Pulsatile-flow more effective for mechanical unloading than continuous-flow

Kato T. Circ Heart Fail. 2011;4:546-553.

Issue: November 2011

In patients with advanced HF, mechanical unloading of the failing myocardium using pulsatile-flow devices is more effective vs. using continuous-flow devices, according to study results.

Researchers analyzed 61 patients who underwent left ventricular assist device implantation. All patients were assigned to two groups. Patients treated with pulsatile-flow LVAD were put into group P (n=31) and patients treated with continuous-flow LVAD were put into group C (n=30). Researchers compared the two groups’ serial echocardiograms, serum levels of brain natriuretic peptide (BNP) and extracellular matrix biomarkers.

When comparing group P with group C, researchers found that postoperative left ventricular ejection fraction was greater (P<.0001) in group P, whereas mitral peak early/early diastolic annular velocity (P=.0002), serum levels on BNP (P<.01), metalloproteinases-9 (P<.05) and tissue inhibitor metalloproteinases-4 (P<.001) were lower in group P. Myocardial expression levels of BNP were lower at the time of LVAD explanation vs. LVAD implantation in group P (P=.024) and group C (P=.049).

According to study results, there was no significant difference of preoperative serum extracellular matrix biomarkers between group P and group C, but extracellular matrix biomarkers were reduced after surgery in group C. Platelet count and sodium concentration increased, and blood urea nitrogen, total bilirubin and direct bilirubin concentration, LV end-diastolic dimension, LV end-systolic dimension, and serum BNP levels decreased after LVAD implantation in both groups. Researchers found that preoperative BNP levels were not different between groups P and C, but postoperative levels were lower in group P vs. group C (P=.007).

Disclosure: Dr. Kato reports no relevant financial disclosures.

Follow CardiologyToday.com on Twitter.