Abstract
Background
Implantation of left-ventricular assist systems (LVASs) has become the standard of
care for advanced heart failure (HF). The absence of pulsatility in previous devices
contributes to vascular and endothelial dysfunction related to atherosclerotic or
vascular complications. We hypothesized that the artificial pulsatility provided by
the HeartMate 3 (HM3) (Abbott, Chicago, IL) LVAS would exert a favourable effect on
the vasculature.
Methods
In 32 patients implanted with HM3 (5 female patients, mean age 55 ± 13.6 years), the
reactive hyperemia index (RHI) and peripheral augmentation index (AI), markers of
endothelial function and arterial stiffness, were measured with an EndoPAT2000 before
and in the third and sixth month after implantation. RHI and AI data from 30 HeartMate
II (HM II) (Abbott) recipients in the third and sixth month after implantation, from
15 patients with advanced HF without LVASs and from 13 healthy volunteers were also
analyzed.
Results
In HM3 recipients, the mean RHI significantly decreased at 3 and 6 months after implantation.
The RHI was substantially lower at baseline than that of healthy or the HF reference
group. Increasing AI values, indicating worsening arterial stiffness, were also observed.
Similar trends were observed in HM II recipients between the third and sixth months
but with higher absolute values of RHI and AI.
Conclusions
We detected impaired vascular function in HM3 patients and provided additional evidence
on the negative effect of low pulsatility on vascular function after LVAS implantation.
The results suggest that the artificial pulsatility of the HM3 does not avert the
progression of endothelial dysfunction.
Résumé
Contexte
L'implantation de dispositifs d'assistance ventriculaire gauche (DAVG) est devenue
un standard des soins pour une insuffisance cardiaque (IC) avancée. L'absence de pulsatilité
dans les dispositifs précédents contribue à la dysfonction vasculaire et endothéliale
liée aux complications athérosclérotiques ou vasculaires. Nous avons émis l'hypothèse
que la pulsatilité artificielle fournie par le DAVG HeartMate 3 (HM3) (Abbott, Chicago,
IL) entraînerait un effet bénéfique sur le système vasculaire.
Méthodes
Chez 32 patients implantés avec le HM3 (5 femmes, âge moyen 55 ± 13,6 ans), l'indice
d'hyperémie réactive (IHR) et l'indice d'amplification périphérique (IAP), marqueurs
de la fonction endothéliale et de la rigidité artérielle, ont été mesurés par un EndoPAT2000
avant puis trois et six mois après implantation. Les données IHR et IAP de 30 patients
porteurs de HeartMate II (HM II) (Abbott) au troisième et sixième mois post-implantation,
de 15 patients atteints d'une IC avancée sans DAVG et de 13 volontaires sains ont
également été analysées.
Résultats
Chez les receveurs du HM3, l'IHR moyen a significativement diminué trois et six mois
après implantation. L'IHR basal était sensiblement plus faible que celui des personnes
en bonne santé ou du groupe IC de référence. Des valeurs croissantes de l'IAP, indiquant
une exacerbation de la rigidité artérielle, ont également été observées. Des tendances
similaires ont été constatées chez les receveurs du HM II entre le troisième et le
sixième mois, mais avec des valeurs absolues de l'IHR et de l'IAP plus élevées.
Conclusions
Nous avons décelé une fonction vasculaire altérée chez les patients porteurs du HM3
et fourni des éléments supplémentaires de l'effet négatif d'une faible pulsatilité
sur la fonction vasculaire après l'implantation d'un DAVG. Les résultats suggèrent
que la pulsatilité artificielle du HM3 n'empêche pas la progression de la dysfonction
endothéliale.
