High Right Ventricular Afterload Is Associated with Impaired Exercise Tolerance in Patients with Left Ventricular Assist Devices

Van Khue Ton, Gautam Ramani, Steven Hsu, C. Danielle Hopkins, David Kaczorowski, Ronson J. Madathil, Susanna Mak, Ryan J. Tedford

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Patients with left ventricular assist device (LVAD) have poor exercise tolerance. We aimed to characterize relationship between right ventricular (RV) afterload and exercise capacity, RV reserve, and adaptation to load. Twelve well-compensated LVAD subjects underwent right heart catheterization at rest and during symptom-limited exercise. Cardiopulmonary exercise tests were also performed. Hemodynamics were compared with age-and sex-matched subjects with pulmonary arterial hypertension (PAH) and normal non-Athletes. Hemodynamic changes were expressed as Δ(exercise-rest). At rest, LVAD subjects had normal biventricular pressures and cardiac output (CO). On exercise, despite similar increases in pulmonary artery wedge pressure (PAWP) between three groups, RV afterload increased only in LVAD cohort (pulmonary elastance [ΔEa] LVAD: 0.4, PAH: 0.1, normal: 0.1 mmHg/ml, p = 0.0024). This afterload increase coincided with the largest rise in right atrial pressure (RAP), lowest change in RV stroke work index, and smallest CO augmentation (ΔCO LVAD: 1.5, PAH: 4.3, normal: 5.7 L/min, p = 0.0014). Peak VO2negatively correlated with RV afterload (Ea) (r =-0.8, p = 0.0101), while VE/VCO2slope had the inverse correlation. During exercise, pulmonary artery pulsatility index worsened while RAP:PAWP ratio was unchanged in LVAD subjects. Well-compensated LVAD patients had poor RV reserve and adaptation to load on exercise compared with PAH and normal subjects.

Original languageEnglish (US)
Pages (from-to)39-45
Number of pages7
JournalASAIO Journal
Volume67
Issue number1
DOIs
StatePublished - Jan 1 2021

Keywords

  • cardiopulmonary exercise stress test
  • exercise hemodynamics
  • left ventricular assist device
  • pulmonary arterial hypertension
  • right ventricular afterload

ASJC Scopus subject areas

  • Bioengineering
  • Biophysics
  • Biomedical Engineering
  • Biomaterials

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