Pulsatility and Flow Patterns across Macro- and Microcirculatory Arteries of Continuous-Flow Left Ventricular Assist Device Patients

Publikation: Beitrag in FachzeitschriftArtikelForschungPeer-Review

Autoren

  • Eric J Stöhr
  • Ruiping Ji
  • Giulio Mondellini
  • Lorenzo Braghieri
  • Koichi Akiyama
  • Francesco Castagna
  • Alberto Pinsino
  • John R Cockcroft
  • Ronald H Silverman
  • Samuel Trocio
  • Oksana Zatvarska
  • Elisa Konofagou
  • Iason Apostolakis
  • Veli K Topkara
  • Hiroo Takayama
  • Koji Takeda
  • Yoshifumi Naka
  • Nir Uriel
  • Melana Yuzefpolskaya
  • Joshua Z Willey
  • Barry J McDonnell
  • Paolo C Colombo

Externe Organisationen

  • Cardiff Metropolitan University
  • Columbia University Irving Medical Center
  • Kyoto Prefectural University of Medicine
Forschungs-netzwerk anzeigen

Details

OriginalspracheEnglisch
Seiten (von - bis)1223-1232
Seitenumfang10
FachzeitschriftJournal of Heart and Lung Transplantation
Jahrgang42
Ausgabenummer9
Frühes Online-Datum23 Apr. 2023
PublikationsstatusVeröffentlicht - Sept. 2023
Extern publiziertJa

Abstract

BACKGROUND: Reduced arterial pulsatility in continuous-flow left ventricular assist devices (CF-LVAD) patients has been implicated in clinical complications. Consequently, recent improvements in clinical outcomes have been attributed to the 'artificial pulse' technology inherent to the HeartMate3 (HM3) LVAD. However, the effect of the 'artificial pulse' on arterial flow, transmission of pulsatility into the microcirculation and its association with LVAD pump parameters is not known.

METHODS: The local flow oscillation (pulsatility index, PI) of common carotid arteries (CCAs), middle cerebral arteries (MCAs) and central retinal arteries (CRAs - representing the microcirculation) were quantified by 2D-aligned, angle-corrected Doppler ultrasound in 148 participants: healthy controls, n=32; heart failure (HF), n=43; HeartMate II (HMII), n=32; HM3, n=41.

RESULTS: In HM3 patients, 2D-Doppler PI in beats with 'artificial pulse' and beats with 'continuous-flow' was similar to that of HMII patients across the macro- and microcirculation. Additionally, peak systolic velocity did not differ between HM3 and HMII patients. Transmission of PI into the microcirculation was higher in both HM3 (during the beats with 'artificial pulse') and in HMII patients compared with HF patients. LVAD pump speed was inversely associated with microvascular PI in HMII and HM3 (HMII, r 2=0.51, P<0.0001; HM3 'continuous-flow', r 2=0.32, P=0.0009; HM3 'artificial pulse', r 2=0.23, P=0.007), while LVAD pump PI was only associated with microcirculatory PI in HMII patients.

CONCLUSIONS: The 'artificial pulse' of the HM3 is detectable in the macro- and microcirculation but without creating a significant alteration in PI compared with HMII patients. Increased transmission of pulsatility and the association between pump speed and PI in the microcirculation indicate that the future clinical care of HM3 patients may involve individualized pump settings according to the microcirculatory PI in specific end-organs.

ASJC Scopus Sachgebiete

Zitieren

Pulsatility and Flow Patterns across Macro- and Microcirculatory Arteries of Continuous-Flow Left Ventricular Assist Device Patients. / Stöhr, Eric J; Ji, Ruiping; Mondellini, Giulio et al.
in: Journal of Heart and Lung Transplantation, Jahrgang 42, Nr. 9, 09.2023, S. 1223-1232.

