Physical Activity Guided by Pulse Pressure in Patients With Continuous Flow Left Ventricular Assist Devices
A Pilot Study
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Continuous flow left ventricular assist devices (cfLVADs) are increasingly used as a bridge to cardiac transplantation or destination therapy in patients with end-stage heart failure.1 Patients implanted with cfLVADs exhibit marked arterial pulse pressure (PP) reductions that could adversely affect cardiovascular health. Indeed, a pulsatile blood pressure provides stimuli for vascular smooth muscle cell growth and arterial baroreceptor functions.2,3 LVAD designs attempting to simulate PP have been developed recently with the hope to improve clinical outcomes.4 Perhaps physiological PP could be augmented through regular physical exercise in nonpulsatile patients implanted with cfLVADs. Yet specific recommendations guiding exercise intervention after cfLVAD implantation do not exist. We reasoned that a standardized exercise training regimen could be developed based on a reference of exercise-induced PP. In this pilot study, we tested the hypothesis that the in-laboratory evaluation of PP during exercise by photoplethysmography could serve as a guide for home-based walking and cycling exercise prescriptions.
We included 3 patients with very low (<10 mm Hg) and 1 control patient with normal resting PP (69 mm Hg) without signs of decompensation (age: 57±11 years, body mass index: 27.9±8.0 kg/m2, preimplant LV ejection fraction: <25%) who had been implanted with cfLVADs (HVAD, HeartWare …