Details
| Original language | English |
|---|---|
| Pages (from-to) | 1223-1232 |
| Number of pages | 10 |
| Journal | Journal of Heart and Lung Transplantation |
| Volume | 42 |
| Issue number | 9 |
| Early online date | 23 Apr 2023 |
| Publication status | Published - Sept 2023 |
| Externally published | Yes |
Abstract
BACKGROUND: Reduced arterial pulsatility in continuous-flow left ventricular assist devices (CF-LVAD) patients has been implicated in clinical complications. Consequently, recent improvements in clinical outcomes have been attributed to the 'artificial pulse' technology inherent to the HeartMate3 (HM3) LVAD. However, the effect of the 'artificial pulse' on arterial flow, transmission of pulsatility into the microcirculation and its association with LVAD pump parameters is not known.
METHODS: The local flow oscillation (pulsatility index, PI) of common carotid arteries (CCAs), middle cerebral arteries (MCAs) and central retinal arteries (CRAs - representing the microcirculation) were quantified by 2D-aligned, angle-corrected Doppler ultrasound in 148 participants: healthy controls, n=32; heart failure (HF), n=43; HeartMate II (HMII), n=32; HM3, n=41.
RESULTS: In HM3 patients, 2D-Doppler PI in beats with 'artificial pulse' and beats with 'continuous-flow' was similar to that of HMII patients across the macro- and microcirculation. Additionally, peak systolic velocity did not differ between HM3 and HMII patients. Transmission of PI into the microcirculation was higher in both HM3 (during the beats with 'artificial pulse') and in HMII patients compared with HF patients. LVAD pump speed was inversely associated with microvascular PI in HMII and HM3 (HMII, r 2=0.51, P<0.0001; HM3 'continuous-flow', r 2=0.32, P=0.0009; HM3 'artificial pulse', r 2=0.23, P=0.007), while LVAD pump PI was only associated with microcirculatory PI in HMII patients.
CONCLUSIONS: The 'artificial pulse' of the HM3 is detectable in the macro- and microcirculation but without creating a significant alteration in PI compared with HMII patients. Increased transmission of pulsatility and the association between pump speed and PI in the microcirculation indicate that the future clinical care of HM3 patients may involve individualized pump settings according to the microcirculatory PI in specific end-organs.
Keywords
- HM3, HMII, LVAD, microcirculation, pulsatility
ASJC Scopus subject areas
- Medicine(all)
- Surgery
- Medicine(all)
- Pulmonary and Respiratory Medicine
- Medicine(all)
- Cardiology and Cardiovascular Medicine
- Medicine(all)
- Transplantation
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In: Journal of Heart and Lung Transplantation, Vol. 42, No. 9, 09.2023, p. 1223-1232.
Research output: Contribution to journal › Article › Research › peer review
}
TY - JOUR
T1 - Pulsatility and Flow Patterns across Macro- and Microcirculatory Arteries of Continuous-Flow Left Ventricular Assist Device Patients
AU - Stöhr, Eric J
AU - Ji, Ruiping
AU - Mondellini, Giulio
AU - Braghieri, Lorenzo
AU - Akiyama, Koichi
AU - Castagna, Francesco
AU - Pinsino, Alberto
AU - Cockcroft, John R
AU - Silverman, Ronald H
AU - Trocio, Samuel
AU - Zatvarska, Oksana
AU - Konofagou, Elisa
AU - Apostolakis, Iason
AU - Topkara, Veli K
AU - Takayama, Hiroo
AU - Takeda, Koji
AU - Naka, Yoshifumi
AU - Uriel, Nir
AU - Yuzefpolskaya, Melana
AU - Willey, Joshua Z
AU - McDonnell, Barry J
AU - Colombo, Paolo C
PY - 2023/9
Y1 - 2023/9
