Echo-guided left ventricular assist device speed optimisation for exercise maximisation.
Echo-guided left ventricular assist device speed optimisation for exercise maximisation.
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DOI：
10.1136/heartjnl-2021-320495
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发表时间：
2022-06-10
期刊：
影响因子：
5.7
通讯作者：
Wierzbicki, Karol
中科院分区：
文献类型：
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作者：
Stapor, Maciej;Pilat, Adam;Gackowski, Andrzej;Misiuda, Agnieszka;Gorkiewicz-Kot, Izabela;Kaleta, Michal;Kleczynski, Pawel;Zmudka, Krzysztof;Legutko, Jacek;Kapelak, Boguslaw;Wierzbicki, Karol
当前一代左心室辅助装置（LVAD）以固定的旋转速度操作，并且没有自动速度调节功能。本研究评价了心肺运动试验（CPET）期间基于主动脉瓣开度（AVO）成像的生理泵速优化概念。这项前瞻性交叉研究（NCT 05063006）入组了植入第三代LVAD（带流体动力轴承）的患者。静息速度优化后，患者被随机分配至固定-改良速度或改良-固定速度CPET序列。定速CPET维持基线泵设置。在改良速度CPET期间，持续改变LVAD速度以保持周期性AVO。我们纳入了22例患者，平均年龄为58.4±7岁，4.5%为女性，54.5%患有缺血性心肌病。所有受试者的AVO评估均可行。保持周期性AVO允许将泵速从2900（IQR 2640-3000）安全地提高到3440转/分钟（RPM）（IQR 3100-3700; p<0.001）。结果，峰值耗氧量从11.1±2.4 mL/kg/min增加到12.8±2.8 mL/kg/min（p<0.001），最大工作负荷从1.1（IQR 0.9-1.5）增加到1.2 W/kg（IQR 0.9-1.7; p=0.028）。博格量表劳累水平从15.2±1.5降至13.5±1.2（p=0.005）。在LVAD患者的CPPWE期间，可以进行经胸AVO成像。基于AVO的动态回声引导泵速调节可提高运动耐量并增加峰值耗氧量和最大工作负荷。
Current generation left ventricular assist devices (LVADs) operate with a fixed rotation speed and no automated speed adjustment function. This study evaluates the concept of physiological pump speed optimisation based on aortic valve opening (AVO) imaging during a cardiopulmonary exercise test (CPET). This prospective crossover study (NCT05063006) enrolled patients with implanted third-generation LVADs with hydrodynamic bearing. After resting speed optimisation, patients were randomised to a fixed-modified speed or modified-fixed speed CPET sequence. Fixed speed CPET maintained baseline pump settings. During the modified speed CPET, the LVAD speed was continuously altered to preserve periodic AVO. We included 22 patients, the mean age was 58.4±7 years, 4.5% were women and 54.5% had ischaemic cardiomyopathy. Exertional AVO assessment was feasible in all subjects. Maintaining periodic AVO allowed to safely raise the pump speed from 2900 (IQR 2640–3000) to 3440 revolutions per minute (RPM) (IQR 3100–3700; p<0.001). As a result, peak oxygen consumption increased from 11.1±2.4 to 12.8±2.8 mL/kg/min (p<0.001) and maximum workload from 1.1 (IQR 0.9–1.5) to 1.2 W/kg (IQR 0.9–1.7; p=0.028). The Borg scale exertion level decreased from 15.2±1.5 to 13.5±1.2 (p=0.005). Transthoracic AVO imaging is possible during CPETs in patients with LVAD. Dynamic echo-guided pump speed adjustment based on the AVO improves exercise tolerance and augments peak oxygen consumption and maximum workload.
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影响因子：
8.9
作者：
Jung, Mette Holme;Gustafsson, Finn
通讯作者：
Gustafsson, Finn
DOI：
10.1161/circheartfailure.120.007448
发表时间：
2021-01
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Sailer C;Edelmann H;Buchanan C;Giro P;Babcock M;Swanson C;Spotts M;Schulte M;Pratt-Cordova A;Coe G;Beindorff M;Page RL 2nd;Ambardekar AV;Pal JD;Kohrt W;Wolfel E;Lawley JS;Tarumi T;Cornwell WK 3rd
通讯作者：
Cornwell WK 3rd
影响因子：
8.9
作者：
Loyaga-Rendon, Renzo Y.;Plaisance, Eric P.;Shah, Keyur
通讯作者：
Shah, Keyur
影响因子：
13
作者：
Moss, Noah;Rakita, Val;Mancini, Donna M.
通讯作者：
Mancini, Donna M.
影响因子：
3.7
作者：
Gross, Christoph;Fresiello, Libera;Moscato, Francesco
通讯作者：
Moscato, Francesco