Echo-guided left ventricular assist device speed optimisation for exercise maximisation
ObjectiveCurrent 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...
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| Published in | Heart (British Cardiac Society) Vol. 108; no. 13; pp. 1055 - 1062 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
BMJ Publishing Group Ltd and British Cardiovascular Society
01.07.2022
BMJ Publishing Group LTD BMJ Publishing Group |
| Series | Original research |
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| Online Access | Get full text |
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| Abstract | ObjectiveCurrent 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).MethodsThis 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.ResultsWe 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).ConclusionsTransthoracic 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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| AbstractList | 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. ObjectiveCurrent 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).MethodsThis 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.ResultsWe 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).ConclusionsTransthoracic 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. 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).OBJECTIVECurrent 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.METHODSThis 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).RESULTSWe 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.CONCLUSIONSTransthoracic 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. |
| Author | Zmudka, Krzysztof Kapelak, Boguslaw Gorkiewicz-Kot, Izabela Legutko, Jacek Gackowski, Andrzej Stapor, Maciej Pilat, Adam Kaleta, Michal Wierzbicki, Karol Misiuda, Agnieszka Kleczynski, Pawel |
| AuthorAffiliation | 6 Department of Interventional Cardiology , Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology , Krakow , Poland 7 Department of Cardiovascular Surgery and Transplantology , Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology , Krakow , Poland 3 Department of Coronary Disease and Heart Failure , Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology , Krakow , Poland 5 Department of Cardiovascular Surgery and Transplantology , John Paul II Hospital , Krakow , Poland 4 Noninvasive Cardiovascular Laboratory , John Paul II Hospital , Krakow , Poland 2 Department of Automatic Control and Robotics , AGH University of Science and Technology , Krakow , Poland 1 Department of Interventional Cardiology , John Paul II Hospital , Krakow , Malopolska , Poland |
| AuthorAffiliation_xml | – name: 1 Department of Interventional Cardiology , John Paul II Hospital , Krakow , Malopolska , Poland – name: 4 Noninvasive Cardiovascular Laboratory , John Paul II Hospital , Krakow , Poland – name: 3 Department of Coronary Disease and Heart Failure , Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology , Krakow , Poland – name: 5 Department of Cardiovascular Surgery and Transplantology , John Paul II Hospital , Krakow , Poland – name: 6 Department of Interventional Cardiology , Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology , Krakow , Poland – name: 2 Department of Automatic Control and Robotics , AGH University of Science and Technology , Krakow , Poland – name: 7 Department of Cardiovascular Surgery and Transplantology , Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology , Krakow , Poland |
| Author_xml | – sequence: 1 givenname: Maciej orcidid: 0000-0003-0480-0729 surname: Stapor fullname: Stapor, Maciej email: m.stapor@szpitaljp2.krakow.pl organization: Department of Interventional Cardiology, John Paul II Hospital, Krakow, Malopolska, Poland – sequence: 2 givenname: Adam surname: Pilat fullname: Pilat, Adam organization: Department of Automatic Control and Robotics, AGH University of Science and Technology, Krakow, Poland – sequence: 3 givenname: Andrzej surname: Gackowski fullname: Gackowski, Andrzej organization: Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland – sequence: 4 givenname: Agnieszka surname: Misiuda fullname: Misiuda, Agnieszka organization: Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland – sequence: 5 givenname: Izabela surname: Gorkiewicz-Kot fullname: Gorkiewicz-Kot, Izabela organization: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland – sequence: 6 givenname: Michal surname: Kaleta fullname: Kaleta, Michal organization: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland – sequence: 7 givenname: Pawel surname: Kleczynski fullname: Kleczynski, Pawel organization: Department of Interventional Cardiology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland – sequence: 8 givenname: Krzysztof surname: Zmudka fullname: Zmudka, Krzysztof organization: Department of Interventional Cardiology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland – sequence: 9 givenname: Jacek surname: Legutko fullname: Legutko, Jacek organization: Department of Interventional Cardiology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland – sequence: 10 givenname: Boguslaw surname: Kapelak fullname: Kapelak, Boguslaw organization: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland – sequence: 11 givenname: Karol surname: Wierzbicki fullname: Wierzbicki, Karol organization: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland |
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| CitedBy_id | crossref_primary_10_3390_ijms24065639 crossref_primary_10_1136_heartjnl_2022_321429 crossref_primary_10_1136_heartjnl_2022_320836 crossref_primary_10_1016_j_hjc_2023_05_011 crossref_primary_10_3389_fcvm_2023_1248300 |
