LVAD implant tied to improvement in cerebral blood flow dynamics
Click Here to Manage Email Alerts
Key takeaways:
- Researchers observed significant improvement in cerebrovascular hemodynamics after LVAD implant in patients with advanced HF.
- They observed no change in cerebral blood flow velocity.
PHILADELPHIA — Among patients with advanced HF requiring a left ventricular assist device, measures of cerebrovascular blood flow improved significantly after device implant, a speaker reported.
Results of a study that evaluated change in cerebral autoregulation and cerebrovascular reactivity after LVAD implant (HeartMate 3, Abbott) — measures of cerebral blood flow — were presented at the American Heart Association Scientific Sessions.
Image: Abode Stock
“LVAD technology has rapidly evolved such that we have not had sufficient time to understand some of the downstream consequences. As we learn more about the LVAD-brain relationship, we will identify opportunities to personalize care aimed at optimizing brain health for this vulnerable patient population,” Christopher G. Favilla, MD, assistant professor of neurology at the Hospital of the University of Pennsylvania, told Healio. “LVAD implantation improves metrics of cerebrovascular health, but there’s room for further improvement if we can better understand how to titrate the pump to optimize cerebral hemodynamics.”
To better understand the impact of LVAD implantation on cerebrovascular hemodynamics, Favilla and colleagues enrolled 20 patients with advanced HF with planned LVAD implantation who underwent serial monitoring of two dynamics of cerebral blood flow: cerebral autoregulation and cerebrovascular reactivity.
Cerebral autoregulation is illustrative of the association between BP and cerebral blood flow and cerebrovascular reactivity is representative of hemodynamic reserve, according to a simultaneous publication in Circulation: Heart Failure.
Cerebral hemodynamic monitoring was done within 72 hours before and after LVAD implant, 14 days after implant and 90 days after implant. Cerebral blood flow velocity was also measured via transcranial Doppler.
Compared with the pre-LVAD measurement, Favilla and colleagues observed no change in cerebral blood flow velocity after LVAD implantation. However, cerebral autoregulation showed improvement early after implant compared with before implant (0.47 vs. 0.26; P = .0007) and was sustained at 14 days (0.47 vs. 0.33; P = .007) and 90 days after implant (0.47 vs. 0.31; P = .03).
Cerebrovascular reactivity was slower to improve after implant, with no significant change at 14 days compared with before implant (1.14 vs. 1.7; P = .25), but researchers did begin to record improvement at 90 days (1.14 vs. 2.11; P = .03), according to the presentation.
“Some cerebral hemodynamic metrics took a few months to improve. This might reflect the time required for vascular adaptation or microvascular remodeling,” Favilla told Healio. “There are still a lot of unanswered questions. For example, the long-term trajectory of cerebral hemodynamics and the association with clinically relevant endpoints such as stroke and cognitive decline remain unknown.”
Reference:
Collapse
Favilla CG, et al. Abstract 179. Presented at: American Heart Association Scientific Sessions; Nov. 11-13, 2023; Philadelphia.
Click Here to Manage Email Alerts