Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance

A. Apostolo, S. Paolillo, M. Contini, C. Vignati, V. Tarzia, J. Campodonico, M. Mapelli, M. Massetti, J. Bejko, F. Righini, T. Bottio, N. Bonini, E. Salvioni, P. Gugliandolo, G. Parati, C. Lombardi, G. Gerosa, L. Salvi, F. Alamanni, P. Agostoni

Research output: Contribution to journalArticle

Abstract

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
Original languageEnglish
Pages (from-to)1361-1371
Number of pages11
JournalJournal of Heart and Lung Transplantation
Volume37
Issue number11
DOIs
Publication statusPublished - 2018

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Heart-Assist Devices
Sleep
Gases
Exercise
Apnea
Exercise Test
Cardiac Output
Nitric Oxide
Workload
Muscles
Central Sleep Apnea
Lung Volume Measurements
Near-Infrared Spectroscopy
Carbon Monoxide
Oxygen Consumption
Myocardium
Lung

Keywords

  • adult
  • apnea hypopnea index
  • Article
  • assisted ventilation
  • cardiac index
  • cardiopulmonary exercise test
  • cardiorespiratory fitness
  • clinical article
  • clinical protocol
  • controlled study
  • electroencephalography
  • exercise
  • female
  • forced expiratory volume
  • heart output
  • human
  • lung diffusion
  • lung gas exchange
  • lung hemodynamics
  • male
  • near infrared spectroscopy
  • oxygenation
  • polysomnography
  • priority journal
  • sleep
  • sleep quality
  • spirometry
  • work capacity
  • workload

Cite this

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, 2018, p. 1361-1371.

Research output: Contribution to journalArticle

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 2018, 'Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance', Journal of Heart and Lung Transplantation, vol. 37, no. 11, pp. 1361-1371. https://doi.org/10.1016/j.healun.2018.07.005
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. / Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance. In: Journal of Heart and Lung Transplantation. 2018 ; Vol. 37, No. 11. pp. 1361-1371.
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title = "Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance",
abstract = "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. {\circledC} 2018 International Society for Heart and Lung Transplantation",
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author = "A. Apostolo and S. Paolillo and M. Contini and C. Vignati and V. Tarzia and J. Campodonico and M. Mapelli and M. Massetti and J. Bejko and F. Righini and T. Bottio and N. Bonini and E. Salvioni and P. Gugliandolo and G. Parati and C. Lombardi and G. Gerosa and L. Salvi and F. Alamanni and P. Agostoni",
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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

PY - 2018

Y1 - 2018

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 - 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 - exercise

KW - female

KW - forced expiratory volume

KW - heart output

KW - human

KW - lung diffusion

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 -