From the Department of Cardiology, Ege University School of Medicine, Izmir, Turkey.
Department of Cardiology, Baskent University Istanbul Hospital, Istanbul, Turkey.
ASAIO J. 2022 Feb 1;68(2):214-219. doi: 10.1097/MAT.0000000000001447.
The peripheral vascular effects of continuous-flow left ventricular assist device (CF-LVAD) implantation are still unclear. The aim of the current study was to determine peripheral vascular function before and after implantation of CF-LVAD in patients with end-stage heart failure (HF), and to compare this data to age- and sex-matched chronic heart failure with reduced ejection fraction (HFrEF) patients. Forty-three consecutive end-stage HF patients (New York Heart Association [NYHA] class III/IV; three women and 40 men; mean age 53 ± 11 years) who planned to receive CF-LVAD implantation comprised the LVAD patient population, and their clinical characteristics, preoperative and third postoperative month peripheral vascular function assessment data including flow-mediated dilation (FMD) and pulsatility index (PI) assessed by ultrasound Doppler in brachial artery were compared to age- and sex-matched chronic, stable HFrEF patients (NYHA class II; five women and 30 men; mean age 51 ± 10 years). After CF-LVAD implantation, median FMD decreased from 5.4 to 3.7% (p < 0.001), and median PI decreased from 6.9 to 1.4 (p < 0.001). In patients with end-stage HF before CF-LVAD implantation, FMD and PI were significantly lower compared to the chronic HFrEF patients (FMD: 5.4% ± 0.9% vs. 7.6% ± 1.1%; p < 0.001, respectively) and (PI: 6.9 ± 1.3 vs. 7.4 ± 1.2; p = 0.023, respectively). The current study revealed impaired peripheral vascular function in the end-stage HF patients compared to stable HFrEF patients, and documented the deterioration of peripheral vascular function after CF-LVAD implantation. These results suggest that impaired peripheral vascular function in the CF-LVAD patients compared to preoperative assessment is a consequence of the nonpulsatile blood flow due to the continuous-flow mechanical support.
连续血流左心室辅助装置（CF-LVAD）植入后的外周血管效应尚不清楚。本研究旨在确定终末期心力衰竭（HF）患者植入 CF-LVAD 前后的外周血管功能，并将这些数据与年龄和性别匹配的慢性射血分数降低心力衰竭（HFrEF）患者进行比较。43 例连续终末期 HF 患者（纽约心脏协会[NYHA]III/IV 级；3 名女性和 40 名男性；平均年龄 53 ± 11 岁）计划接受 CF-LVAD 植入，他们的临床特征、术前和术后第三个月外周血管功能评估数据（包括肱动脉超声多普勒血流介导的扩张[FMD]和搏动指数[PI]）与年龄和性别匹配的慢性、稳定的 HFrEF 患者（NYHA II 级；5 名女性和 30 名男性；平均年龄 51 ± 10 岁）进行了比较。CF-LVAD 植入后，中位 FMD 从 5.4%降至 3.7%（p < 0.001），中位 PI 从 6.9 降至 1.4（p < 0.001）。在植入 CF-LVAD 之前的终末期 HF 患者中，FMD 和 PI 明显低于慢性 HFrEF 患者（FMD：5.4%±0.9%vs.7.6%±1.1%；p < 0.001）和（PI：6.9±1.3 vs.7.4±1.2；p = 0.023）。本研究表明，与稳定的 HFrEF 患者相比，终末期 HF 患者的外周血管功能受损，并记录了 CF-LVAD 植入后外周血管功能的恶化。这些结果表明，与术前评估相比，CF-LVAD 患者的外周血管功能受损是由于连续血流机械支持导致的非搏动血流所致。
