Lvad pump speed increase is associated with increased peak exercise cardiac output and vo2, postponed anaerobic threshold and improved ventilatory efficiency

C. Vignati, A. Apostolo, G. Cattadori, S. Farina, A. Del Torto, S. Scuri, G. Gerosa, T. Bottio, V. Tarzia, J. Bejko, E. Sisillo, F. Nicoli, S. Sciomer, F. Alamanni, S. Paolillo, P. Agostoni

Research output: Contribution to journalArticle

11 Citations (Scopus)

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 2 days 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 ± 1.0 L/min (ΔCO 0.4 ± 0.6 L/min, p = 0.04) and from 5.3 ± 1.3 to 5.9 ± 1.4 L/min (ΔCO 0.6 ± 0.7 L/min, p < 0.01) at rest and peak exercise, respectively. Similarly, VO2 increased from 788 ± 169 to 841 ± 152 mL/min (ΔVO2 52 ± 76 mL/min, p = 0.01) and from 568 ± 116 to 619 ± 124 mL/min (ΔVO2 69 ± 96 mL/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. © 2016 Elsevier Ireland Ltd
Original languageEnglish
Pages (from-to)28-32
Number of pages5
JournalInternational Journal of Cardiology
Volume230
DOIs
Publication statusPublished - 2017

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Anaerobic Threshold
Cardiac Output
Exercise
Equipment and Supplies
Heart Failure
Spirometry
Ireland
Echocardiography
Oxygen

Keywords

  • Cardiac output
  • Exercise testing
  • Heart failure
  • LVAD
  • adult
  • anaerobic threshold
  • Article
  • cardiopulmonary exercise test
  • clinical article
  • clinical evaluation
  • controlled study
  • disease severity
  • echocardiography
  • exercise
  • female
  • heart failure
  • heart output
  • human
  • laboratory test
  • left ventricular assist device
  • lung diffusion
  • male
  • oxygen consumption
  • spirometry
  • ventilatory efficiency
  • crossover procedure
  • double blind procedure
  • heart assist device
  • lung gas exchange
  • middle aged
  • pathophysiology
  • physiology
  • randomized controlled trial
  • Anaerobic Threshold
  • Cardiac Output
  • Cross-Over Studies
  • Double-Blind Method
  • Exercise
  • Female
  • Heart Failure
  • Heart-Assist Devices
  • Humans
  • Male
  • Middle Aged
  • Oxygen Consumption
  • Pulmonary Gas Exchange

Cite this

Lvad pump speed increase is associated with increased peak exercise cardiac output and vo2, postponed anaerobic threshold and improved ventilatory efficiency. / Vignati, C.; Apostolo, A.; Cattadori, G.; Farina, S.; Del Torto, A.; Scuri, S.; Gerosa, G.; Bottio, T.; Tarzia, V.; Bejko, J.; Sisillo, E.; Nicoli, F.; Sciomer, S.; Alamanni, F.; Paolillo, S.; Agostoni, P.

In: International Journal of Cardiology, Vol. 230, 2017, p. 28-32.