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References
- The role of durable left ventricular assist devices in advanced heart failure: would my patient benefit?.Can J Cardiol. 2017; 33: 540-554
- Destination therapy: left ventricular assist devices: recommendations for the way forward.Can J Cardiol. 2019; 35: S199
- Attenuation in peripheral endothelial function after continuous flow left ventricular assist device therapy is associated with cardiovascular adverse events.Circ J. 2015; 79: 770-777
- Peripheral vascular reactivity in patients with pulsatile vs axial flow left ventricular assist device support.J Heart Lung Transplant. 2006; 25: 391-394
- Further peripheral vascular dysfunction in heart failure patients with a continuous-flow left ventricular assist device: the role of pulsatility.JACC Heart Fail. 2015; 9: 703-711
- Activation of endothelial and coagulation systems in left ventricular assist device recipients.Ann Thorac Surg. 2009; 88: 1171-1179
- Risk prediction in cardiovascular disease: the prognostic singnificance of endothelial dysfunction.Can J Cardiol. 2009; 25: 15A-20A
- Cerebrovascular disease in the era of left ventricular assist devices with continuous flow: risk factors, diagnosis, and treatment.J Heart Lung Transplant. 2014; 33: 878-887
- The incidence, predictors and outcomes of gastrointestinal bleeding in patients with left ventricular assist device (LVAD).Dig Dis Sci. 2015; 60: 3697-3706
- In vivo assessment of a rotary left ventricular assist device-induced artificial pulse in the proximal and distal aorta.Artif Organs. 2006; 30: 638-642
- Flow modulation algorithms for continuous flow left ventricular assist devices to increase vascular pulsatility: a computer simulation study.Cardiovasc Eng Technol. 2011; 2: 90-100
- Rotary pump speed modulation for generating pulsatile flow and phasic left ventricular volume unloading in a bovine model of chronic ischemic heart failure.J Heart Lung Transplant. 2015; 34: 122-131
- Physiology of the assisted circulation in cardiogenic shock: a state-of-the-art perspective.Can J Cardiol. 2020; 36: 170-183
- A fully magnetically levitated left ventricular assist device: final report.N Engl J Med. 2019; 380: 1618-1627
- Assessment of peripheral vascular endothelial function with finger arterial pulse wave amplitude.Am Heart J. 2003; 146: 168-174
- The assessment of endothelial function: from research into clinical practice.Circulation. 2012; 126: 753-767
- Assessing endothelial vasodilator function with the Endo-PAT2000.J Vis Exp. 2010; : 2167
- Augmentation index association with reactive hyperemia as assessed by peripheral arterial tonometry in hypertension.Am J Hypertens. 2011; 24: 1234-1238
- Evaluation of the EndoPAT as a tool to assess endothelial function.Int J Vasc Med. 2012; 2012904141
- Delayed reversal of impaired metabolic vasodilation in patients with end-stage heart failure during long-term circulatory support with a left ventricular assist device.J Heart Lung Transplant. 1997; 16: 449-453
- Impact of mechanical unloading on microvascular and associated central remodeling features of the failing human heart.J Am Coll Cardiol. 2010; 56: 382-391
- Endothelial function in patients with continuous-flow left ventricular assist devices.Angiology. 2020; 63319720946977
- Effects of continuous flow left ventricular assist device support on microvascular endothelial function.J Cardiovasc Transl Res. 2012; 5: 345-350
- Release of endothelium-derived relaxing factor is modulated both by frequency and amplitude of pulsatile flow.Am J Physiol. 1991; 261: H257-H262
- Pulsatile stretch and shear stress: physical stimuli determining the production of endothelium-derived relaxing factors.J Vasc Res. 1998; 35: 73-84
- Augmentative effect of pulsatility on the wall shear stress in tube flow.Artif Organs. 1999; 23: 727-731
- Augmentation index, left ventricular contractility, and wave reflection.Hypetension. 2009; 54: 1099-1105
- Arterial ageing: from endothelial dysfunction to vascular calcification.J Intern Med. 2017; 281: 471-482
- Dynamic changes in aortic vascular stiffness in patients bridged to transplant with continuous-flow left ventricular assist devices.JACC Heart Fail. 2017; 5: 449-459
Article info
Publication history
Published online: June 03, 2021
Accepted:
May 29,
2021
Received:
September 29,
2020
Footnotes
See page 1584 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
