Work

Novel markers of myocardial recovery in patients with left ventricular assist device: A cardiopulmonary exercise test and hemodynamic analysis

Year: 2025

Type: article

Abstract: Background Left ventricular assist device (LVAD)-associated myocardial recovery is possible. Beyond peak O 2 consumption (pVO 2 ), parameters obtained from cardiopulmonary exercise testing (CPET), such as post-exercise oxygen uptake recovery delay (VO 2 RD), ventilatory efficiency (V E /VCO 2 slope), and pressure-flow slopes from invasive hemodynamics, may offer novel insights in recovery assessment. Methods We performed a retrospective analysis of 46 LVAD recipients with CPET (2014-2024), of whom five had complete recovery and LVAD explant (recovered group). A subset (n=23) had invasive hemodynamics during CPET. VO 2 RD thresholds were defined as the time required for VO 2 to fall below 12.5%, 25%, and 50% of pVO 2 (T 12.5% , T 25% , T 50% ). Pressure-flow slopes were derived by regressing pulmonary artery wedge pressure (PAWP) and mean pulmonary artery pressure (PAP) against cardiac output (CO) throughout exercise. Results Compared to non-recovered group, recovered patients had higher LVEF (47% [45–48] vs. 19% [16–28], p=0.001), higher pVO 2 (14.0 [13.6–20.6] vs. 11.0 [9.9–12.3]ml/kg/min, p=0.007), shorter VO 2 RD thresholds (T 12.5% : 31.4±11.7 vs. 47.7±19.1sec, p=0.03; T 25% : 46.8±7.1 vs. 65.3±25sec, p=0.0038; T 50% : 82±10.1 vs. 99.6±20.9sec, p=0.027), lower PAWP/CO (1.1 vs. 3.6 mmHg/L/min, p=0.003) and PAP/CO (2.4 vs. 4.3 mmHg/L/min, p=0.03) slopes. V E /VCO 2 slope components in all exercise phases were similar. Conclusions VO 2 RD and pressure-flow slopes were lower in recovered patients, and could be incorporated into a prospective wean protocol assessing for complete myocardial recovery in LVAD-supported patients.

Source: JHLT Open

DOI: 10.1016/j.jhlto.2025.100444