Research output: Contribution to journalArticle

@article{2c6a03cbc6fb4ce3b55ddd0250206489,
title = "Lvad pump speed increase is associated with increased peak exercise cardiac output and vo2, postponed anaerobic threshold and improved ventilatory efficiency",
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 2 days 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 ± 1.0 L/min (ΔCO 0.4 ± 0.6 L/min, p = 0.04) and from 5.3 ± 1.3 to 5.9 ± 1.4 L/min (ΔCO 0.6 ± 0.7 L/min, p < 0.01) at rest and peak exercise, respectively. Similarly, VO2 increased from 788 ± 169 to 841 ± 152 mL/min (ΔVO2 52 ± 76 mL/min, p = 0.01) and from 568 ± 116 to 619 ± 124 mL/min (ΔVO2 69 ± 96 mL/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. {\circledC} 2016 Elsevier Ireland Ltd",
keywords = "Cardiac output, Exercise testing, Heart failure, LVAD, adult, anaerobic threshold, Article, cardiopulmonary exercise test, clinical article, clinical evaluation, controlled study, disease severity, echocardiography, exercise, female, heart failure, heart output, human, laboratory test, left ventricular assist device, lung diffusion, male, oxygen consumption, spirometry, ventilatory efficiency, crossover procedure, double blind procedure, heart assist device, lung gas exchange, middle aged, pathophysiology, physiology, randomized controlled trial, Anaerobic Threshold, Cardiac Output, Cross-Over Studies, Double-Blind Method, Exercise, Female, Heart Failure, Heart-Assist Devices, Humans, Male, Middle Aged, Oxygen Consumption, Pulmonary Gas Exchange",
author = "C. Vignati and A. Apostolo and G. Cattadori and S. Farina and {Del Torto}, A. and S. Scuri and G. Gerosa and T. Bottio and V. Tarzia and J. Bejko and E. Sisillo and F. Nicoli and S. Sciomer and F. Alamanni and S. Paolillo and P. Agostoni",
note = "Cited By :1 Export Date: 6 March 2018 CODEN: IJCDD Correspondence Address: Agostoni, P.; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Italy; email: piergiuseppe.agostoni@unimi.it Tradenames: Jarvik 2000 References: Yancy, C.W., Jessup, M., Bozkurt, B., Butler, J., Casey, D.E., Jr., Drazner, M.H., Fonarow, G.C., Wilkoff, B.L., ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines (2013) J. Am. Coll. Cardiol., 62, pp. e147-e239; McMurray, J.J., Adamopoulos, S., Anker, S.D., Auricchio, A., Bohm, M., Dickstein, K., Falk, V., Ponikowski, P., Esc guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the esc (2012) Eur. J. Heart Fail., 14, pp. 803-869; Agostoni, P., Wasserman, K., Guazzi, M., Cattadori, G., Palermo, P., Marenzi, G., Guazzi, M.D., Exercise-induced hemoconcentration in heart failure due to dilated cardiomyopathy (1999) Am. J. Cardiol., 83, pp. 278-280. , [A276]; Agostoni, P., Wasserman, K., Perego, G.B., Marenzi, G.C., Guazzi, M., Assanelli, E., Lauri, G., Guazzi, M.D., Oxygen transport to muscle during exercise in chronic congestive heart failure secondary to idiopathic dilated cardiomyopathy (1997) Am. J. Cardiol., 79, pp. 1120-1124; Walley, K.R., Heterogeneity of oxygen delivery impairs oxygen extraction by peripheral tissues: theory (1996) J. Appl. Physiol., 81, pp. 885-894; Cattadori, G., Schmid, J.P., Brugger, N., Gondoni, E., Palermo, P., Agostoni, P., Hemodynamic effects of exercise training in heart failure (2011) J. Card. Fail., 17, pp. 916-922; Koike, A., Weiler-Ravell, D., McKenzie, D.K., Zanconato, S., Wasserman, K., Evidence that the metabolic acidosis threshold is the anaerobic