N2 - BACKGROUND: Reduced arterial pulsatility in continuous-flow left ventricular assist devices (CF-LVAD) patients has been implicated in clinical complications. Consequently, recent improvements in clinical outcomes have been attributed to the 'artificial pulse' technology inherent to the HeartMate3 (HM3) LVAD. However, the effect of the 'artificial pulse' on arterial flow, transmission of pulsatility into the microcirculation and its association with LVAD pump parameters is not known.METHODS: The local flow oscillation (pulsatility index, PI) of common carotid arteries (CCAs), middle cerebral arteries (MCAs) and central retinal arteries (CRAs - representing the microcirculation) were quantified by 2D-aligned, angle-corrected Doppler ultrasound in 148 participants: healthy controls, n=32; heart failure (HF), n=43; HeartMate II (HMII), n=32; HM3, n=41.RESULTS: In HM3 patients, 2D-Doppler PI in beats with 'artificial pulse' and beats with 'continuous-flow' was similar to that of HMII patients across the macro- and microcirculation. Additionally, peak systolic velocity did not differ between HM3 and HMII patients. Transmission of PI into the microcirculation was higher in both HM3 (during the beats with 'artificial pulse') and in HMII patients compared with HF patients. LVAD pump speed was inversely associated with microvascular PI in HMII and HM3 (HMII, r 2=0.51, P<0.0001; HM3 'continuous-flow', r 2=0.32, P=0.0009; HM3 'artificial pulse', r 2=0.23, P=0.007), while LVAD pump PI was only associated with microcirculatory PI in HMII patients. CONCLUSIONS: The 'artificial pulse' of the HM3 is detectable in the macro- and microcirculation but without creating a significant alteration in PI compared with HMII patients. Increased transmission of pulsatility and the association between pump speed and PI in the microcirculation indicate that the future clinical care of HM3 patients may involve individualized pump settings according to the microcirculatory PI in specific end-organs.
AB - BACKGROUND: Reduced arterial pulsatility in continuous-flow left ventricular assist devices (CF-LVAD) patients has been implicated in clinical complications. Consequently, recent improvements in clinical outcomes have been attributed to the 'artificial pulse' technology inherent to the HeartMate3 (HM3) LVAD. However, the effect of the 'artificial pulse' on arterial flow, transmission of pulsatility into the microcirculation and its association with LVAD pump parameters is not known.METHODS: The local flow oscillation (pulsatility index, PI) of common carotid arteries (CCAs), middle cerebral arteries (MCAs) and central retinal arteries (CRAs - representing the microcirculation) were quantified by 2D-aligned, angle-corrected Doppler ultrasound in 148 participants: healthy controls, n=32; heart failure (HF), n=43; HeartMate II (HMII), n=32; HM3, n=41.RESULTS: In HM3 patients, 2D-Doppler PI in beats with 'artificial pulse' and beats with 'continuous-flow' was similar to that of HMII patients across the macro- and microcirculation. Additionally, peak systolic velocity did not differ between HM3 and HMII patients. Transmission of PI into the microcirculation was higher in both HM3 (during the beats with 'artificial pulse') and in HMII patients compared with HF patients. LVAD pump speed was inversely associated with microvascular PI in HMII and HM3 (HMII, r 2=0.51, P<0.0001; HM3 'continuous-flow', r 2=0.32, P=0.0009; HM3 'artificial pulse', r 2=0.23, P=0.007), while LVAD pump PI was only associated with microcirculatory PI in HMII patients. CONCLUSIONS: The 'artificial pulse' of the HM3 is detectable in the macro- and microcirculation but without creating a significant alteration in PI compared with HMII patients. Increased transmission of pulsatility and the association between pump speed and PI in the microcirculation indicate that the future clinical care of HM3 patients may involve individualized pump settings according to the microcirculatory PI in specific end-organs.
KW - HM3
KW - HMII
KW - LVAD
KW - microcirculation
KW - pulsatility
UR - http://www.scopus.com/inward/record.url?scp=85159572707&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2023.04.002
DO - 10.1016/j.healun.2023.04.002
M3 - Article
C2 - 37098374
VL - 42
SP - 1223
EP - 1232
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
IS - 9
ER -