Effect of Exercise and Pump Speed Modulation on Invasive Hemodynamics in Patients with Centrifugal Continuous Flow Left Ventricular Assist Devices

The effects of exercise, increasing pump speed, or both on invasive hemodynamics in centrifugal flow LVAD patients were analyzed in this small study.  Findings included:

• Increasing pump speed at rest increased pump flow and decreased PCWP.
• Exercise increased pump flow but yielded increased right and left-sided filling pressures.
• Exercise combined with increased pump speed increased pump flow further (synergistic effect) without lowering right- and left-sided filling pressures.

Questions raised:

• What should be done to improve unloading in LVAD patients during exercise?
• Should algorithms be included in the LVAD that automatically uptitrate RPMs during exercise?
• Would increasing pump speeds further, beyond manufacturer's recommendations, safely improve unloading during exercise?