threshold (1990) J. Appl. Physiol., 68, pp. 2521-2526; Agostoni, P., Emdin, M., Corra, U., Veglia, F., Magri, D., Tedesco, C.C., Berton, E., Guazzi, M., Permanent atrial fibrillation affects exercise capacity in chronic heart failure patients (2008) Eur. Heart J., 29, pp. 2367-2372; Magri, D., Agostoni, P., Corra, U., Passino, C., Scrutinio, D., Perrone-Filardi, P., Correale, M., Sinagra, G., Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation (2015) Eur. J. Prev. Cardiol., 22, pp. 1046-1055; Felker, G.M., Rogers, J.G., Same bridge, new destinations rethinking paradigms for mechanical cardiac support in heart failure (2006) J. Am. Coll. Cardiol., 47, pp. 930-932; Frazier, O.H., Myers, T.J., Jarvik, R.K., Westaby, S., Pigott, D.W., Gregoric, I.D., Khan, T., Macris, M.P., Research and development of an implantable, axial-flow left ventricular assist device: the jarvik 2000 heart (2001) Ann. Thorac. Surg., 71, pp. S125-S132. , [discussion S144-126]; Wasserman, K., Hansen, J.E., Sue, D.Y., Stringer, W.W., Whipp, B.J., Clinical exercise testing (2005) Principles of Exercise Testing and Interpretation Including Pathophysiology and Clinical Applications, pp. 138-139. , Lippincott Williams & Wilkins; Habedank, D., Reindl, I., Vietzke, G., Bauer, U., Sperfeld, A., Glaser, S., Wernecke, K.D., Kleber, F.X., Ventilatory efficiency and exercise tolerance in 101 healthy volunteers (1998) Eur. J. Appl. Physiol. Occup. Physiol., 77, pp. 421-426; Gabrielsen, A., Videbaek, R., Schou, M., Damgaard, M., Kastrup, J., Norsk, P., Non-invasive measurement of cardiac output in heart failure patients using a new foreign gas rebreathing technique (2002) Clin. Sci. (Lond.), 102, pp. 247-252; Cattadori, G., Schmid, J.P., Agostoni, P., Noninvasive measurement of cardiac output during exercise by inert gas rebreathing technique (2009) Heart Fail. Clin., 5 (2), pp. 209-215; Jaski, B.E., Kim, J., Maly, R.S., Branch, K.R., Adamson, R., Favrot, L.K., Smith, S.C., Jr., Dembitsky, W.P., Effects of exercise during long-term support with a left ventricular assist device. Results of the experience with left ventricular assist device with exercise (evade) pilot trial (1997) Circulation, 95, pp. 2401-2406; Brassard, P., Jensen, A.S., Nordsborg, N., Gustafsson, F., Moller, J.E., Hassager, C., Boesgaard, S., Madsen, P.L., Central and peripheral blood flow during exercise with a continuous-flow left ventricular assist device: Constant versus increasing pump speed: A pilot study (2011) Circ. Heart Fail., 4, pp. 554-560; Jung, M.H., Hansen, P.B., Sander, K., Olsen, P.S., Rossing, K., Boesgaard, S., Russell, S.D., Gustafsson, F., Effect of increasing pump speed during exercise on peak oxygen uptake in heart failure patients supported with a continuous-flow left ventricular assist device. A double-blind randomized study (2014) Eur. J. Heart Fail., 16, pp. 403-408; Hayward, C.S., Salamonsen, R., Keogh, A.M., Woodard, J., Ayre, P., Prichard, R., Kotlyar, E., Spratt, P., Impact of left ventricular assist device speed adjustment on exercise tolerance and markers of wall stress (2015) Int. J. Artif. Organs, 38, pp. 501-507; Muthiah, K., Robson, D., Prichard, R., Walker, R., Gupta, S., Keogh, A.M., Macdonald, P.S., Hayward, C.S., Effect of exercise and pump speed modulation on invasive hemodynamics in patients with centrifugal continuous-flow left ventricular assist devices (2015) J. Heart Lung Transplant., 34, pp. 