Mirza Kiran K, Gustafsson Finn
Department of Cardiology, Rigshospitalet Copenhagen, Denmark.
Card Fail Rev. 2020 Oct 16;6:e29. doi: 10.15420/cfr.2020.15. eCollection 2020 Mar.
Continuous-flow left ventricular assist devices (LVAD) are increasingly used as destination therapy in patients with end-stage heart failure and, with recent improvements in pump design, adverse event rates are decreasing. Implanted patients experience improved survival, quality of life (QoL) and functional capacity (FC). However, improvement in FC and QoL after implantation is not unequivocal, and this has implications for patient selection and preimplantation discussions with patients and relatives. This article identifies preimplantation predictors of lack of improvement in FC and QoL after continuous-flow LVAD implantation and discusses potential mechanisms, allowing for the identification of potential factors that can be modified. In particular, the pathophysiology behind insufficient improvement in peak oxygen uptake is discussed. Data are included from 40 studies, resulting in analysis of >700 exercise tests. Mean peak oxygen uptake was 13.4 ml/kg/min (equivalent to 48% of predicted value; 259 days after implantation, range 31-1,017 days) and mean 6-minute walk test distance was 370 m (182 days after implantation, range 43-543 days). Finally, the interplay between improvement in FC and QoL is discussed.
连续流左心室辅助装置（LVAD）越来越多地被用作终末期心力衰竭患者的目标治疗手段，并且随着泵设计的不断改进，不良事件发生率正在下降。植入该装置的患者生存率、生活质量（QoL）和功能能力（FC）均有所改善。然而，植入后FC和QoL的改善并不明确，这对患者选择以及与患者及其亲属进行植入前讨论具有重要意义。本文确定了连续流LVAD植入后FC和QoL改善不足的植入前预测因素，并讨论了潜在机制，以便识别可改变的潜在因素。特别讨论了峰值摄氧量改善不足背后的病理生理学。数据来自40项研究，共分析了700多次运动测试。平均峰值摄氧量为13.4 ml/kg/min（相当于预测值的48%；植入后259天，范围为31 - 1017天），平均6分钟步行试验距离为370 m（植入后182天，范围为43 - 543天）。最后，讨论了FC和QoL改善之间的相互作用。
