Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance

被引：35

作者：

Apostolo, Anna ^{[1
]}

Paolillo, Stefania ^{[2
]}

Cotini, Mauro ^{[1
]}

Vignati, Carlo ^{[1
,7
]}

Tarzia, Vincenzo ^{[3
]}

Campodonico, Jeness ^{[1
]}

Mapelli, Massimo ^{[1
]}

Massetti, Massimo ^{[4
]}

Bejko, Jonida ^{[3
]}

Righini, Francesca ^{[1
]}

Bottio, Tomaso ^{[3
]}

Bonini, Niccolo ^{[1
]}

Salvioni, Elisabetta ^{[1
]}

Gugliandolo, Paolo ^{[1
]}

Parati, Gianfranco ^{[5
,6
]}

Lombardi, Carolina ^{[5
]}

Gerosa, Gino ^{[3
]}

Salvi, Luca ^{[1
]}

Alamanni, Francesco ^{[1
]}

Agostoni, Piergiuseppe ^{[1
,7
]}

机构：

[1] IRCCS, Ctr Cardiol Monzino, Milan, Italy

[2] IRCCS, Ist Ricerca Diagnost & Nucl, Naples, Italy

[3] Univ Padua, Dept Cardiac Thorac & Vasc Sci, Cardiac Surg Unit, Padua, Italy

[4] Catholic Univ, Gemelli Hosp, Dept Cardiovasc Sci, Rome, Italy

[5] Ist Auxol Italiano, San Luca Hosp, Dept Cardiovasc Neural & Metab Sci, Milan, Italy

[6] Univ Milano Bicocca, Dept Med & Surg, Milan, Italy

[7] Univ Milan, Dept Clin Sci & Community Hlth, Cardiovasc Sect, Milan, Italy

来源：

JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2018年 / 37卷 / 11期

关键词：

LVAD; exercise; CPET; cardiac output; lung diffusion; muscle oxygenation; CHRONIC HEART-FAILURE; SINGLE-BREATH DETERMINATION; LUNG DIFFUSING-CAPACITY; CONSTANT WORK RATE; PUMP SPEED; CARDIAC-OUTPUT; ANAEROBIC THRESHOLD; NITRIC-OXIDE; DOUBLE-BLIND; FLOW;

D O I：

10.1016/j.healun.2018.07.005

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

BACKGROUND: Increasing left ventricular assist device (LVAD) pump speed according to the patient's activity is a fascinating hypothesis. This study analyzed the short-term effects of LVAD speed increase on cardiopulmonary exercise test (CPET) performance, muscle oxygenation (near-infrared spectroscopy), diffusion capacity of the lung for carbon monoxide (DLco) and nitric oxide (Duvo), and sleep quality. METHODS: We analyzed CPET, DLco and DLNO, and sleep in 33 patients supported with the Jarvik 2000 (Jarvik Heart Inc., New York, NY). After a maximal CPET (n = 28), patients underwent 2 maximal CPETs with LVAD speed randomly set at 3 or increased from 3 to 5 during effort (n = 15). Then, at LVAD speed randomly set at 2 or 4, we performed (1) constant workload CPETs assessing 02 kinetics, cardiac output (CO), and muscle oxygenation (n = 15); (2) resting DLco and DLNO (n = 18); and (3) nocturnal cardiorespiratory monitoring (n = 29). RESULTS: The progressive pump speed increase raised peak volume of oxygen consumption (12.5 2.5 ml/min/kg vs 11.7 2.8 ml/min/kg at speed 3; p = 0.001). During constant workload, from speed 2 to 4, CO increased (at rest: 3.18 0.76 liters/min vs 3.69 0.75 liters/min, p = 0.015; during exercise: 5.91 1.31 liters/min vs 6.69 0.99 liters/min, p = 0.014), and system efficiency (r = 65.8 15.1 seconds vs 49.9 14.8 seconds, p = 0.002) and muscle oxygenation improved. At speed 4, DLco decreased, and obstructive apneas increased despite a significant apnea/hypopnea index and a reduction of central apneas. CONCLUSIONS: Short-term LVAD speed increase improves exercise performance, CO, 02 kinetics, and muscle oxygenation. However, it deteriorates lung diffusion and increases obstructive apneas, likely due to an increase of intrathoracic fluids. Self-adjusting LVAD speed is a fascinating but possibly unsafe option, probably requiring a monitoring of intrathoracic fluids. J Heart Lung Transplant 2018;37:1361-1371 (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.

引用

页码：1361 / 1371

页数：11

共 46 条

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Reduced in vivo skeletal muscle oxygen consumption in patients with chronic heart failure -: A study using Near Infrared Spectrophotometry (NIRS) [J].