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Echo-guided LVAD speed optimization for exercise maximization
Abstract Background Continuous-flow left ventricular assist devices (LVAD) are becoming a destination therapy in patients with end-stage left ventricular dysfunction and a competitive method for heart transplantation. Current generation pumps operate with a fixed rotation speed and do not have the a...
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| Published in: | European heart journal 2021-10, Vol.42 (Supplement_1) |
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| Main Authors: | , , , , , , , , |
| Format: | Article |
| Language: | English |
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| container_issue | Supplement_1 |
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| container_title | European heart journal |
| container_volume | 42 |
| creator | Stapor, M Pilat, A Gackowski, A Gorkiewicz-Kot, I Kleczynski, P Zmudka, K Legutko, J Kapelak, B Wierzbicki, K |
| description | Abstract
Background
Continuous-flow left ventricular assist devices (LVAD) are becoming a destination therapy in patients with end-stage left ventricular dysfunction and a competitive method for heart transplantation. Current generation pumps operate with a fixed rotation speed and do not have the automatic speed adjustment capability. However, it was shown that acceleration of the pump speed during stress test increases the maximum exercise tolerance.
Purpose
The study aimed to evaluate the concept of dynamic pump speed optimization based on the echocardiographic assessment of aortic valve opening (AVO) during the cardiopulmonary exercise test (CPET).
Methods
Patients with implanted third-generation centrifugal continuous-flow LVAD's with hydrodynamic bearing were prospectively included. Two CPET's were performed after resting speed optimization. The first one with maintained baseline pump speed settings, and the second one with gradually increased speed depending on live echocardiographic imaging. The sequence of tests was random.
Results
Exercise AVO was apparent in all 22 included patients. The resting pump speed was 2691 RPM and incremented on average by 566 RPM (20%). Pump power and flow raised from 5.6 to 9.8 Watts (p |
| doi_str_mv | 10.1093/eurheartj/ehab724.0947 |
| format | article |
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Background
Continuous-flow left ventricular assist devices (LVAD) are becoming a destination therapy in patients with end-stage left ventricular dysfunction and a competitive method for heart transplantation. Current generation pumps operate with a fixed rotation speed and do not have the automatic speed adjustment capability. However, it was shown that acceleration of the pump speed during stress test increases the maximum exercise tolerance.
Purpose
The study aimed to evaluate the concept of dynamic pump speed optimization based on the echocardiographic assessment of aortic valve opening (AVO) during the cardiopulmonary exercise test (CPET).
Methods
Patients with implanted third-generation centrifugal continuous-flow LVAD's with hydrodynamic bearing were prospectively included. Two CPET's were performed after resting speed optimization. The first one with maintained baseline pump speed settings, and the second one with gradually increased speed depending on live echocardiographic imaging. The sequence of tests was random.
Results
Exercise AVO was apparent in all 22 included patients. The resting pump speed was 2691 RPM and incremented on average by 566 RPM (20%). Pump power and flow raised from 5.6 to 9.8 Watts (p<0.0001) and from 5.8 to 7.3 l/min (p<0.0001), respectively. Peak VO2 increased from 11.1 to 12.8 ml/kg/min (p=0.0003) and maximum workload from 1.1 to 1.2 W/kg (p=0.03). The Borg scale exertion level decreased from 15.2 to 13.5 (p=0.0049). There was a visible trend towards longer exercise time (36s) but no statistical significance was achieved (p=0.1).
