High Right Ventricular Afterload Is Associated with Impaired Exercise Tolerance in Patients with Left Ventricular Assist Devices.
Van-Khue TonGautam RamaniSteven HsuC Danielle HopkinsDavid KaczorowskiRonson J MadathilSusanna MakRyan J TedfordPublished in: ASAIO journal (American Society for Artificial Internal Organs : 1992) (2021)
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 VO2 negatively correlated with RV afterload (Ea) (r = -0.8, p = 0.0101), while VE/VCO2 slope 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.
Keyphrases
- pulmonary artery
- left ventricular assist device
- pulmonary arterial hypertension
- high intensity
- mycobacterium tuberculosis
- pulmonary hypertension
- physical activity
- resistance training
- coronary artery
- left ventricular
- atrial fibrillation
- end stage renal disease
- chronic kidney disease
- acute coronary syndrome
- ejection fraction
- prognostic factors
- subarachnoid hemorrhage
- percutaneous coronary intervention
- patient reported outcomes