Improvement in Early Oxygen Uptake Kinetics With Left Ventricular Assist Device Support

Abstract

Sustained myocardial recovery and reversal of heart failure has been reported with the use of left ventricular assist devices (LVADs). However, clinical predictors of sustained recovery have not been clearly defined, and little information exists regarding exercise improvement in LVAD patients. Therefore, we sought to determine whether peripheral oxygen delivery and utilization were improved with LVAD support. Eleven patients with available pre- and post-LVAD cardiopulmonary exercise (CPX) data were studied retrospectively. Five patients received a HeartMate XVE for destination therapy (DT) and six patients received a Thoratec PVAD pneumatic LVAD for bridge-to-recovery (BTR). Oxygen uptake kinetics was assessed by fitting a single exponential function to the VO2 response. There was a significant improvement in several key parameters of cardiac performance including peak VO2, VO2 at anaerobic threshold (AT), oxygen kinetics as measured by mean response time (MRT), and oxygen deficit during LVAD support. Oxygen deficiency improved from 0.29 +/- 0.16 ml/kg to 0.16 +/- 0.06 ml/kg (p = 0.023), as did MRT 68 +/- 47.7 seconds to 35.8 +/- 13.3 seconds (p = 0.046) with LVAD support. Improved oxygen kinetics suggests improved peripheral utilization of oxygen, and may offer an additional clinical parameter to predict the likelihood of sustained recovery.