Right ventricular function and cardiopulmonary performance among patients with heart failure supported by durable mechanical circulatory support devices

Tomio Tran, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Akshay Muralidhar, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Kendall Hunter, Department of Bioengineering, Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Cullen Buchanan, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Greg Coe, Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Michinari Hieda, Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Campus, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas Texas.
Christine Tompkins, Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia.
Matthew Zipse, Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Melanie J. Spotts, Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Stephanie G. Laing, Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Kristina Fosmark, Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Jordan Hoffman, Department of Cardiac Surgery, Vanderbilt University, Nashville, Tennessee.
Amrut V. Ambardekar, Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Eugene E. Wolfel, Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Justin Lawley, Department of Sport Science, University of Innsbruck, Innsbruck, Austria.
Benjamin Levine, Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Campus, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas Texas.
Wendy M. Kohrt, Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Jay Pal, Department of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
William K. Cornwell, Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado. Electronic address: william.cornwell@ucdenver.edu.

Document Type

Article

Abstract

BACKGROUND: Patients with continuous-flow left ventricular assist devices (CF-LVADs) experience limitations in functional capacity and frequently, right ventricular (RV) dysfunction. We sought to characterize RV function in the context of global cardiopulmonary performance during exercise in this population. METHODS: A total of 26 patients with CF-LVAD (aged 58 ± 11 years, 23 males) completed a hemodynamic assessment with either conductance catheters (Group 1, n = 13) inserted into the right ventricle to generate RV pressure‒volume loops or traditional Swan‒Ganz catheters (Group 2, n = 13) during invasive cardiopulmonary exercise testing. Hemodynamics were collected at rest, 2 sub-maximal levels of exercise, and peak effort. Breath-by-breath gas exchange parameters were collected by indirect calorimetry. Group 1 participants also completed an invasive ramp test during supine rest to determine the impact of varying levels of CF-LVAD support on RV function. RESULTS: In Group 1, pump speed modulations minimally influenced RV function. During upright exercise, there were modest increases in RV contractility during sub-maximal exercise, but there were no appreciable increases at peak effort. Ventricular‒arterial coupling was preserved throughout the exercise. In Group 2, there were large increases in pulmonary arterial, left-sided filling, and right-sided filling pressures during sub-maximal and peak exercises. Among all participants, the cardiac output‒oxygen uptake relationship was preserved at 5.8:1. Ventilatory efficiency was severely abnormal at 42.3 ± 11.6. CONCLUSIONS: Patients with CF-LVAD suffer from limited RV contractile reserve; marked elevations in pulmonary, left-sided filling, and right-sided filling pressures during exercise; and severe ventilatory inefficiency. These findings explain mechanisms for persistent reductions in functional capacity in this patient population.

Medical Subject Headings

Cardiac Catheterization; Cardiac Output (physiology); Electrocardiography; Exercise (physiology); Exercise Test; Female; Heart Failure (diagnosis, physiopathology, therapy); Heart Ventricles (physiopathology); Heart-Assist Devices; Humans; Male; Middle Aged; Myocardial Contraction (physiology); Stroke Volume; Ventricular Function, Right (physiology)

Publication Date

2-1-2021

Publication Title

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

E-ISSN

1557-3117

Volume

40

Issue

2

First Page

128

Last Page

137

PubMed ID

33281029

Digital Object Identifier (DOI)

10.1016/j.healun.2020.11.009

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