Conclusion
Ultrasonographic AVO analysis is possible during CPET's in patients supported with LVAD. Dynamic echo-guided pump speed adjustment based on the AVO improves exercise tolerance, augments peak VO2 consumption and maximal workload. An automatic speed adjustment in the next generations of LVAD controllers might improve functional capacity and requires further basic, technological and clinical research.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): 1. Cor Aegrum Foundation of Cardiac Surgery Development in Cracow2. Medtronic Poland Sp. z o.o.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehab724.0947</identifier><language>eng</language><publisher>Oxford University Press</publisher><ispartof>European heart journal, 2021-10, Vol.42 (Supplement_1)</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com. 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids></links><search><creatorcontrib>Stapor, M</creatorcontrib><creatorcontrib>Pilat, A</creatorcontrib><creatorcontrib>Gackowski, A</creatorcontrib><creatorcontrib>Gorkiewicz-Kot, I</creatorcontrib><creatorcontrib>Kleczynski, P</creatorcontrib><creatorcontrib>Zmudka, K</creatorcontrib><creatorcontrib>Legutko, J</creatorcontrib><creatorcontrib>Kapelak, B</creatorcontrib><creatorcontrib>Wierzbicki, K</creatorcontrib><title>Echo-guided LVAD speed optimization for exercise maximization</title><title>European heart journal</title><description>Abstract
Background
Continuous-flow left ventricular assist devices (LVAD) are becoming a destination therapy in patients with end-stage left ventricular dysfunction and a competitive method for heart transplantation. Current generation pumps operate with a fixed rotation speed and do not have the automatic speed adjustment capability. However, it was shown that acceleration of the pump speed during stress test increases the maximum exercise tolerance.
Purpose
The study aimed to evaluate the concept of dynamic pump speed optimization based on the echocardiographic assessment of aortic valve opening (AVO) during the cardiopulmonary exercise test (CPET).
Methods
Patients with implanted third-generation centrifugal continuous-flow LVAD's with hydrodynamic bearing were prospectively included. Two CPET's were performed after resting speed optimization. The first one with maintained baseline pump speed settings, and the second one with gradually increased speed depending on live echocardiographic imaging. The sequence of tests was random.
Results
Exercise AVO was apparent in all 22 included patients. The resting pump speed was 2691 RPM and incremented on average by 566 RPM (20%). Pump power and flow raised from 5.6 to 9.8 Watts (p<0.0001) and from 5.8 to 7.3 l/min (p<0.0001), respectively. Peak VO2 increased from 11.1 to 12.8 ml/kg/min (p=0.0003) and maximum workload from 1.1 to 1.2 W/kg (p=0.03). The Borg scale exertion level decreased from 15.2 to 13.5 (p=0.0049). There was a visible trend towards longer exercise time (36s) but no statistical significance was achieved (p=0.1).
Conclusion
Ultrasonographic AVO analysis is possible during CPET's in patients supported with LVAD. Dynamic echo-guided pump speed adjustment based on the AVO improves exercise tolerance, augments peak VO2 consumption and maximal workload. An automatic speed adjustment in the next generations of LVAD controllers might improve functional capacity and requires further basic, technological and clinical research.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): 1. Cor Aegrum Foundation of Cardiac Surgery Development in Cracow2. Medtronic Poland Sp. z o.o.