This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mancini, D. Articles by Oz, M. Search for Related Content PubMed PubMed Citation Articles by Mancini, D. Articles by Oz, M.

(Circulation. 1998;98:1178-1183.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Comparison of Exercise Performance in Patients With Chronic Severe Heart Failure Versus Left Ventricular Assist Devices

Donna Mancini, MD; Rochelle Goldsmith, PhD; Howard Levin, MD; Ainat Beniaminovitz, MD; Eric Rose, MD; Katharine Catanese, RN; Margaret Flannery, RN; ; Mehmet Oz, MD

From the Divisions of Circulatory Physiology (D.M., R.G., A.B.), Cardiology (D.M., H.L., A.B.), and Cardiothoracic Surgery (E.R., K.C., M.F., M.O.), Columbia Presbyterian Medical Center, New York, NY.

Background—Left ventricular assist devices (LVADs) are frequently used as a bridge to cardiac transplantation and may be useful as long-term therapy. The purpose of this study was to compare the exercise performance of LVAD patients with that of ambulatory heart failure patients.

Methods and Results—Exercise testing with hemodynamic and respiratory gas measurements was performed in 65 congestive heart failure (CHF) patients (age 53±10 years) and 20 LVAD patients (age 49±8 years). Peak O₂ was significantly higher in the LVAD than the CHF patients (CHF, 12±3; LVAD, 15.9±3.8 mL · kg^-1 · min^-1; P<0.001), as was the O₂ at the anaerobic threshold (CHF, 8.1±2.1; LVAD, 12.2±2.9 mL · kg^-1 · min^-1; P<0.001). At rest, mean arterial blood pressure (CHF, 87±11; LVAD, 94±9 mm Hg) and cardiac output (CHF, 4±1; LVAD, 4.9±0.9 L/min) were increased, whereas mean pulmonary artery pressure (CHF, 28±11; LVAD, 18±4 mm Hg) and pulmonary artery wedge pressure (CHF, 16±10; LVAD 5±3 mm Hg) were reduced (all P<0.01). At peak exercise, heart rate (CHF,125±24; LVAD, 148±24 bpm), blood pressure (CHF, 87±14; LVAD,96±12 mm Hg), and cardiac output (CHF, 7.6±2.2; LVAD, 11.2±2.6 L/min) were higher (all P<0.01), whereas mean pulmonary artery pressure (CHF, 48±12; LVAD, 30±5 mm Hg) and mean pulmonary capillary wedge pressure (CHF, 31±11; LVAD, 14±6 mm Hg) were lower in the LVAD group (both P<0.001). In the LVAD patients, Fick cardiac output was higher than LVAD flow sensor value measurements (Fick, 11.6±2.5; LVAD, 8.1±1.2 L/min; P<0.001).

Conclusions—Hemodynamic measurements at rest and during exercise are significantly improved in patients with devices compared with those in ambulatory heart failure patients awaiting cardiac transplantation. Similarly, the exercise capacity of device patients is better than that of transplant candidates and in the majority of patients is similar to that of patients with mild CHF.

Key Words: exercise • heart failure • heart assist device

This article has been cited by other articles:

				S. Klotz, J. Stypmann, H. Welp, C. Schmid, G. Drees, A. Rukosujew, and H. H. Scheld Does Continuous Flow Left Ventricular Assist Device Technology Have a Positive Impact on Outcome Pretransplant and Posttransplant? Ann. Thorac. Surg., November 1, 2006; 82(5): 1774 - 1778. [Abstract] [Full Text] [PDF]

				S. Klotz, A. Barbone, S. Reiken, J. W. Holmes, Y. Naka, M. C. Oz, A. R. Marks, and D. Burkhoff Left ventricular assist device support normalizes left and right ventricular beta-adrenergic pathway properties J. Am. Coll. Cardiol., March 1, 2005; 45(5): 668 - 676. [Abstract] [Full Text] [PDF]

				M. L. Ogletree-Hughes, L. B. Stull, W. E. Sweet, N. G. Smedira, P. M. McCarthy, and C. S. Moravec Mechanical Unloading Restores {beta}-Adrenergic Responsiveness and Reverses Receptor Downregulation in the Failing Human Heart Circulation, August 21, 2001; 104(8): 881 - 886. [Abstract] [Full Text] [PDF]

				A. Barbone, J. W. Holmes, P. M. Heerdt, A. H.S. The', Y. Naka, N. Joshi, M. Daines, A. R. Marks, M. C. Oz, and D. Burkhoff Comparison of Right and Left Ventricular Responses to Left Ventricular Assist Device Support in Patients With Severe Heart Failure: A Primary Role of Mechanical Unloading Underlying Reverse Remodeling Circulation, August 7, 2001; 104(6): 670 - 675. [Abstract] [Full Text] [PDF]

				N. de Jonge, H. Kirkels, J. R. Lahpor, C. Klopping, E. J. Hulzebos, A. Brutel de la Riviere, and E. O. Robles de Medina Exercise performance in patients with end-stage heart failure after implantation of a left ventricular assist device and after heart transplantation: An outlook for permanent assisting? J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1794 - 1799. [Abstract] [Full Text] [PDF]

				M. C. Deng, M. Loebe, A. El-Banayosy, E. Gronda, P. G. M. Jansen, M. Vigano, G. M. Wieselthaler, B. Reichart, E. Vitali, A. Pavie, et al. Mechanical Circulatory Support for Advanced Heart Failure : Effect of Patient Selection on Outcome Circulation, January 16, 2001; 103(2): 231 - 237. [Abstract] [Full Text] [PDF]

				A. J. Bank, S. H. Mir, D. Q. Nguyen, R. M. Bolman III, S. J. Shumway, L. W. Miller, D. R. Kaiser, S. M. Ormaza, and S. J. Park Effects of left ventricular assist devices on outcomes in patients undergoing heart transplantation Ann. Thorac. Surg., May 1, 2000; 69(5): 1369 - 1374. [Abstract] [Full Text] [PDF]

				D. M. Mancini, A. Beniaminovitz, H. Levin, K. Catanese, M. Flannery, M. DiTullio, S. Savin, M. E. Cordisco, E. Rose, and M. Oz Low Incidence of Myocardial Recovery After Left Ventricular Assist Device Implantation in Patients With Chronic Heart Failure Circulation, December 1, 1998; 98(22): 2383 - 2389. [Abstract] [Full Text] [PDF]