Hemodynamic Response to Exercise in Patients Supported by Continuous Flow Left Ventricular Assist Devices
Hemodynamic Response to Exercise in Patients Supported by Continuous Flow Left Ventricular Assist Devices
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DOI：
10.1016/j.jchf.2019.10.013
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发表时间：
2020-04-01
影响因子：
13
通讯作者：
Mancini, Donna M.
中科院分区：
文献类型：
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作者：
Moss, Noah;Rakita, Val;Mancini, Donna M.
目的研究LVAD支持患者对运动的血流动力学反应，并找出与峰值氧耗量(VO2)最相关的参数。背景：尽管持续血流左心室辅助装置(LVAD)改善了心力衰竭患者的存活率，但峰值运动能力仍然受损。这种功能能力下降的机制仍不清楚。方法从2017年12月到2019年6月，接受VAD后血流动力学优化的患者入选。置入Swan Ganz导尿管，进行直立递增踏车测功术和呼吸气体分析。在运动中每隔3分钟记录一次血流动力学、混合静脉饱和度和动脉血压。峰值VO2(ml/min)与最大Fick心输出量(CO)、最大装置流量、假设的固有CO(Fick CO-装置流量)、跨左室压差(平均动脉压-肺毛细血管楔压)、跨右室峰压差(平均肺动脉压-右房压)和体循环阻力呈线性相关。共有34名男性和11名女性。平均年龄60+/-10岁。VO2峰值平均为10.6±3.1ml/kg/min。Fick CO与最大VO2的相关性最大，r=0.73p<；0.0001，其次是本征CO(r=0.67p<；0.0001)。预测峰值VO2的多变量模型包括Fick CO和峰值动脉静脉血氧分压(AVO(2))之差。结论LVAD支持患者存在严重的峰值运动能力受损。最大Fick心输出量与峰值运动成绩的相关性最好。(C)2020年，由美国心脏病学会基金会提供。
OBJECTIVES This study sought to characterize the hemodynamic response to exercise in LVAD-supported patients and identify parameters most strongly associated with peak oxygen consumption (VO2).BACKGROUND Despite improved survival for heart failure patients afforded by continuous flow left ventricular assist devices (LVADs), peak exercise capacity remains impaired. Mechanisms underlying this reduced functional capacity remain poorly understood.METHODS Patients referred for post-VAD hemodynamic optimization from December 2017 through June 2019 were enrolled. Swan Ganz catheters were inserted and upright incremental bicycle ergometry with respiratory gas analysis was performed. Hemodynamic measurements, mixed venous saturation, and arterial blood pressure were recorded every 3 min during exercise. Linear correlations were performed between peak VO2 (ml/min) and peak Fick cardiac output (CO), peak device flow, the assumed intrinsic CO derived as Fick CO-device flow, peak pressure differential across the LVAD (mean arterial pressure-pulmonary capillary wedge pressure), peak pressure differential across right ventricle (mean pulmonary artery pressure - right atrial pressure) and systemic vascular resistance.RESULTS Forty-five patients supported by axial flow pumps (n = 12) and centrifugal flow pumps (n = 33) were studied. There were 34 men and 11 women. Age averaged 60 +/- 10 years. Peak VO2 averaged 10.6 +/- 3.1 ml/kg/min. Fick CO had the greatest correlation with peak VO2 with r = 0.73 (p < 0.0001) followed by intrinsic CO (r = 0.67; p < 0.0001). Multivariate model that best predicted peak VO2 included Fick CO and peak arterial venous oxygen (AVO(2)) difference.CONCLUSIONS LVAD supported patients have severely impaired peak exercise capacity. The peak Fick cardiac output was the best correlate of peak exercise performance. (c) 2020 by the American College of Cardiology Foundation.