522-529; Compostella, L., Russo, N., Setzu, T., Compostella, C., Bellotto, F., Exercise performance of chronic heart failure patients in the early period of support by an axial-flow left ventricular assist device as destination therapy (2014) Artif. Organs, 38, pp. 366-373; Dunlay, S.M., Allison, T.G., Pereira, N.L., Changes in cardiopulmonary exercise testing parameters following continuous flow left ventricular assist device implantation and heart transplantation (2014) J. Card. Fail., 20, pp. 548-554; Leibner, E.S., Cysyk, J., Eleuteri, K., El-Banayosy, A., Boehmer, J.P., Pae, W.E., Changes in the functional status measures of heart failure patients with mechanical assist devices (2013) ASAIO J., 59, pp. 117-122; Jung, M.H., Gustafsson, F., Exercise in heart failure patients supported with a left ventricular assist device (2015) J. Heart Lung Transplant., 34, pp. 489-496; Abshire, M., Dennison Himmelfarb, C.R., Russell, S.D., Functional status in left ventricular assist device-supported patients: a literature review (2014) J. Card. Fail., 20, pp. 973-983; Westaby, S., Siegenthaler, M., Beyersdorf, F., Massetti, M., Pepper, J., Khayat, A., Hetzer, R., Frazier, O.H., Destination therapy with a rotary blood pump and novel power delivery (2010) Eur. J. Cardiothorac. Surg., 37, pp. 350-356; Westaby, S., Frazier, O.H., Banning, A., Six years of continuous mechanical circulatory support (2006) N. Engl. J. Med., 355, pp. 325-327; Pedrotty, D.M., Rame, J.E., Margulies, K.B., Management of ventricular arrhythmias in patients with ventricular assist devices (2013) Curr. Opin. Cardiol., 28, pp. 360-368; Patil, N.P., Sabashnikov, A., Mohite, P.N., Garcia, D., Weymann, A., Zych, B., Bowles, C.T., Simon, A.R., De novo aortic regurgitation after continuous-flow left ventricular assist device implantation (2014) Ann. Thorac. Surg., 98, pp. 850-857; Bhat, G., Gopalakrishnan, M., Aggarwal, A., Gastrointestinal bleeding with continuous flow left ventricular assist devices (lvads) (2013) Recent advances in the field of ventricular assist devices, pp. 51-65. , K. Komamura; Beaver, W.L., Wasserman, K., Whipp, B.J., A new method for detecting anaerobic threshold by gas exchange (1986) J. Appl. Physiol., 60, pp. 2020-2027; Agostoni, P.G., Wasserman, K., Perego, G.B., Guazzi, M., Cattadori, G., Palermo, P., Lauri, G., Marenzi, G., Non-invasive measurement of stroke volume during exercise in heart failure patients (2000) Clin. Sci. (Lond.), 98, pp. 545-551; Perego, G.B., Marenzi, G.C., Guazzi, M., Sganzerla, P., Assanelli, E., Palermo, P., Conconi, B., Agostoni, P.G., Contribution of po2, p50, and hb to changes in arteriovenous o2 content during exercise in heart failure (1996) J. Appl. Physiol., 80, pp. 623-631; Stringer, W.W., Hansen, J.E., Wasserman, K., Cardiac output estimated noninvasively from oxygen uptake during exercise (1997) J. Appl. Physiol., 82, pp. 908-912; Koike, A., Wasserman, K., Taniguchi, K., Hiroe, M., Marumo, F., Critical capillary oxygen partial pressure and lactate threshold in patients with cardiovascular disease (1994) J. Am. Coll. Cardiol., 23, pp. 1644-1650",
year = "2017",
doi = "10.1016/j.ijcard.2016.12.112",
language = "English",
volume = "230",
pages = "28--32",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Lvad pump speed increase is associated with increased peak exercise cardiac output and vo2, postponed anaerobic threshold and improved ventilatory efficiency

