Further Peripheral Vascular Dysfunction in Heart Failure Patients With a Continuous-Flow Left Ventricular Assist Device: The Role of Pulsatility.
OBJECTIVE
Using flow-mediated vasodilation (FMD) and reactive hyperemia (RH), this study aimed to provide greater insight into left ventricular assist device (LVAD)-induced changes in peripheral vascular function.


BACKGROUND
Peripheral endothelial function is recognized to be impaired in patients with heart failure with reduced ejection fraction (HFrEF), but the peripheral vascular effects of continuous-flow LVAD implantation, now used as either a bridge to transplantation or as a destination therapy, remain unclear.


METHODS
Sixty-eight subjects (13 New York Heart Association [NYHA] functional class II HFrEF patients, 19 NYHA functional class III/IV HFrEF patients, 20 NYHA functional class III/IV HFrEF patients post-LVAD implantation, and 16 healthy age-matched control subjects) underwent FMD and RH testing in the brachial artery with blood flow velocity, artery diameters, and pulsatility index (PI) assessed by ultrasound Doppler.


RESULTS
PI was significantly lower in the LVAD group (2.0 ± 0.4) compared with both the HFrEF II (8.6 ± 0.8) and HFrEF III/IV (8.1 ± 0.9) patients, who, in turn, had significantly lower PI than the control subjects (12.8 ± 0.9). Likewise, LVAD %FMD/shear rate (0.09 ± 0.01 %Δ/s(-1)) was significantly reduced compared with all other groups (control subjects, 0.24 ± 0.03; HFrEF II, 0.17 ± 0.02; and HFrEF III/IV, 0.13 ± 0.02 %Δ/s(-1)), and %FMD/shear rate significantly correlated with PI (r = 0.45). RH was unremarkable across groups.


CONCLUSIONS
Although central hemodynamics are improved in patients with HFrEF by a continuous-flow LVAD, peripheral vascular function is further compromised, which is likely due, at least in part, to the reduction in pulsatility that is a characteristic of such a mechanical assist device.
Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, Utah; Department of Internal Medicine, Division of Geriatrics, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: melissa.witman@utah.edu.
Melissa A H
MA
Witman
Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, Utah; Department of Internal Medicine, Division of Geriatrics, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah.
Ryan S
RS
Garten
Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah.
Jayson R
JR
Gifford
Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah.
H Jonathan
HJ
Groot
Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, Utah; Department of Internal Medicine, Division of Geriatrics, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah.
Joel D
JD
Trinity
Department of Internal Medicine, Division of Cardiovascular Medicine, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah.
Josef
J
Stehlik
Department of Internal Medicine, Division of Cardiovascular Medicine, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah.
Jose N
JN
Nativi
Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
Craig H
CH
Selzman
Department of Internal Medicine, Division of Cardiovascular Medicine, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah.
Stavros G
SG
Drakos
Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, Utah; Department of Internal Medicine, Division of Geriatrics, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah; Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah.
Russell S
RS
Richardson
D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D011673:Pulsatile Flow / Q000502:physiology*; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance / Q000502:physiology*; D014664:Vasodilation / Q000502:physiology*
HFrEF; blood flow; flow-mediated vasodilation; mechanical assist; pulsatility