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Elevation of right-sided pressures and right ventricular echocardiographic parameters: predictors of Exercise Limitation in Patients with Implanted Continuous Flow Left Ventricular Assist Devices

Session Poster Session 2

Speaker Oscar Gonzalez Fernandez

Event : ESC Congress 2019

  • Topic : heart failure
  • Sub-topic : Ventricular Assist Devices
  • Session type : Poster Session

Authors : N Bouzas Cruz (Newcastle-Upon-Tyne,GB), O Gonzalez-Fernandez (Newcastle-Upon-Tyne,GB), A Koshy (Newcastle-Upon-Tyne,GB), N Okwose (Newcastle-Upon-Tyne,GB), T Green (Newcastle-Upon-Tyne,GB), A Woods (Newcastle-Upon-Tyne,GB), N Robinson-Smith (Newcastle-Upon-Tyne,GB), S Tovey (Newcastle-Upon-Tyne,GB), A Mcdiarmid (Newcastle-Upon-Tyne,GB), G Parry (Newcastle-Upon-Tyne,GB), S Schueler (Newcastle-Upon-Tyne,GB), DG Jakovljevic (Newcastle-Upon-Tyne,GB), GA Macgowan (Newcastle-Upon-Tyne,GB)

Authors:
N. Bouzas Cruz1 , O. Gonzalez-Fernandez1 , A. Koshy1 , N. Okwose1 , T. Green1 , A. Woods1 , N. Robinson-Smith1 , S. Tovey1 , A. McDiarmid1 , G. Parry1 , S. Schueler1 , D.G. Jakovljevic1 , G.A. MacGowan1 , 1Freeman Hospital - Newcastle upon Tyne - United Kingdom ,

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 976

Introduction: Left Ventricular Assist Devices (LVAD) improve survival and functional capacity in patients with advanced heart failure (HF). However, there are potential complications.

Purpose: We sought to determine parameters of exercise intolerance in a group of patients with the HeartWare LVAD (HVAD) compared to a group of HF patients.

Methods: This was a single-centre parallel prospective group-study. Briefly, echocardiograms, right heart catheterisation (RHC) and cardiopulmonary exercise tests were performed in forty-two patients admitted for a heart transplant assessment between August2017 and October2018.Of them 20 belonged to the HVAD group and 22 to the HF group.

Results: In our study, HVAD patients had a better exercise capacity than HF patients, although no significant differences were noted (14.0±5.0 ml/kg/min vs 11.3±3.9 ml/kg/min, p=0.06). To determine exercise tolerance, both HVAD and HF groups were subdivided into 2 groups based on the median peak exercise oxygen consumption (peakVO2) for that group. The table shows the comparison between preserved and non-preserved exercise tolerance in HF and HVADpatients. First of all, in the HVADgroup, all resting RHC pressures were significantly lower in the preserved exercise capacity group. However, in HFpatients there were no statistically significant differences between both subgroups in right-sided pressures, but Thermodilution exercise-induced change in cardiac output (ΔCO) and cardiac index (ΔCI) was significantly higher in the patients with preserved exercise tolerance. Secondly, in the HVADgroup the right ventricle was significantly larger in the reduced exercise tolerance subgroup. Moreover, patients with lower peak VO2 had more significant tricuspid regurgitation. Nevertheless, in HFpatients none of the echocardiographic parameters were related to the exercise capacity.

Conclusion: Right-sided parameters in the echocardiogram and RHC pressures discriminate between preserved and non-preserved exercise capacity in HVADpatients, but not in HFpatients. In these last patients only ΔCO and ΔCI were statistically correlated with peak exercise oxygen consumption

HFHVAD
> Median Peak V02< Median Peak V02p> Median Peak V02< Median Peak V02p
Thermodilution CO, l/min:
• Rest4.3±1.04.4±1.80.824.8±0.84.2±1.20.21
• Exercise5.6±1.74.8±1.80.367.1±3.24.8±0.80.05
• ΔCO1.26±1.00.26±0.70.022.2±2.50.4±0.70.05
Right Atrium pressure, mmHg7.0±4.56.8±4.100.924.3±3.210.6±6.400.02
Mean Pulmonary Artery pressure, mmHg26.4±12.626.5±10.90.9716.8±5.430.5±12.50.01
Tricuspid Regurgitation, n (%):
• None1 (9)1 (9)1 (12)0 (0)
• Mild7 (64)8 (73)7 (88)4 (44)
• Moderate2 (18)0 (0)0 (0)4 (44)
• Severe1 (9)2 (18)0.360 (0)1 (12)0.03
Right Ventricle Basal Diastolic Diameter, cm4.0±1.04.1±1.00.833.7±0.54.4±0.50.02

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