Vascular Function in Heart Failure Patients Implanted with a Continuous‐Flow Left Ventricular Assist Device: Impact of Increasing Peripheral Vascular Pulsatility

Abstract

Vascular function is thought to be attenuated in heart failure patients implanted with a continuous‐flow left ventricular assist device (LVAD), likely due to a decrease peripheral vascular pulsatility, which may contribute to the observed serious cardiovascular complications. However, the impact of increasing pulsatility on vascular function in this population is unknown.MethodsFifteen LVAD recipients and fifteen controls, matched for age and physical activity, underwent 45‐minutes of unilateral arm pulsatility treatment, evoked by cuff inflation, distal to the elbow, with a two second duty cycle. Vascular function was assessed by brachial artery flow mediated dilation (FMD, Doppler ultrasound).ResultsBaseline FMD, expressed as percent dilation, was not different between the LVAD recipients and controls (LVAD: 4.1±1.8; Controls: 4.1±1.5%), however, FMD/shear rate was significantly lower (LVAD: 0.10±0.04; Controls: 0.16±0.07) and time to peak dilation significantly longer in the LVAD group (LVAD: 77±21; Controls: 41±16s). The LVAD recipients exhibited a significantly attenuated pulsatility index (PI) compared to controls at baseline (LVAD: 3±2; Controls: 14±7), but experienced a similar PI during the pulsatility treatment (LVAD: 29±21; Controls: 33±15). Both % FMD (LVAD: 6.9±1.9; Controls 6.9±2.7%) and FMD/Shear rate (LVAD: 0.19±0.08; Controls 0.30±0.17) increased similarly in both groups with the pulsatility treatment, while time to peak was unaltered.ConclusionsLVAD recipients exhibit vascular dysfunction. Pulsatility treatment improved vascular function in both groups, but, most importantly, this intervention restored vascular function in the LVAD recipients to the baseline level of the controls, and may, through this improved vascular health, reduce cardiovascular complications in this population.Support or Funding InformationThis research was supported by the National Institutes of Health under Ruth L. Kirschstein National Research Service Award NIH 1T32HL139451 from the National Heart, Lung, and Blood Institute.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.