Hemodynamic parameters at rest predicting exercise capacity in patients supported with left ventricular assist device.

IF 1.1 4区 医学 Q4 ENGINEERING, BIOMEDICAL
Journal of Artificial Organs Pub Date : 2024-03-01 Epub Date: 2023-03-18 DOI:10.1007/s10047-023-01388-x
Hirotoshi Kato, Togo Iwahana, Ryohei Ono, Sho Okada, Goro Matsumiya, Yoshio Kobayashi
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Abstract

Left ventricular assist devices improve prognosis and quality of life, but exercise capacity remains limited in most patients after device implantation. Left ventricular assist device optimization through right heart catheterization reduces device-related complications. However, hemodynamic parameters associated with exercise capacity under optimized conditions. The aim of this study was to elucidate the predictors of exercise capacity from hemodynamic parameters at rest after left ventricular assist device optimization. We retrospectively reviewed 24 patients who underwent a ramp test with right heart catheterization, echocardiography and cardiopulmonary exercise testing more than 6 months after left ventricular assist device implantation. Pump speed was optimized to a lower setting that achieved right atrial pressure < 12 mmHg, pulmonary capillary wedge pressure < 18 mmHg, and cardiac index > 2.2 L/min/m2, then exercise capacity was assessed by cardiopulmonary exercise testing. After left ventricular assist device optimization, the mean right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and peak oxygen consumption were 7 ± 5 mmHg, 10 ± 7 mmHg, 2.7 ± 0.5 L/min/m2, and 13.2 ± 3.0 mL/min/kg, respectively. Pulse pressure, stroke volume, right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure were significantly associated with peak oxygen consumption. Multivariate linear regression analysis of factors predicting peak oxygen consumption revealed that pulse pressure, right atrial pressure, and aortic insufficiency remained independent predictors (β = 0.401, p = 0.007; β = - 0.558, p < 0.001; β = - 0.369, p = 0.010, respectively). Our findings suggests that cardiac reserve, volume status, right ventricular function, and aortic insufficiency predict exercise capacity in patients with a left ventricular assist device.

Abstract Image

预测使用左心室辅助装置的患者运动能力的静态血流动力学参数。
左心室辅助装置可改善预后和生活质量,但大多数患者在植入装置后运动能力仍然有限。通过右心导管手术优化左心室辅助装置可减少与装置相关的并发症。然而,血液动力学参数与优化条件下的运动能力有关。本研究旨在从左心室辅助装置优化后静息状态下的血液动力学参数阐明运动能力的预测因素。我们对 24 名患者进行了回顾性研究,这些患者在植入左心室辅助装置 6 个多月后接受了右心导管检查、超声心动图检查和心肺运动测试。将泵速优化至较低设置,使右心房压力达到 2.2 升/分钟/平方米,然后通过心肺运动测试评估运动能力。左心室辅助装置优化后,平均右心房压、肺毛细血管楔压、心脏指数和峰值耗氧量分别为 7 ± 5 mmHg、10 ± 7 mmHg、2.7 ± 0.5 L/min/m2 和 13.2 ± 3.0 mL/min/kg。脉压、每搏量、右心房压、平均肺动脉压和肺毛细血管楔压与峰值耗氧量显著相关。对预测峰值耗氧量的因素进行的多变量线性回归分析表明,脉压、右心房压和主动脉瓣关闭不全仍然是独立的预测因素(β = 0.401,p = 0.007;β = - 0.558,p = 0.007)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Artificial Organs
Journal of Artificial Organs 医学-工程:生物医学
CiteScore
2.80
自引率
15.40%
发文量
68
审稿时长
6-12 weeks
期刊介绍: The aim of the Journal of Artificial Organs is to introduce to colleagues worldwide a broad spectrum of important new achievements in the field of artificial organs, ranging from fundamental research to clinical applications. The scope of the Journal of Artificial Organs encompasses but is not restricted to blood purification, cardiovascular intervention, biomaterials, and artificial metabolic organs. Additionally, the journal will cover technical and industrial innovations. Membership in the Japanese Society for Artificial Organs is not a prerequisite for submission.
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