Details
| Original language | English |
|---|---|
| Pages (from-to) | 763-766 |
| Number of pages | 4 |
| Journal | Experimental physiology |
| Volume | 105 |
| Issue number | 5 |
| Early online date | 27 Feb 2020 |
| Publication status | Published - 30 Apr 2020 |
| Externally published | Yes |
Abstract
New Findings: LVAD patients are predisposed to hypertension which may increase the risk of stroke. Hypertension may result from markedly elevated levels of sympathetic nerve activity, which occurs through a baroreceptor-mediated pathway in response to chronic exposure to a non-physiologic (and reduced) pulse. Cerebral autoregulatory processes appear to be preserved in the absence of a physiologic pulse. Nevertheless, the rate of ischemic/embolic and hemorrhagic stroke is unacceptably high and is a major cause of morbidity and mortality in these patients. Despite normalization of a resting cardiac output, LVAD patients suffer from persistent, severe reductions in functional capacity. Abstract: Current generation left ventricular assist devices (LVADs) have led to significant improvements in survival compared to medical therapy alone, when used for management of patients with advanced heart failure. However, there are a number of side-effects associated with LVAD use, including hypertension, gastrointestinal bleeding, stroke, as well as persistent and severe limitations in functional capacity despite normalization of a resting cardiac output. These issues are, in large part, related to chronic exposure to a non-physiologic pulse, which contributes to a hyperadrenergic environment characterized by markedly elevated levels of sympathetic nerve activity through a baroreceptor-mediated pathway. In addition, these machines are unable to participate in, or contribute to, normal cardiovascular/autonomic reflexes that attempt to modulate flow through the body. Efforts to advance device technology and develop biologically sensitive devices may resolve these issues, and lead to further improvements in quality-of-life, functional capacity, and ultimately, survival, for the patients they support.
Keywords
- blood pressure, cerebral autoregulation, exercise, LVAD, nonpulsatile flow
ASJC Scopus subject areas
- Biochemistry, Genetics and Molecular Biology(all)
- Physiology
- Nursing(all)
- Nutrition and Dietetics
- Medicine(all)
- Physiology (medical)
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In: Experimental physiology, Vol. 105, No. 5, 30.04.2020, p. 763-766.
Research output: Contribution to journal › Article › Research › peer review
}
TY - JOUR
T1 - Bionic women and men - Part 4
T2 - Cardiovascular, cerebrovascular and exercise responses among patients supported with left ventricular assist devices
AU - Buchanan, Cullen
AU - Kanwar, Manreet
AU - Cockcroft, John R.
AU - McDonnell, Barry
AU - Stöhr, Eric J.
AU - Cornwell, William K.
N1 - Funding information: Drs McDonnell and Stöhr have received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sk?odowska-Curie grant agreement No 705219. Dr. Cornwell has received funding by an NIH/NHLBI Mentored Patient-Oriented Research Career Development Award (#1K23HLI32048-01), as well as the NIH/NCATS (#UL1TR002535), Susie and Kurt Lochmiller Distinguished Heart Transplant Fund, the Clinical Translational Science Institute at the University of Colorado Anschutz Medical Campus, and Medtronic Inc. Dr. Kanwar has received research funding by Abbott Inc, but none relevant to this submission.
PY - 2020/4/30
Y1 - 2020/4/30
N2 - New Findings: LVAD patients are predisposed to hypertension which may increase the risk of stroke. Hypertension may result from markedly elevated levels of sympathetic nerve activity, which occurs through a baroreceptor-mediated pathway in response to chronic exposure to a non-physiologic (and reduced) pulse. Cerebral autoregulatory processes appear to be preserved in the absence of a physiologic pulse. Nevertheless, the rate of ischemic/embolic and hemorrhagic stroke is unacceptably high and is a major cause of morbidity and mortality in these patients. Despite normalization of a resting cardiac output, LVAD patients suffer from persistent, severe reductions in functional capacity. Abstract: Current generation left ventricular assist devices (LVADs) have led to significant improvements in survival compared to medical therapy alone, when used for management of patients with advanced heart failure. However, there are a number of side-effects associated with LVAD use, including hypertension, gastrointestinal bleeding, stroke, as well as persistent and severe limitations in functional capacity despite normalization of a resting cardiac output. These issues are, in large part, related to chronic exposure to a non-physiologic pulse, which contributes to a hyperadrenergic environment characterized by markedly elevated levels of sympathetic nerve activity through a baroreceptor-mediated pathway. In addition, these machines are unable to participate in, or contribute to, normal cardiovascular/autonomic reflexes that attempt to modulate flow through the body. Efforts to advance device technology and develop biologically sensitive devices may resolve these issues, and lead to further improvements in quality-of-life, functional capacity, and ultimately, survival, for the patients they support.
AB - New Findings: LVAD patients are predisposed to hypertension which may increase the risk of stroke. Hypertension may result from markedly elevated levels of sympathetic nerve activity, which occurs through a baroreceptor-mediated pathway in response to chronic exposure to a non-physiologic (and reduced) pulse. Cerebral autoregulatory processes appear to be preserved in the absence of a physiologic pulse. Nevertheless, the rate of ischemic/embolic and hemorrhagic stroke is unacceptably high and is a major cause of morbidity and mortality in these patients. Despite normalization of a resting cardiac output, LVAD patients suffer from persistent, severe reductions in functional capacity. Abstract: Current generation left ventricular assist devices (LVADs) have led to significant improvements in survival compared to medical therapy alone, when used for management of patients with advanced heart failure. However, there are a number of side-effects associated with LVAD use, including hypertension, gastrointestinal bleeding, stroke, as well as persistent and severe limitations in functional capacity despite normalization of a resting cardiac output. These issues are, in large part, related to chronic exposure to a non-physiologic pulse, which contributes to a hyperadrenergic environment characterized by markedly elevated levels of sympathetic nerve activity through a baroreceptor-mediated pathway. In addition, these machines are unable to participate in, or contribute to, normal cardiovascular/autonomic reflexes that attempt to modulate flow through the body. Efforts to advance device technology and develop biologically sensitive devices may resolve these issues, and lead to further improvements in quality-of-life, functional capacity, and ultimately, survival, for the patients they support.
KW - blood pressure
KW - cerebral autoregulation
KW - exercise
KW - LVAD
KW - nonpulsatile flow
UR - http://www.scopus.com/inward/record.url?scp=85082412757&partnerID=8YFLogxK
U2 - 10.1113/EP088325
DO - 10.1113/EP088325
M3 - Article
C2 - 32105385
AN - SCOPUS:85082412757
VL - 105
SP - 763
EP - 766
JO - Experimental physiology
JF - Experimental physiology
SN - 0958-0670
IS - 5
ER -