PMID- 26277768 OWN - NLM STAT- MEDLINE DCOM- 20160621 LR - 20181113 IS - 2213-1787 (Electronic) IS - 2213-1779 (Print) IS - 2213-1779 (Linking) VI - 3 IP - 9 DP - 2015 Sep TI - Further Peripheral Vascular Dysfunction in Heart Failure Patients With a Continuous-Flow Left Ventricular Assist Device: The Role of Pulsatility. PG - 703-11 LID - S2213-1779(15)00341-8 [pii] LID - 10.1016/j.jchf.2015.04.012 [doi] AB - OBJECTIVES: Using flow-mediated vasodilation (FMD) and reactive hyperemia (RH), this study aimed to provide greater insight into left ventricular assist device (LVAD)-induced changes in peripheral vascular function. BACKGROUND: Peripheral endothelial function is recognized to be impaired in patients with heart failure with reduced ejection fraction (HFrEF), but the peripheral vascular effects of continuous-flow LVAD implantation, now used as either a bridge to transplantation or as a destination therapy, remain unclear. METHODS: Sixty-eight subjects (13 New York Heart Association [NYHA] functional class II HFrEF patients, 19 NYHA functional class III/IV HFrEF patients, 20 NYHA functional class III/IV HFrEF patients post-LVAD implantation, and 16 healthy age-matched control subjects) underwent FMD and RH testing in the brachial artery with blood flow velocity, artery diameters, and pulsatility index (PI) assessed by ultrasound Doppler. RESULTS: PI was significantly lower in the LVAD group (2.0 +/- 0.4) compared with both the HFrEF II (8.6 +/- 0.8) and HFrEF III/IV (8.1 +/- 0.9) patients, who, in turn, had significantly lower PI than the control subjects (12.8 +/- 0.9). Likewise, LVAD %FMD/shear rate (0.09 +/- 0.01 %Delta/s(-1)) was significantly reduced compared with all other groups (control subjects, 0.24 +/- 0.03; HFrEF II, 0.17 +/- 0.02; and HFrEF III/IV, 0.13 +/- 0.02 %Delta/s(-1)), and %FMD/shear rate significantly correlated with PI (r = 0.45). RH was unremarkable across groups. CONCLUSIONS: Although central hemodynamics are improved in patients with HFrEF by a continuous-flow LVAD, peripheral vascular function is further compromised, which is likely due, at least in part, to the reduction in pulsatility that is a characteristic of such a mechanical assist device. CI - Copyright (c) 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Witman, Melissa A H AU - Witman MA AD - Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, Utah; Department of Internal Medicine, Division of Geriatrics, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: melissa.witman@utah.edu. FAU - Garten, Ryan S AU - Garten RS AD - Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, Utah; Department of Internal Medicine, Division of Geriatrics, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah. FAU - Gifford, Jayson R AU - Gifford JR AD - Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah. FAU - Groot, H Jonathan AU - Groot HJ AD - Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah. FAU - Trinity, Joel D AU - Trinity JD AD - Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, Utah; Department of Internal Medicine, Division of Geriatrics, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah. FAU - Stehlik, Josef AU - Stehlik J AD - Department of Internal Medicine, Division of Cardiovascular Medicine, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah. FAU - Nativi, Jose N AU - Nativi JN AD - Department of Internal Medicine, Division of Cardiovascular Medicine, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah. FAU - Selzman, Craig H AU - Selzman CH AD - Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah. FAU - Drakos, Stavros G AU - Drakos SG AD - Department of Internal Medicine, Division of Cardiovascular Medicine, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah. FAU - Richardson, Russell S AU - Richardson RS AD - Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, Utah; Department of Internal Medicine, Division of Geriatrics, George E. Whalen VA Medical Center and University of Utah Medical Center, University of Utah School of Medicine, Salt Lake City, Utah; Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah. LA - eng GR - P01 HL091830/HL/NHLBI NIH HHS/United States GR - R01 HL089592/HL/NHLBI NIH HHS/United States GR - 4R01 HL089592/HL/NHLBI NIH HHS/United States GR - P01 HL-091830/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20150812 PL - United States TA - JACC Heart Fail JT - JACC. Heart failure JID - 101598241 SB - IM CIN - JACC Heart Fail. 2015 Sep;3(9):712-4. PMID: 26277763 MH - Brachial Artery/diagnostic imaging/physiopathology MH - Endothelium, Vascular/physiopathology MH - Female MH - Heart Failure/complications/physiopathology/*surgery MH - Heart-Assist Devices MH - Humans MH - Male MH - Middle Aged MH - Peripheral Vascular Diseases/diagnostic imaging/etiology/*physiopathology MH - Pulsatile Flow/*physiology MH - Ultrasonography, Doppler MH - Vascular Resistance/*physiology MH - Vasodilation/*physiology PMC - PMC4568148 MID - NIHMS712909 OTO - NOTNLM OT - HFrEF OT - blood flow OT - flow-mediated vasodilation OT - mechanical assist OT - pulsatility EDAT- 2015/08/19 06:00 MHDA- 2016/06/22 06:00 PMCR- 2016/09/01 CRDT- 2015/08/17 06:00 PHST- 2015/03/23 00:00 [received] PHST- 2015/04/07 00:00 [accepted] PHST- 2015/08/17 06:00 [entrez] PHST- 2015/08/19 06:00 [pubmed] PHST- 2016/06/22 06:00 [medline] PHST- 2016/09/01 00:00 [pmc-release] AID - S2213-1779(15)00341-8 [pii] AID - 10.1016/j.jchf.2015.04.012 [doi] PST - ppublish SO - JACC Heart Fail. 2015 Sep;3(9):703-11. doi: 10.1016/j.jchf.2015.04.012. Epub 2015 Aug 12.