Publikation: Beitrag in FachzeitschriftArtikelForschungPeer-Review

Stöhr, EJ, Ji, R, Mondellini, G, Braghieri, L, Akiyama, K, Castagna, F, Pinsino, A, Cockcroft, JR, Silverman, RH, Trocio, S, Zatvarska, O, Konofagou, E, Apostolakis, I, Topkara, VK, Takayama, H, Takeda, K, Naka, Y, Uriel, N, Yuzefpolskaya, M, Willey, JZ, McDonnell, BJ & Colombo, PC 2023, 'Pulsatility and Flow Patterns across Macro- and Microcirculatory Arteries of Continuous-Flow Left Ventricular Assist Device Patients', Journal of Heart and Lung Transplantation, Jg. 42, Nr. 9, S. 1223-1232. https://doi.org/10.1016/j.healun.2023.04.002
Stöhr, E. J., Ji, R., Mondellini, G., Braghieri, L., Akiyama, K., Castagna, F., Pinsino, A., Cockcroft, J. R., Silverman, R. H., Trocio, S., Zatvarska, O., Konofagou, E., Apostolakis, I., Topkara, V. K., Takayama, H., Takeda, K., Naka, Y., Uriel, N., Yuzefpolskaya, M., ... Colombo, P. C. (2023). Pulsatility and Flow Patterns across Macro- and Microcirculatory Arteries of Continuous-Flow Left Ventricular Assist Device Patients. Journal of Heart and Lung Transplantation, 42(9), 1223-1232. https://doi.org/10.1016/j.healun.2023.04.002
Stöhr EJ, Ji R, Mondellini G, Braghieri L, Akiyama K, Castagna F et al. Pulsatility and Flow Patterns across Macro- and Microcirculatory Arteries of Continuous-Flow Left Ventricular Assist Device Patients. Journal of Heart and Lung Transplantation. 2023 Sep;42(9):1223-1232. Epub 2023 Apr 23. doi: 10.1016/j.healun.2023.04.002
Download
@article{edeb368d6cf74f79a7cccd9cd88180c0,
title = "Pulsatility and Flow Patterns across Macro- and Microcirculatory Arteries of Continuous-Flow Left Ventricular Assist Device Patients",
abstract = "BACKGROUND: Reduced arterial pulsatility in continuous-flow left ventricular assist devices (CF-LVAD) patients has been implicated in clinical complications. Consequently, recent improvements in clinical outcomes have been attributed to the 'artificial pulse' technology inherent to the HeartMate3 (HM3) LVAD. However, the effect of the 'artificial pulse' on arterial flow, transmission of pulsatility into the microcirculation and its association with LVAD pump parameters is not known.METHODS: The local flow oscillation (pulsatility index, PI) of common carotid arteries (CCAs), middle cerebral arteries (MCAs) and central retinal arteries (CRAs - representing the microcirculation) were quantified by 2D-aligned, angle-corrected Doppler ultrasound in 148 participants: healthy controls, n=32; heart failure (HF), n=43; HeartMate II (HMII), n=32; HM3, n=41.RESULTS: In HM3 patients, 2D-Doppler PI in beats with 'artificial pulse' and beats with 'continuous-flow' was similar to that of HMII patients across the macro- and microcirculation. Additionally, peak systolic velocity did not differ between HM3 and HMII patients. Transmission of PI into the microcirculation was higher in both HM3 (during the beats with 'artificial pulse') and in HMII patients compared with HF patients. LVAD pump speed was inversely associated with microvascular PI in HMII and HM3 (HMII, r 2=0.51, P<0.0001; HM3 'continuous-flow', r 2=0.32, P=0.0009; HM3 'artificial pulse', r 2=0.23, P=0.007), while LVAD pump PI was only associated with microcirculatory PI in HMII patients. CONCLUSIONS: The 'artificial pulse' of the HM3 is detectable in the macro- and microcirculation but without creating a significant alteration in PI compared with HMII patients. Increased transmission of pulsatility and the association between pump speed and PI in the microcirculation indicate that the future clinical care of HM3 patients may involve individualized pump settings according to the microcirculatory PI in specific end-organs.",
keywords = "HM3, HMII, LVAD, microcirculation, pulsatility",
author = "St{\"o}hr, {Eric J} and Ruiping Ji and Giulio Mondellini and Lorenzo Braghieri and Koichi Akiyama and Francesco Castagna and Alberto Pinsino and Cockcroft, {John R} and Silverman, {Ronald H} and Samuel Trocio and Oksana Zatvarska and Elisa Konofagou and Iason Apostolakis and Topkara, {Veli K} and Hiroo Takayama and Koji Takeda and Yoshifumi Naka and Nir Uriel and Melana Yuzefpolskaya and Willey, {Joshua Z} and McDonnell, {Barry J} and Colombo, {Paolo C}",
year = "2023",
month = sep,
doi = "10.1016/j.healun.2023.04.002",
language = "English",
volume = "42",
pages = "1223--1232",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "9",

}

Download

TY - JOUR

T1 - Pulsatility and Flow Patterns across Macro- and Microcirculatory Arteries of Continuous-Flow Left Ventricular Assist Device Patients

