Continuous-Flow Left Ventricular Assist Device Support Improves Myocardial Supply:Demand in Chronic Heart Failure

Kevin G. Soucy, Carlo R. Bartoli, Dustin Phillips, Guruprasad A. Giridharan, Michael A. Sobieski, William B. Wead, Robert D. Dowling, Zhongjun J. Wu, Sumanth D. Prabhu, Mark S. Slaughter, Steven C. Koenig

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Continuous-flow left ventricular assist devices (CF LVADs) are rotary blood pumps that improve mean blood flow, but with potential limitations of non-physiological ventricular volume unloading and diminished vascular pulsatility. In this study, we tested the hypothesis that left ventricular unloading with increasing CF LVAD flow increases myocardial flow normalized to left ventricular work. Healthy (n = 8) and chronic ischemic heart failure (IHF, n = 7) calves were implanted with CF LVADs. Acute hemodynamics and regional myocardial blood flow were measured during baseline (LVAD off, clamped), partial (2–4 L/min) and full (>4 L/min) LVAD support. IHF calves demonstrated greater reduction of cardiac energy demand with increasing LVAD support compared to healthy calves, as calculated by rate-pressure product. Coronary artery flows (p < 0.05) and myocardial blood flow (left ventricle (LV) epicardium and myocardium, p < 0.05) decreased with increasing LVAD support in normal calves. In the IHF model, blood flow to the septum, LV, LV epicardium, and LV myocardium increased significantly with increasing LVAD support when normalized to cardiac energy demand (p < 0.05). In conclusion, myocardial blood flow relative to cardiac demand significantly increased in IHF calves, thereby demonstrating that CF LVAD unloading effectively improves cardiac supply and demand ratio in the setting of ischemic heart failure.

Original languageEnglish (US)
Pages (from-to)1475-1486
Number of pages12
JournalAnnals of Biomedical Engineering
Volume45
Issue number6
DOIs
StatePublished - Jun 1 2017

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Left ventricular assist devices
Blood
Unloading
Hemodynamics
Pumps

All Science Journal Classification (ASJC) codes

  • Biomedical Engineering

Cite this

Soucy, K. G., Bartoli, C. R., Phillips, D., Giridharan, G. A., Sobieski, M. A., Wead, W. B., ... Koenig, S. C. (2017). Continuous-Flow Left Ventricular Assist Device Support Improves Myocardial Supply:Demand in Chronic Heart Failure. Annals of Biomedical Engineering, 45(6), 1475-1486. https://doi.org/10.1007/s10439-017-1804-x
Soucy, Kevin G. ; Bartoli, Carlo R. ; Phillips, Dustin ; Giridharan, Guruprasad A. ; Sobieski, Michael A. ; Wead, William B. ; Dowling, Robert D. ; Wu, Zhongjun J. ; Prabhu, Sumanth D. ; Slaughter, Mark S. ; Koenig, Steven C. / Continuous-Flow Left Ventricular Assist Device Support Improves Myocardial Supply:Demand in Chronic Heart Failure. In: Annals of Biomedical Engineering. 2017 ; Vol. 45, No. 6. pp. 1475-1486.
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abstract = "Continuous-flow left ventricular assist devices (CF LVADs) are rotary blood pumps that improve mean blood flow, but with potential limitations of non-physiological ventricular volume unloading and diminished vascular pulsatility. In this study, we tested the hypothesis that left ventricular unloading with increasing CF LVAD flow increases myocardial flow normalized to left ventricular work. Healthy (n = 8) and chronic ischemic heart failure (IHF, n = 7) calves were implanted with CF LVADs. Acute hemodynamics and regional myocardial blood flow were measured during baseline (LVAD off, clamped), partial (2–4 L/min) and full (>4 L/min) LVAD support. IHF calves demonstrated greater reduction of cardiac energy demand with increasing LVAD support compared to healthy calves, as calculated by rate-pressure product. Coronary artery flows (p < 0.05) and myocardial blood flow (left ventricle (LV) epicardium and myocardium, p < 0.05) decreased with increasing LVAD support in normal calves. In the IHF model, blood flow to the septum, LV, LV epicardium, and LV myocardium increased significantly with increasing LVAD support when normalized to cardiac energy demand (p < 0.05). In conclusion, myocardial blood flow relative to cardiac demand significantly increased in IHF calves, thereby demonstrating that CF LVAD unloading effectively improves cardiac supply and demand ratio in the setting of ischemic heart failure.",
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Soucy, KG, Bartoli, CR, Phillips, D, Giridharan, GA, Sobieski, MA, Wead, WB, Dowling, RD, Wu, ZJ, Prabhu, SD, Slaughter, MS & Koenig, SC 2017, 'Continuous-Flow Left Ventricular Assist Device Support Improves Myocardial Supply:Demand in Chronic Heart Failure', Annals of Biomedical Engineering, vol. 45, no. 6, pp. 1475-1486. https://doi.org/10.1007/s10439-017-1804-x

Continuous-Flow Left Ventricular Assist Device Support Improves Myocardial Supply:Demand in Chronic Heart Failure. / Soucy, Kevin G.; Bartoli, Carlo R.; Phillips, Dustin; Giridharan, Guruprasad A.; Sobieski, Michael A.; Wead, William B.; Dowling, Robert D.; Wu, Zhongjun J.; Prabhu, Sumanth D.; Slaughter, Mark S.; Koenig, Steven C.

In: Annals of Biomedical Engineering, Vol. 45, No. 6, 01.06.2017, p. 1475-1486.

Research output: Contribution to journalArticle

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T1 - Continuous-Flow Left Ventricular Assist Device Support Improves Myocardial Supply:Demand in Chronic Heart Failure

AU - Soucy, Kevin G.

AU - Bartoli, Carlo R.

AU - Phillips, Dustin

AU - Giridharan, Guruprasad A.

AU - Sobieski, Michael A.

AU - Wead, William B.

AU - Dowling, Robert D.

AU - Wu, Zhongjun J.

AU - Prabhu, Sumanth D.

AU - Slaughter, Mark S.

AU - Koenig, Steven C.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Continuous-flow left ventricular assist devices (CF LVADs) are rotary blood pumps that improve mean blood flow, but with potential limitations of non-physiological ventricular volume unloading and diminished vascular pulsatility. In this study, we tested the hypothesis that left ventricular unloading with increasing CF LVAD flow increases myocardial flow normalized to left ventricular work. Healthy (n = 8) and chronic ischemic heart failure (IHF, n = 7) calves were implanted with CF LVADs. Acute hemodynamics and regional myocardial blood flow were measured during baseline (LVAD off, clamped), partial (2–4 L/min) and full (>4 L/min) LVAD support. IHF calves demonstrated greater reduction of cardiac energy demand with increasing LVAD support compared to healthy calves, as calculated by rate-pressure product. Coronary artery flows (p < 0.05) and myocardial blood flow (left ventricle (LV) epicardium and myocardium, p < 0.05) decreased with increasing LVAD support in normal calves. In the IHF model, blood flow to the septum, LV, LV epicardium, and LV myocardium increased significantly with increasing LVAD support when normalized to cardiac energy demand (p < 0.05). In conclusion, myocardial blood flow relative to cardiac demand significantly increased in IHF calves, thereby demonstrating that CF LVAD unloading effectively improves cardiac supply and demand ratio in the setting of ischemic heart failure.

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