Exercise physiology in left ventricular assist device patients: insights from hemodynamic simulations.
Exercise capacity
cardiovascular model
ventricular assist device
Journal
Annals of cardiothoracic surgery
ISSN: 2225-319X
Titre abrégé: Ann Cardiothorac Surg
Pays: China
ID NLM: 101605877
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
entrez:
23
6
2021
pubmed:
24
6
2021
medline:
24
6
2021
Statut:
ppublish
Résumé
Left ventricular assist devices (LVADs) assure longer survival to patients, but exercise capacity is limited compared to normal values. Overall, LVAD patients show high wedge pressure and low cardiac output during maximal exercise, a phenomenon hinting at the need for increased LVAD support. Clinical studies investigating the hemodynamic benefits of an LVAD speed increase during exercise, ended in inhomogeneous and sometimes contradictory results. The native ventricle-LVAD interaction changes between rest and exercise, and this evolution is complex, multifactorial and patient-specific. The aim of this paper is to provide a comprehensive overview on the patient-LVAD interaction during exercise and to delineate possible therapeutic strategies for the future. A computational cardiorespiratory model was used to simulate the hemodynamics of peak bicycle exercise in LVAD patients. The simulator included the main cardiovascular and respiratory impairments commonly observed in LVAD patients, so as to represent an average hemodynamic response to exercise. In addition, other exercise responses were simulated, by tuning the chronotropic, inotropic and vascular functions, and implementing aortic regurgitation and stenosis in the simulator. These profiles were tested under different LVAD speeds and LVAD pressure-flow characteristics. Simulations output showed consistency with clinical data from the literature. The simulator allowed the working condition of the assisted ventricle at exercise to be investigated, clarifying the reasons behind the high wedge pressure and poor cardiac output observed in the clinics. Patients with poorer inotropic, chronotropic and vascular functions, are likely to benefit more from an LVAD speed increase during exercise. Similarly, for these patients, a flatter LVAD pressure-flow characteristic can assure better hemodynamic support under physical exertion. Overall, the study evidenced the need for a patient-specific approach on supporting exercise hemodynamics. In this frame, a complex simulator can constitute a valuable tool to define and test personalized speed control algorithms and strategies.
Identifiants
pubmed: 34159115
doi: 10.21037/acs-2020-cfmcs-23
pii: acs-10-03-339
pmc: PMC8185386
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
339-352Informations de copyright
2021 Annals of Cardiothoracic Surgery. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: The authors have no conflicts of interest to declare.
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