AU - Vignati, C.

AU - Apostolo, A.

AU - Cattadori, G.

AU - Farina, S.

AU - Del Torto, A.

AU - Scuri, S.

AU - Gerosa, G.

AU - Bottio, T.

AU - Tarzia, V.

AU - Bejko, J.

AU - Sisillo, E.

AU - Nicoli, F.

AU - Sciomer, S.

AU - Alamanni, F.

AU - Paolillo, S.

AU - Agostoni, P.

N1 - Cited By :1 Export Date: 6 March 2018 CODEN: IJCDD Correspondence Address: Agostoni, P.; Centro Cardiologico Monzino, IRCCS, Via Parea 4, Italy; email: piergiuseppe.agostoni@unimi.it Tradenames: Jarvik 2000 References: Yancy, C.W., Jessup, M., Bozkurt, B., Butler, J., Casey, D.E., Jr., Drazner, M.H., Fonarow, G.C., Wilkoff, B.L., ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines (2013) J. Am. Coll. Cardiol., 62, pp. e147-e239; McMurray, J.J., Adamopoulos, S., Anker, S.D., Auricchio, A., Bohm, M., Dickstein, K., Falk, V., Ponikowski, P., Esc guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the esc (2012) Eur. J. Heart Fail., 14, pp. 803-869; Agostoni, P., Wasserman, K., Guazzi, M., Cattadori, G., Palermo, P., Marenzi, G., Guazzi, M.D., Exercise-induced hemoconcentration in heart failure due to dilated cardiomyopathy (1999) Am. J. Cardiol., 83, pp. 278-280. , [A276]; Agostoni, P., Wasserman, K., Perego, G.B., Marenzi, G.C., Guazzi, M., Assanelli, E., Lauri, G., Guazzi, M.D., Oxygen transport to muscle during exercise in chronic congestive heart failure secondary to idiopathic dilated cardiomyopathy (1997) Am. J. Cardiol., 79, pp. 1120-1124; Walley, K.R., Heterogeneity of oxygen delivery impairs oxygen extraction by peripheral tissues: theory (1996) J. Appl. Physiol., 81, pp. 885-894; Cattadori, G., Schmid, J.P., Brugger, N., Gondoni, E., Palermo, P., Agostoni, P., Hemodynamic effects of exercise training in heart failure (2011) J. Card. Fail., 17, pp. 916-922; Koike, A., Weiler-Ravell, D., McKenzie, D.K., Zanconato, S., Wasserman, K., Evidence that the metabolic acidosis threshold is the anaerobic threshold (1990) J. Appl. Physiol., 68, pp. 2521-2526; Agostoni, P., Emdin, M., Corra, U., Veglia, F., Magri, D., Tedesco, C.C., Berton, E., Guazzi, M., Permanent atrial fibrillation affects exercise capacity in chronic heart failure patients (2008) Eur. Heart J., 29, pp. 2367-2372; Magri, D., Agostoni, P., Corra, U., Passino, C., Scrutinio, D., Perrone-Filardi, P., Correale, M., Sinagra, G., Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation (2015) Eur. J. Prev. Cardiol., 22, pp. 1046-1055; Felker, G.M., Rogers, J.G., Same bridge, new destinations rethinking paradigms for mechanical cardiac support in heart failure (2006) J. Am. Coll. Cardiol., 47, pp. 930-932; Frazier, O.H., Myers, T.J., Jarvik, R.K., Westaby, S., Pigott, D.W., Gregoric, I.D., Khan, T., Macris, M.P., Research and development of an implantable, axial-flow left ventricular assist device: the jarvik 2000 heart (2001) Ann. Thorac. Surg., 71, pp. S125-S132. , [discussion S144-126]; Wasserman, K., Hansen, J.E., Sue, D.Y., Stringer, W.W., Whipp, B.J., Clinical exercise testing (2005) Principles of Exercise Testing and Interpretation Including Pathophysiology and Clinical Applications, pp. 138-139. , Lippincott Williams & Wilkins; Habedank, D., Reindl, I., Vietzke, G., Bauer, U., Sperfeld, A., Glaser, S., Wernecke, K.D., Kleber, F.X., Ventilatory efficiency and exercise tolerance in 101 healthy volunteers (1998) Eur. J. Appl. Physiol. Occup. Physiol., 77, pp. 421-426; Gabrielsen, A., Videbaek, R., Schou, M., Damgaard, M., Kastrup, J., Norsk, P., Non-invasive measurement of cardiac output in heart failure patients using a new foreign gas rebreathing technique (2002) Clin. Sci. (Lond.), 102, pp. 247-252; Cattadori, G., Schmid, J.P., Agostoni, P., Noninvasive measurement of cardiac output during exercise by inert gas rebreathing technique (2009) Heart Fail. Clin., 5 (2), pp. 209-215; Jaski, B.E., Kim, J., Maly, R.S., Branch, K.R., Adamson, R., Favrot, L.K., Smith, S.C., Jr., Dembitsky, W.P., Effects of exercise during long-term support with a left ventricular assist device. Results of the experience with left ventricular assist device with exercise (evade) pilot trial (1997) Circulation, 95, pp. 2401-2406; Brassard, P., Jensen, A.S., Nordsborg, N., Gustafsson, F., Moller, J.E., Hassager, C., Boesgaard, S., Madsen, P.L., Central