxygenation
- polysomnography
- priority journal
- sleep
- sleep quality
- spirometry
- work capacity
- workload
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Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance. / Apostolo, A.; Paolillo, S.; Contini, M.; Vignati, C.; Tarzia, V.; Campodonico, J.; Mapelli, M.; Massetti, M.; Bejko, J.; Righini, F.; Bottio, T.; Bonini, N.; Salvioni, E.; Gugliandolo, P.; Parati, G.; Lombardi, C.; Gerosa, G.; Salvi, L.; Alamanni, F.; Agostoni, P.
In: Journal of Heart and Lung Transplantation, Vol. 37, No. 11, 05.09.2018, p. 1361-1371.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance
AU - Apostolo, A.
AU - Paolillo, S.
AU - Contini, M.
AU - Vignati, C.
AU - Tarzia, V.
AU - Campodonico, J.
AU - Mapelli, M.
AU - Massetti, M.
AU - Bejko, J.
AU - Righini, F.
AU - Bottio, T.
AU - Bonini, N.
AU - Salvioni, E.
AU - Gugliandolo, P.
AU - Parati, G.
AU - Lombardi, C.
AU - Gerosa, G.
AU - Salvi, L.
AU - Alamanni, F.
AU - Agostoni, P.
N1 - Cited By :1 Export Date: 29 January 2019 CODEN: JHLTE Correspondence Address: Agostoni, P.; Centro Cardiologico Monzino, IRCCS, Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Parea, 4, Italy; email: piergiuseppe.agostoni@unimi.it Funding details: RC2618281 Funding text 1: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose. The authors thank Dr Emanuele Spadafora (PhD student, Centro Cardiologico Monzino, Italy) for technical support during study procedures, Dr Silvia Scuri (Engineer, Artech Srl, Modena, Italy) for LVAD technical assistance, and Dr Michela Palmieri for English language editing. This study was supported by the Italian Ministry of Health (RC2618281). 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Salamonsen, R.F., Mason, D.G., Ayre, P.J., Response of rotary blood pumps to changes in preload and afterload at a fixed speed setting are unphysiological when compared with the natural heart (2011) Artif Organs, 35, pp. E47-E53; Uriel, N., Adatya, S., Maly, J., Clinical hemodynamic evaluation of patients implanted with a fully magnetically levitated left ventricular assist device (HeartMate 3) (2017) J Heart Lung Transplant, 36, pp. 28-35; Burkhoff, D., Sayer, G., Doshi, D., Uriel, N., Hemodynamics of mechanical circulatory support (2015) J Am Coll Cardiol, 66, pp. 2663-2674; Agostoni, P., Cattadori, G., Apostolo, A., Noninvasive measurement of cardiac output during exercise by inert gas rebreathing technique: a new tool for heart failure evaluation (2005) J Am Coll Cardiol, 46, pp. 1779-1781; Agostoni, P., Vignati, C., Gentile, P., Reference values for peak exercise cardiac output in healthy individuals (2017) Chest, 151, pp. 1329-1337; Jung, M.H., Houston, B., Russell, S.D., Gustafsson, F., Pump speed modulations and sub-maximal exercise tolerance in left ventricular assist device recipients: a double-blind, randomized trial (2017) J Heart Lung Transplant, 36, pp. 36-41; Abozguia, K., Phan, T.T., Shivu, G.N., Reduced in vivo skeletal muscle oxygen consumption in patients with chronic heart failure—a study using near infrared spectrophotometry (NIRS) (2008) Eur J Heart Fail, 10, pp. 652-657; Van Beekvelt, M.C., Colier, W.N., Wevers, R.A., Van Engelen, B.G., Performance of near-infrared spectroscopy in measuring local O(2) consumption and blood flow in skeletal muscle (2001) J Appl Physiol (1985), 90, pp. 511-519; Agostoni, P., Bussotti, M., Cattadori, G., Gas diffusion and alveolar-capillary unit in chronic heart failure (2006) Eur Heart J, 27, pp. 2538-2543; Agostoni, P.G., Bussotti, M., Palermo, P., Guazzi, M., Does lung diffusion impairment affect exercise capacity in patients with heart failure (2002) Heart, 88, pp. 453-459; Cattadori, G., Wasserman, K., Meloni, C., Alveolar membrane conductance decreases as BNP increases during exercise in ‘heart failure. 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PY - 2018/9/5
Y1 - 2018/9/5