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| DOI | 10.1136/heartjnl-2021-320495 |
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| Keywords | cardiomyopathy, dilated heart-assist devices echocardiography heart failure, systolic |
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A simulation study publication-title: Artif Organs doi: 10.1111/aor.13569 – volume: 34 start-page: R1 year: 2013 ident: 2023100108000733000_108.13.1055.23 article-title: Developments in control systems for rotary left ventricular assist devices for heart failure patients: a review publication-title: Physiol Meas doi: 10.1088/0967-3334/34/1/R1 – ident: 2023100108000733000_108.13.1055.16 doi: 10.1016/j.jchf.2015.03.003 – ident: 2023100108000733000_108.13.1055.13 doi: 10.1002/ejhf.52 – ident: 2023100108000733000_108.13.1055.8 doi: 10.1016/j.jacc.2012.07.052 – volume: 43 start-page: 222 year: 2019 ident: 2023100108000733000_108.13.1055.7 article-title: LVAD pump flow does not adequately increase with exercise publication-title: Artif Organs doi: 10.1111/aor.13349 – volume: 14 year: 2021 ident: 2023100108000733000_108.13.1055.6 article-title: Impairments in blood pressure regulation and cardiac baroreceptor sensitivity among patients with heart failure supported with continuous-flow left ventricular assist devices publication-title: Circ Heart Fail doi: 10.1161/CIRCHEARTFAILURE.120.007448 – volume: 43 start-page: 458 year: 2019 ident: 2023100108000733000_108.13.1055.26 article-title: Beat-to-beat detection of aortic valve opening in HeartWare left ventricular assist device patients publication-title: Artif Organs doi: 10.1111/aor.13381 – volume: 10 start-page: S1802 year: 2018 ident: 2023100108000733000_108.13.1055.14 article-title: Effects of pump speed changes on exercise capacity in patients supported with a left ventricular assist device-an overview publication-title: J Thorac Dis doi: 10.21037/jtd.2018.01.114 – volume: 44 start-page: 2377 year: 2016 ident: 2023100108000733000_108.13.1055.21 article-title: Evaluation of physiological control systems for rotary left ventricular assist devices: an in-vitro study publication-title: Ann Biomed Eng doi: 10.1007/s10439-016-1552-3 – volume: 63 start-page: 1201 year: 2016 ident: 2023100108000733000_108.13.1055.27 article-title: Continuous monitoring of aortic valve opening in rotary blood pump patients publication-title: IEEE Trans Biomed Eng doi: 10.1109/TBME.2015.2489188 – ident: 2023100108000733000_108.13.1055.24 doi: 10.1093/ejcts/ezu006 – volume: 109 start-page: 649 year: 2020 ident: 2023100108000733000_108.13.1055.1 article-title: The Society of Thoracic Surgeons Intermacs 2019 annual report: the changing landscape of devices and indications publication-title: Ann Thorac Surg doi: 10.1016/j.athoracsur.2019.12.005 – volume: 21 start-page: 785 year: 2015 ident: 2023100108000733000_108.13.1055.10 article-title: Left ventricular decompression during speed optimization RAMPs in patients supported by continuous-flow left ventricular assist devices: Device-Specific performance characteristics and impact on diagnostic algorithms publication-title: J Card Fail doi: 10.1016/j.cardfail.2015.06.010 – volume: 4 start-page: 40 year: 2014 ident: 2023100108000733000_108.13.1055.19 article-title: Systemic perfusion at peak incremental exercise in left ventricular assist device recipients: partitioning pump and native left ventricle relative contribution publication-title: IJC Heart & Vessels doi: 10.1016/j.ijchv.2014.07.004 – ident: 2023100108000733000_108.13.1055.20 doi: 10.1161/CIRCHEARTFAILURE.110.958041 – ident: 2023100108000733000_108.13.1055.4 doi: 10.1016/j.jchf.2019.10.013 – volume: 15 year: 2020 ident: 2023100108000733000_108.13.1055.25 article-title: Hemodynamic exercise responses with a continuous-flow left ventricular assist device: comparison of patients' response and cardiorespiratory simulations publication-title: PLoS One doi: 10.1371/journal.pone.0229688 – ident: 2023100108000733000_108.13.1055.2 doi: 10.1016/j.healun.2014.12.006 – ident: 2023100108000733000_108.13.1055.17 doi: 10.1093/ejcts/ezw147 – volume: 40 start-page: 128 year: 2021 ident: 2023100108000733000_108.13.1055.5 article-title: Right ventricular function and cardiopulmonary performance among patients with heart failure supported by durable mechanical circulatory support devices publication-title: J Heart Lung Transplant doi: 10.1016/j.healun.2020.11.009 – ident: 2023100108000733000_108.13.1055.29 doi: 10.1117/12.772845 |
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| Snippet | ObjectiveCurrent generation left ventricular assist devices (LVADs) operate with a fixed rotation speed and no automated speed adjustment function. This study... Current generation left ventricular assist devices (LVADs) operate with a fixed rotation speed and no automated speed adjustment function. This study evaluates... |
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| SourceType | Open Access Repository Aggregation Database Index Database Enrichment Source Publisher |
| StartPage | 1055 |
| SubjectTerms | Cardiomyopathy cardiomyopathy, dilated echocardiography Heart failure Heart Failure and Cardiomyopathies heart failure, systolic heart-assist devices Hemodynamics Patients Physiology Quality of life Transplants & implants Ultrasonic imaging Video recorders Workloads |
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| Title | Echo-guided left ventricular assist device speed optimisation for exercise maximisation |
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