Pulsatility and flow patterns across macro- and microcirculatory arteries of continuous-flow left ventricular assist device patients
Section snippets
Study population
Four groups of volunteers were enrolled: (1) HF patients, (2) HF patients implanted with the HMII LVAD, (3) HF patients implanted with HM3 LVAD and (4) healthy volunteers. Healthy individuals were included if they did not have any known/diagnosed chronic diseases including hypertension and diabetes, were not taking any regular medication and did not report a current illness. Heart failure patients were included if they were diagnosed with HF for at least 6 months and had a left ventricular
Baseline characteristics
Our final cohort included a total of 148 participants: HF: n = 43; HMII: n = 32; HM3: n = 41; healthy controls: n = 32. Baseline demographics and clinical characteristics are shown in Table 1. INTERMACS profile at the time of LVAD implant did not differ between HMII and HM3 patients. Healthy subjects were younger and had a lower BMI. Pump power, flow, and pulsatility index were higher in HMII than HM3. Due to the consecutive recruitment, duration of LVAD support was longer in HMII compared with
Discussion
Our study provides several novel findings. First, the artificial pulsatility of the HM3 is clearly detectable in the central and medium-sized arteries as well as in the microcirculation. Second, in HM3 patients, the 2D-Doppler PI was higher in beats with "artificial pulse" than in beats with "continuous flow" throughout these vascular compartments; however, although nominally higher, the "artificial pulse" PI of the HM3 was not statistically different from the PI of the HMII. Third,
Disclosure statement
This project has received funding from the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No 705219. This study was also supported by the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York − Presbyterian Hospital/ Columbia University, NIH grant P30 EY019007 and an unrestricted grant to the Department of Ophthalmology of Columbia University from Research to Prevent Blindness.
The authors have no conflicts of interest
References (43)
- et al.
Mechanical unloading in heart failure
J Am Coll Cardiol
(2018) - et al.
Effect of pulsatile and nonpulsatile flow on cerebral perfusion in patients with left ventricular assist devices
J Heart Lung Transplant
(2014) - et al.
Abnormalities of brain imaging in patients after left ventricular assist device support following explantation
J Heart Lung Transplant
(2020) - et al.
Further peripheral vascular dysfunction in heart failure patients with a continuous-flow left ventricular assist device: the role of pulsatility
JACC Heart Fail
(2015) - et al.
One-year outcomes with the HeartMate 3 left ventricular assist device
J Thorac Cardiovasc Surg
(2018) - et al.
Retinal microvascular function is associated with the cerebral microcirculation as determined by intravoxel incoherent motion MRI
J Neurol Sci
(2022) - et al.
Cerebral vasoreactivity in HeartMate 3 patients
J Heart Lung Transplant
(2021) - et al.
Matrix-degrading enzyme expression and aortic fibrosis during continuous-flow left ventricular mechanical support
J Am Coll Cardiol
(2021) Continuous-flow rotary left ventricular assist devices with "3rd generation" design
Semin Thorac Cardiovasc Surg
(2008)- et al.
Association of nasal mucosal vascular alterations, gastrointestinal arteriovenous malformations, and bleeding in patients with continuous-flow left ventricular assist devices
JACC Heart Fail
(2016)
Gastrointestinal angiodysplasia in heart failure and during CF LVAD support
J Heart Lung Transplant
Dynamic changes in aortic vascular stiffness in patients bridged to transplant with continuous-flow left ventricular assist devices
JACC Heart Fail
Increased aortic stiffness is associated with higher rates of stroke, gastrointestinal bleeding and pump thrombosis in patients with a continuous flow left ventricular assist device
J Card Fail
Cerebral amyloid angiopathy: diagnosis, clinical implications, and management strategies in atrial fibrillation
J Am Coll Cardiol
Mechanisms of exercise intolerance in heart failure with preserved ejection fraction: the role of abnormal peripheral oxygen extraction
Circ Heart Fail
Mechanotransduction in vascular physiology and atherogenesis
Nat Rev Mol Cell Biol
A comparative study of cerebral microcirculation during pulsatile and nonpulsatile selective cerebral perfusion: assessment by synchrotron radiation microangiography
ASAIO J
Association between the severity of acquired von Willebrand syndrome and gastrointestinal bleeding after continuous-flow left ventricular assist device implantation
Eur J Cardiothorac Surg
Prevalence of cerebral microbleeds in patients with continuous-flow left ventricular assist devices
J Am Heart Assoc
A fully magnetically levitated left ventricular assist device - final report
N Engl J Med
A fully magnetically levitated circulatory pump for advanced heart failure
N Engl J Med
Cited by (0)
- #
Now: COR-HELIX (CardiOvascular Regulation and Human Exercise Laboratory – Integration and Xploration), Institute of Sports Science, Leibniz Universität Hannover, 30167 Hannover, Germany
- ##
Now: Department of Anesthesiology, Yodogawa Christian Hospital, Osaka, Japan