Markers of Right Ventricular Dysfunction Predict Maximal Exercise Capacity After Left Ventricular Assist Device Implantation

Noelia Bouzas-Cruz, Aaron Koshy, Oscar Gonzalez-Fernandez, Carlos Ferrera, Thomas Green, Nduka Okwose, Andrew Woods, Sian Tovey, Nicola Robinson-Smith, Adam K Mcdiarmid, Gareth Parry, Jose R Gonzalez-Juanatey, Stephan Schueler, Djordje G Jakovljevic, Guy Macgowan

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Although left ventricular assist device (LVAD) improves functional capacity, on average LVAD patients are unable to achieve the aerobic capacity of normal healthy subjects or mild heart failure patients. The aim of this study was to examine if markers of right ventricular (RV) function influence maximal exercise capacity. This was a single-center prospective study that enrolled 20 consecutive HeartWare ventricular assist device patients who were admitted at the Freeman Hospital (Newcastle upon Tyne, United Kingdom) for a heart transplant assessment from August 2017 to October 2018. Mean peak oxygen consumption (Peak VO2) was 14.0 ± 5.0 ml/kg/min, and mean peak age and gender-adjusted percent predicted oxygen consumption (%VO2) was 40.0% ± 11.5%. Patients were subdivided into two groups based on the median peak VO2, so each group consisted of 10 patients (50%). Right-sided and pulmonary pressures were consistently higher in the group with poorer exercise tolerance. Patients with poor exercise tolerance (peak VO2 below the median) had higher right atrial pressures at rest (10.6 ± 6.4 vs. 4.3 mmHg ± 3.2; p = 0.02) and the increase with passive leg raising was significantly greater than those with preserved exercise tolerance (peak VO2 above the median). Patients with poor functional capacity also had greater RV dimensions (4.4 cm ± 0.5 vs. 3.7 cm ± 0.5; p = 0.02) and a higher incidence of significant tricuspid regurgitation (moderate or severe tricuspid regurgitation in five patients in the poor exercise capacity group vs. none in the preserved exercise capacity group; p = 0.03). In conclusion, echocardiographic and hemodynamic markers of RV dysfunction discriminate between preserved and nonpreserved exercise capacity in HeartWare ventricular assist device patients.

    Original languageEnglish
    Pages (from-to)284-289
    Number of pages6
    JournalASAIO Journal
    Volume67
    Issue number3
    Early online date14 Oct 2020
    DOIs
    Publication statusPublished - 1 Mar 2021

    Keywords

    • left ventricular assist device
    • exercise tolerance
    • right ventricle
    • tricuspid regurgitation

    ASJC Scopus subject areas

    • Bioengineering
    • Biophysics
    • Biomedical Engineering
    • Biomaterials

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