The Effects of Continuous‐flow Left Ventricular Assist Devices on Peripheral Vascular Function

Abstract

Peripheral endothelial function is known to be impaired in patients with heart failure (HF), but the vascular effects of continuous‐flow left ventricular assist device (LVAD) implantation, now employed as either a bridge to transplantation or as destination therapy, remain unclear. Using flow‐mediated vasodilation (FMD) and passive leg movement, this study aimed to provide greater insight into LVAD‐induced changes in vascular function. 8 healthy age‐matched controls (61 ± 3 yrs), 10 HF patients (61 ± 2 yrs), and 12 LVAD patients (57 ± 3 yrs) underwent FMD testing of the brachial artery and passive leg movement‐induced hyperemia assessment, with blood flow velocity and artery diameters assessed by ultrasound Doppler. FMD was significantly lower in HF (4.7 ± 0.7%) compared to the healthy controls (7.1 ± 1.2%) and lower than both of these groups in the LVAD patients (2.7 ± 0.8%). The change in leg blood flow from baseline to peak during passive movement followed a similar pattern. The hyperemic response in patients with HF was significantly attenuated compared to the controls (90 ± 9%Δ and 160 ± 27%Δ, respectively) and the response in the LVAD patients was significantly lower than both groups (45 ± 10%Δ). These results suggest that despite circulatory assistance, peripheral vascular function and hemodynamic regulation are attenuated in patients following LVAD implantation.