and peripheral blood flow during exercise with a continuous-flow left ventricular assist device: Constant versus increasing pump speed: A pilot study (2011) Circ. Heart Fail., 4, pp. 554-560; Jung, M.H., Hansen, P.B., Sander, K., Olsen, P.S., Rossing, K., Boesgaard, S., Russell, S.D., Gustafsson, F., Effect of increasing pump speed during exercise on peak oxygen uptake in heart failure patients supported with a continuous-flow left ventricular assist device. A double-blind randomized study (2014) Eur. J. Heart Fail., 16, pp. 403-408; Hayward, C.S., Salamonsen, R., Keogh, A.M., Woodard, J., Ayre, P., Prichard, R., Kotlyar, E., Spratt, P., Impact of left ventricular assist device speed adjustment on exercise tolerance and markers of wall stress (2015) Int. J. Artif. Organs, 38, pp. 501-507; Muthiah, K., Robson, D., Prichard, R., Walker, R., Gupta, S., Keogh, A.M., Macdonald, P.S., Hayward, C.S., Effect of exercise and pump speed modulation on invasive hemodynamics in patients with centrifugal continuous-flow left ventricular assist devices (2015) J. Heart Lung Transplant., 34, pp. 522-529; Compostella, L., Russo, N., Setzu, T., Compostella, C., Bellotto, F., Exercise performance of chronic heart failure patients in the early period of support by an axial-flow left ventricular assist device as destination therapy (2014) Artif. Organs, 38, pp. 366-373; Dunlay, S.M., Allison, T.G., Pereira, N.L., Changes in cardiopulmonary exercise testing parameters following continuous flow left ventricular assist device implantation and heart transplantation (2014) J. Card. Fail., 20, pp. 548-554; Leibner, E.S., Cysyk, J., Eleuteri, K., El-Banayosy, A., Boehmer, J.P., Pae, W.E., Changes in the functional status measures of heart failure patients with mechanical assist devices (2013) ASAIO J., 59, pp. 117-122; Jung, M.H., Gustafsson, F., Exercise in heart failure patients supported with a left ventricular assist device (2015) J. Heart Lung Transplant., 34, pp. 489-496; Abshire, M., Dennison Himmelfarb, C.R., Russell, S.D., Functional status in left ventricular assist device-supported patients: a literature review (2014) J. Card. Fail., 20, pp. 973-983; Westaby, S., Siegenthaler, M., Beyersdorf, F., Massetti, M., Pepper, J., Khayat, A., Hetzer, R., Frazier, O.H., Destination therapy with a rotary blood pump and novel power delivery (2010) Eur. J. Cardiothorac. Surg., 37, pp. 350-356; Westaby, S., Frazier, O.H., Banning, A., Six years of continuous mechanical circulatory support (2006) N. Engl. J. Med., 355, pp. 325-327; Pedrotty, D.M., Rame, J.E., Margulies, K.B., Management of ventricular arrhythmias in patients with ventricular assist devices (2013) Curr. Opin. Cardiol., 28, pp. 360-368; Patil, N.P., Sabashnikov, A., Mohite, P.N., Garcia, D., Weymann, A., Zych, B., Bowles, C.T., Simon, A.R., De novo aortic regurgitation after continuous-flow left ventricular assist device implantation (2014) Ann. Thorac. Surg., 98, pp. 850-857; Bhat, G., Gopalakrishnan, M., Aggarwal, A., Gastrointestinal bleeding with continuous flow left ventricular assist devices (lvads) (2013) Recent advances in the field of ventricular assist devices, pp. 51-65. , K. Komamura; Beaver, W.L., Wasserman, K., Whipp, B.J., A new method for detecting anaerobic threshold by gas exchange (1986) J. Appl. Physiol., 60, pp. 2020-2027; Agostoni, P.G., Wasserman, K., Perego, G.B., Guazzi, M., Cattadori, G., Palermo, P., Lauri, G., Marenzi, G., Non-invasive measurement of stroke volume during exercise in heart failure patients (2000) Clin. Sci. (Lond.), 98, pp. 545-551; Perego, G.B., Marenzi, G.C., Guazzi, M., Sganzerla, P., Assanelli, E., Palermo, P., Conconi, B., Agostoni, P.G., Contribution of po2, p50, and hb to changes in arteriovenous o2 content during exercise in heart failure (1996) J. Appl. Physiol., 80, pp. 623-631; Stringer, W.W., Hansen, J.E., Wasserman, K., Cardiac output estimated noninvasively from oxygen uptake during exercise (1997) J. Appl. Physiol., 82, pp. 908-912; Koike, A., Wasserman, K., Taniguchi, K., Hiroe, M., Marumo, F., Critical capillary oxygen partial pressure and lactate threshold in patients with cardiovascular disease (1994) J. Am. Coll. Cardiol., 23, pp. 1644-1650

