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Exercise increased cardiac output, pulmonary artery pressure among patients with LVADs
Andersen M. J Am Coll Cardiol Img. 2010;3:854-859.
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Patients with a left ventricular assist device who underwent exercise experienced increases in cardiac output and systolic/diastolic pulmonary artery pressure but little increase in filling pressure, study data suggested.
The study included 12 patients (>18 years of age) who had a history of severe HF. Each of the patients had continuous-flow LVAD (HeartMate II, Thoratec) implanted 2 months before enrollment and were in stable condition.
The researchers performed a resting study that was deemed optimal for the individual patient and then a bicycle exercise test. All patients underwent 2-D and Doppler echocardiographic examinations using a cardiac ultrasound system. Researchers compared echocardiographic indices of contraction and filling pressure with invasive measures, including right heart catheterization, and performed analyses blinded to all invasive measurements.
According to study results, exercise induced an increase in cardiac output, systolic pulmonary artery pressure and diastolic pulmonary artery pressure. Although researchers did not see any changes in LV dimensions or fractional shortening on echocardiography, systolic mitral annular motion increased — parallel to cardiac output — from 4.1 ± 1.3 cm/s to 8.7 ± 3.7 cm/s (P=.007) and diastolic E/e' ratio decreased from 11.2 ± 2.5 to 7.8 ± 1.7 (P=.01).
“The present study demonstrates a hemodynamic response to exercise in patients with continuous flow LVADs characterized by a considerable increase in cardiac output with little concomitant increase in filling pressure,” the researchers wrote. “These findings emphasize the potential role of exercise echocardiography in studying exercise hemodynamics in LVAD patients.”
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