</description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqNkMtKAzEYhYMoWKuvIPMCaXObTLJwUWq9wICbIu5CmvnjpDhmSGag-vS2tHTt6hw4fGfxIXRPyYwSzecwphZsGrZzaO2mYmJGtKgu0ISWjGEtRXmJJoTqEkupPq7RTc5bQoiSVE7Qw8q1EX-OoYGmqN8Xj0XuYV9jP4Qu_NohxO_Cx1TADpILGYrO7s7LLbry9ivD3SmnaP20Wi9fcP32_Lpc1NgpXWEKiiphJXNOcdFozWVJGdPMSyU5J04IxZkgG-84KMd9Y0EQaKz3zlXC8SmSx1uXYs4JvOlT6Gz6MZSYgwNzdmBODszBwR6kRzCO_X-ZP2xmZTg</recordid><startdate>20211012</startdate><enddate>20211012</enddate><creator>Stapor, M</creator><creator>Pilat, A</creator><creator>Gackowski, A</creator><creator>Gorkiewicz-Kot, I</creator><creator>Kleczynski, P</creator><creator>Zmudka, K</creator><creator>Legutko, J</creator><creator>Kapelak, B</creator><creator>Wierzbicki, K</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20211012</creationdate><title>Echo-guided LVAD speed optimization for exercise maximization</title><author>Stapor, M ; Pilat, A ; Gackowski, A ; Gorkiewicz-Kot, I ; Kleczynski, P ; Zmudka, K ; Legutko, J ; Kapelak, B ; Wierzbicki, K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c897-1e8184a62cc834d9936512292f686330c4483240bfc3e8c3fdae40edaffcc74c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stapor, M</creatorcontrib><creatorcontrib>Pilat, A</creatorcontrib><creatorcontrib>Gackowski, A</creatorcontrib><creatorcontrib>Gorkiewicz-Kot, I</creatorcontrib><creatorcontrib>Kleczynski, P</creatorcontrib><creatorcontrib>Zmudka, K</creatorcontrib><creatorcontrib>Legutko, J</creatorcontrib><creatorcontrib>Kapelak, B</creatorcontrib><creatorcontrib>Wierzbicki, K</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stapor, M</au><au>Pilat, A</au><au>Gackowski, A</au><au>Gorkiewicz-Kot, I</au><au>Kleczynski, P</au><au>Zmudka, K</au><au>Legutko, J</au><au>Kapelak, B</au><au>Wierzbicki, K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Echo-guided LVAD speed optimization for exercise maximization</atitle><jtitle>European heart journal</jtitle><date>2021-10-12</date><risdate>2021</risdate><volume>42</volume><issue>Supplement_1</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Abstract
Background
Continuous-flow left ventricular assist devices (LVAD) are becoming a destination therapy in patients with end-stage left ventricular dysfunction and a competitive method for heart transplantation. Current generation pumps operate with a fixed rotation speed and do not have the automatic speed adjustment capability. However, it was shown that acceleration of the pump speed during stress test increases the maximum exercise tolerance.
Purpose
The study aimed to evaluate the concept of dynamic pump speed optimization based on the echocardiographic assessment of aortic valve opening (AVO) during the cardiopulmonary exercise test (CPET).
Methods
Patients with implanted third-generation centrifugal continuous-flow LVAD's with hydrodynamic bearing were prospectively included. Two CPET's were performed after resting speed optimization. The first one with maintained baseline pump speed settings, and the second one with gradually increased speed depending on live echocardiographic imaging. The sequence of tests was random.
Results
Exercise AVO was apparent in all 22 included patients. The resting pump speed was 2691 RPM and incremented on average by 566 RPM (20%). Pump power and flow raised from 5.6 to 9.8 Watts (p<0.0001) and from 5.8 to 7.3 l/min (p<0.0001), respectively. Peak VO2 increased from 11.1 to 12.8 ml/kg/min (p=0.0003) and maximum workload from 1.1 to 1.2 W/kg (p=0.03). The Borg scale exertion level decreased from 15.2 to 13.5 (p=0.0049). There was a visible trend towards longer exercise time (36s) but no statistical significance was achieved (p=0.1).
Conclusion
Ultrasonographic AVO analysis is possible during CPET's in patients supported with LVAD. Dynamic echo-guided pump speed adjustment based on the AVO improves exercise tolerance, augments peak VO2 consumption and maximal workload. An automatic speed adjustment in the next generations of LVAD controllers might improve functional capacity and requires further basic, technological and clinical research.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): 1. Cor Aegrum Foundation of Cardiac Surgery Development in Cracow2. Medtronic Poland Sp. z o.o.</abstract><pub>Oxford University Press</pub><doi>10.1093/eurheartj/ehab724.0947</doi></addata></record> |
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| source | Oxford Journals - Connect here FIRST to enable access |
| title | Echo-guided LVAD speed optimization for exercise maximization |
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