PY - 2017

Y1 - 2017

N2 - 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 2 days 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 ± 1.0 L/min (ΔCO 0.4 ± 0.6 L/min, p = 0.04) and from 5.3 ± 1.3 to 5.9 ± 1.4 L/min (ΔCO 0.6 ± 0.7 L/min, p < 0.01) at rest and peak exercise, respectively. Similarly, VO2 increased from 788 ± 169 to 841 ± 152 mL/min (ΔVO2 52 ± 76 mL/min, p = 0.01) and from 568 ± 116 to 619 ± 124 mL/min (ΔVO2 69 ± 96 mL/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. © 2016 Elsevier Ireland Ltd

AB - 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 2 days 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 ± 1.0 L/min (ΔCO 0.4 ± 0.6 L/min, p = 0.04) and from 5.3 ± 1.3 to 5.9 ± 1.4 L/min (ΔCO 0.6 ± 0.7 L/min, p < 0.01) at rest and peak exercise, respectively. Similarly, VO2 increased from 788 ± 169 to 841 ± 152 mL/min (ΔVO2 52 ± 76 mL/min, p = 0.01) and from 568 ± 116 to 619 ± 124 mL/min (ΔVO2 69 ± 96 mL/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. © 2016 Elsevier Ireland Ltd

KW - Cardiac output

KW - Exercise testing

KW - Heart failure

KW - LVAD

KW - adult

KW - anaerobic threshold

KW - Article

KW - cardiopulmonary exercise test

KW - clinical article

KW - clinical evaluation

KW - controlled study

KW - disease severity

KW - echocardiography

KW - exercise

KW - female

KW - heart failure

KW - heart output

KW - human

KW - laboratory test

KW - left ventricular assist device

KW - lung diffusion

KW - male

KW - oxygen consumption

KW - spirometry

KW - ventilatory efficiency

KW - crossover procedure

KW - double blind procedure

KW - heart assist device

KW - lung gas exchange

KW - middle aged

KW - pathophysiology

KW - physiology

KW - randomized controlled trial

KW - Anaerobic Threshold

KW - Cardiac Output

KW - Cross-Over Studies

KW - Double-Blind Method

KW - Exercise

KW - Female

KW - Heart Failure

KW - Heart-Assist Devices

KW - Humans

KW - Male

KW - Middle Aged

KW - Oxygen Consumption

KW - Pulmonary Gas Exchange

U2 - 10.1016/j.ijcard.2016.12.112

DO - 10.1016/j.ijcard.2016.12.112

M3 - Article

VL - 230

SP - 28

EP - 32

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -