TY - JOUR
T1 - High Right Ventricular Afterload Is Associated with Impaired Exercise Tolerance in Patients with Left Ventricular Assist Devices
AU - Ton, Van Khue
AU - Ramani, Gautam
AU - Hsu, Steven
AU - Hopkins, C. Danielle
AU - Kaczorowski, David
AU - Madathil, Ronson J.
AU - Mak, Susanna
AU - Tedford, Ryan J.
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - 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.
AB - 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.
KW - cardiopulmonary exercise stress test
KW - exercise hemodynamics
KW - left ventricular assist device
KW - pulmonary arterial hypertension
KW - right ventricular afterload
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U2 - 10.1097/MAT.0000000000001169
DO - 10.1097/MAT.0000000000001169
M3 - Article
C2 - 32412930
AN - SCOPUS:85098829480
SN - 1058-2916
VL - 67
SP - 39
EP - 45
JO - ASAIO Journal
JF - ASAIO Journal
IS - 1
ER -