Cardiovascular autonomic control in patients undergoing left ventricular assist device (LVAD) support and pharmacologic therapy.

Objectives: The objective of the study is to determine cardiac autonomic control in patients undergoing assessment for and/or LVAD therapy.

Methods: Heart rate variability (HRV) was measured in 17 explanted LVAD, 17 implanted LVAD and 23 NYHA III-IV classified chronic heart failure (CHF) patients and ten healthy matched controls under three conditions: supine free breathing, standing and supine controlled breathing. Five measures of HRV were assessed: mean R-R interval (mR-R), high frequency (HF) and low frequency (LF) spectral power, LF in normalised units (LFnu), and LF to HF (LF:HF) ratio.

Reversal of severe heart failure with a continuous-flow left ventricular assist device and pharmacological therapy: a prospective study.

Background: We have previously shown that a specific combination of drug therapy and left ventricular assist device unloading results in significant myocardial recovery, sufficient to allow pump removal, in two thirds of patients with dilated cardiomyopathy receiving a Heartmate I pulsatile device. However, this protocol has not been used with nonpulsatile devices.

Methods And Results: We report the results of a prospective study of 20 patients who received a combination of angiotensin-converting enzymes, β-blockers, angiotensin II inhibitors, and aldosterone antagonists followed by the β₂-agonist clenbuterol and were regularly tested (echocardiograms, exercise tests, catheterizations) with the pump at low speed.

The impact of acute reduction of continuous-flow left ventricular assist device support on cardiac and exercise performance.

Background: The use of the HeartMate II continuous-flow left ventricular assist device (LVAD) improves survival, quality of life and functional capacity of patients with advanced heart failure. However, no study so far has shown the benefits of these devices for cardiac function during peak exercise.

Objective: To assess cardiac and exercise performance in patients implanted with the HeartMate II LVAD under two settings: (i) optimal device support and (ii) reduced device support.

Comparison of cardiac power output and exercise performance in patients with left ventricular assist devices, explanted (recovered) patients, and those with moderate to severe heart failure.

Peak cardiac power output (CPO), as a direct measurement of overall cardiac function, has been shown to be a most powerful predictor of prognosis for patients with chronic heart failure. The present study assessed CPO and exercise performance in patients implanted with a left ventricular assist device (LVAD), those explanted due to myocardial recovery, and those with moderate to severe heart failure. Hemodynamic and respiratory gas exchange measurements were undertaken at rest and at peak graded exercise.

Reversible loss of pre-excitation as a sign of acute cardiac rejection.

A 50-year-old woman presented with signs of mild heart failure 16 months after orthotopic heart transplantation. Cardiac biopsy revealed ISHLT Grade 2R rejection, which was treated with corticosteroids. Electrocardiograms (ECGs) after transplantation showed a pre-excitation pattern; the presenting ECG showed complete loss of pre-excitation, which returned fully within 7 days of steroid therapy.