AU - Stöhr, Eric J

AU - Ji, Ruiping

AU - Mondellini, Giulio

AU - Braghieri, Lorenzo

AU - Akiyama, Koichi

AU - Castagna, Francesco

AU - Pinsino, Alberto

AU - Cockcroft, John R

AU - Silverman, Ronald H

AU - Trocio, Samuel

AU - Zatvarska, Oksana

AU - Konofagou, Elisa

AU - Apostolakis, Iason

AU - Topkara, Veli K

AU - Takayama, Hiroo

AU - Takeda, Koji

AU - Naka, Yoshifumi

AU - Uriel, Nir

AU - Yuzefpolskaya, Melana

AU - Willey, Joshua Z

AU - McDonnell, Barry J

AU - Colombo, Paolo C

PY - 2023/9

Y1 - 2023/9

N2 - BACKGROUND: Reduced arterial pulsatility in continuous-flow left ventricular assist devices (CF-LVAD) patients has been implicated in clinical complications. Consequently, recent improvements in clinical outcomes have been attributed to the 'artificial pulse' technology inherent to the HeartMate3 (HM3) LVAD. However, the effect of the 'artificial pulse' on arterial flow, transmission of pulsatility into the microcirculation and its association with LVAD pump parameters is not known.METHODS: The local flow oscillation (pulsatility index, PI) of common carotid arteries (CCAs), middle cerebral arteries (MCAs) and central retinal arteries (CRAs - representing the microcirculation) were quantified by 2D-aligned, angle-corrected Doppler ultrasound in 148 participants: healthy controls, n=32; heart failure (HF), n=43; HeartMate II (HMII), n=32; HM3, n=41.RESULTS: In HM3 patients, 2D-Doppler PI in beats with 'artificial pulse' and beats with 'continuous-flow' was similar to that of HMII patients across the macro- and microcirculation. Additionally, peak systolic velocity did not differ between HM3 and HMII patients. Transmission of PI into the microcirculation was higher in both HM3 (during the beats with 'artificial pulse') and in HMII patients compared with HF patients. LVAD pump speed was inversely associated with microvascular PI in HMII and HM3 (HMII, r 2=0.51, P<0.0001; HM3 'continuous-flow', r 2=0.32, P=0.0009; HM3 'artificial pulse', r 2=0.23, P=0.007), while LVAD pump PI was only associated with microcirculatory PI in HMII patients. CONCLUSIONS: The 'artificial pulse' of the HM3 is detectable in the macro- and microcirculation but without creating a significant alteration in PI compared with HMII patients. Increased transmission of pulsatility and the association between pump speed and PI in the microcirculation indicate that the future clinical care of HM3 patients may involve individualized pump settings according to the microcirculatory PI in specific end-organs.

AB - BACKGROUND: Reduced arterial pulsatility in continuous-flow left ventricular assist devices (CF-LVAD) patients has been implicated in clinical complications. Consequently, recent improvements in clinical outcomes have been attributed to the 'artificial pulse' technology inherent to the HeartMate3 (HM3) LVAD. However, the effect of the 'artificial pulse' on arterial flow, transmission of pulsatility into the microcirculation and its association with LVAD pump parameters is not known.METHODS: The local flow oscillation (pulsatility index, PI) of common carotid arteries (CCAs), middle cerebral arteries (MCAs) and central retinal arteries (CRAs - representing the microcirculation) were quantified by 2D-aligned, angle-corrected Doppler ultrasound in 148 participants: healthy controls, n=32; heart failure (HF), n=43; HeartMate II (HMII), n=32; HM3, n=41.RESULTS: In HM3 patients, 2D-Doppler PI in beats with 'artificial pulse' and beats with 'continuous-flow' was similar to that of HMII patients across the macro- and microcirculation. Additionally, peak systolic velocity did not differ between HM3 and HMII patients. Transmission of PI into the microcirculation was higher in both HM3 (during the beats with 'artificial pulse') and in HMII patients compared with HF patients. LVAD pump speed was inversely associated with microvascular PI in HMII and HM3 (HMII, r 2=0.51, P<0.0001; HM3 'continuous-flow', r 2=0.32, P=0.0009; HM3 'artificial pulse', r 2=0.23, P=0.007), while LVAD pump PI was only associated with microcirculatory PI in HMII patients. CONCLUSIONS: The 'artificial pulse' of the HM3 is detectable in the macro- and microcirculation but without creating a significant alteration in PI compared with HMII patients. Increased transmission of pulsatility and the association between pump speed and PI in the microcirculation indicate that the future clinical care of HM3 patients may involve individualized pump settings according to the microcirculatory PI in specific end-organs.

KW - HM3

KW - HMII

KW - LVAD

KW - microcirculation

KW - pulsatility

UR - http://www.scopus.com/inward/record.url?scp=85159572707&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2023.04.002

DO - 10.1016/j.healun.2023.04.002

M3 - Article

C2 - 37098374

VL - 42

SP - 1223

EP - 1232

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 9

ER -

Von denselben Autoren