N2 - BACKGROUND: Increasing left ventricular assist device (LVAD) pump speed according to the patient's activity is a fascinating hypothesis. This study analyzed the short-term effects of LVAD speed increase on cardiopulmonary exercise test (CPET) performance, muscle oxygenation (near-infrared spectroscopy), diffusion capacity of the lung for carbon monoxide (DLCO) and nitric oxide (DLNO), and sleep quality. METHODS: We analyzed CPET, DLCO and DLNO, and sleep in 33 patients supported with the Jarvik 2000 (Jarvik Heart Inc., New York, NY). After a maximal CPET (n = 28), patients underwent 2 maximal CPETs with LVAD speed randomly set at 3 or increased from 3 to 5 during effort (n = 15). Then, at LVAD speed randomly set at 2 or 4, we performed (1) constant workload CPETs assessing O2 kinetics, cardiac output (CO), and muscle oxygenation (n = 15); (2) resting DLCO and DLNO (n = 18); and (3) nocturnal cardiorespiratory monitoring (n = 29). RESULTS: The progressive pump speed increase raised peak volume of oxygen consumption (12.5 ± 2.5 ml/min/kg vs 11.7 ± 2.8 ml/min/kg at speed 3; p = 0.001). During constant workload, from speed 2 to 4, CO increased (at rest: 3.18 ± 0.76 liters/min vs 3.69 ± 0.75 liters/min, p = 0.015; during exercise: 5.91 ± 1.31 liters/min vs 6.69 ± 0.99 liters/min, p = 0.014), and system efficiency (τ = 65.8 ± 15.1 seconds vs 49.9 ± 14.8 seconds, p = 0.002) and muscle oxygenation improved. At speed 4, DLCO decreased, and obstructive apneas increased despite a significant apnea/hypopnea index and a reduction of central apneas. CONCLUSIONS: Short-term LVAD speed increase improves exercise performance, CO, O2 kinetics, and muscle oxygenation. However, it deteriorates lung diffusion and increases obstructive apneas, likely due to an increase of intrathoracic fluids. Self-adjusting LVAD speed is a fascinating but possibly unsafe option, probably requiring a monitoring of intrathoracic fluids. © 2018 International Society for Heart and Lung Transplantation
AB - BACKGROUND: Increasing left ventricular assist device (LVAD) pump speed according to the patient's activity is a fascinating hypothesis. This study analyzed the short-term effects of LVAD speed increase on cardiopulmonary exercise test (CPET) performance, muscle oxygenation (near-infrared spectroscopy), diffusion capacity of the lung for carbon monoxide (DLCO) and nitric oxide (DLNO), and sleep quality. METHODS: We analyzed CPET, DLCO and DLNO, and sleep in 33 patients supported with the Jarvik 2000 (Jarvik Heart Inc., New York, NY). After a maximal CPET (n = 28), patients underwent 2 maximal CPETs with LVAD speed randomly set at 3 or increased from 3 to 5 during effort (n = 15). Then, at LVAD speed randomly set at 2 or 4, we performed (1) constant workload CPETs assessing O2 kinetics, cardiac output (CO), and muscle oxygenation (n = 15); (2) resting DLCO and DLNO (n = 18); and (3) nocturnal cardiorespiratory monitoring (n = 29). RESULTS: The progressive pump speed increase raised peak volume of oxygen consumption (12.5 ± 2.5 ml/min/kg vs 11.7 ± 2.8 ml/min/kg at speed 3; p = 0.001). During constant workload, from speed 2 to 4, CO increased (at rest: 3.18 ± 0.76 liters/min vs 3.69 ± 0.75 liters/min, p = 0.015; during exercise: 5.91 ± 1.31 liters/min vs 6.69 ± 0.99 liters/min, p = 0.014), and system efficiency (τ = 65.8 ± 15.1 seconds vs 49.9 ± 14.8 seconds, p = 0.002) and muscle oxygenation improved. At speed 4, DLCO decreased, and obstructive apneas increased despite a significant apnea/hypopnea index and a reduction of central apneas. CONCLUSIONS: Short-term LVAD speed increase improves exercise performance, CO, O2 kinetics, and muscle oxygenation. However, it deteriorates lung diffusion and increases obstructive apneas, likely due to an increase of intrathoracic fluids. Self-adjusting LVAD speed is a fascinating but possibly unsafe option, probably requiring a monitoring of intrathoracic fluids. © 2018 International Society for Heart and Lung Transplantation
KW - cardiac output
KW - CPET
KW - exercise
KW - lung diffusion
KW - LVAD
KW - muscle oxygenation
KW - adult
KW - apnea hypopnea index
KW - Article
KW - assisted ventilation
KW - cardiac index
KW - cardiopulmonary exercise test
KW - cardiorespiratory fitness
KW - clinical article
KW - clinical protocol
KW - controlled study
KW - electroencephalography
KW - female
KW - forced expiratory volume
KW - heart output
KW - human
KW - lung gas exchange
KW - lung hemodynamics
KW - male
KW - near infrared spectroscopy
KW - oxygenation
KW - polysomnography
KW - priority journal
KW - sleep
KW - sleep quality
KW - spirometry
KW - work capacity
KW - workload
U2 - 10.1016/j.healun.2018.07.005
DO - 10.1016/j.healun.2018.07.005
M3 - Article
VL - 37
SP - 1361
EP - 1371
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
IS - 11
ER -