Impact of right ventricular reserve on exercise capacity and quality of life in patients with left ventricular assist device

• Published in: American journal of physiology. Heart and circulatory physiology 2023-03, Vol.324 (3), p.H355-H363
• Main Authors: Takenaka, Sakae, Sato, Takuma, Nagai, Toshiyuki, Omote, Kazunori, Kobayashi, Yuta, Kamiya, Kiwamu, Konishi, Takao, Tada, Atsushi, Mizuguchi, Yoshifumi, Takahashi, Yuki, Naito, Seiichiro, Saiin, Kohei, Ishizaka, Suguru, Wakasa, Satoru, Anzai, Toshihisa
• Format: Article
• Language: English
• Subjects: Exercise Tolerance; Heart Failure; Heart Ventricles; Heart-Assist Devices; Humans; Quality of Life; Stroke; Ventricular Function, Right
• ISSN: 0363-6135; 1522-1539
• DOI: 10.1152/ajpheart.00626.2022

Although measuring right ventricular (RV) function during exercise is more informative than assessing it at rest, the relationship between RV reserve function, exercise capacity, and health-related quality of life (HRQoL) in patients with left ventricular assist devices (LVAD) remains unresolved. We aimed to investigate whether RV reserve assessed by the change in RV stroke work index (RVSWI) during exercise is correlated with exercise capacity and HRQoL in patients with LVAD. We prospectively assessed 24 consecutive patients with LVAD who underwent invasive right heart catheterization in the supine position. Exercise capacity and HRQoL were assessed using the 6-min walk distance (6 MWD) and peak oxygen consumption (V̇o ) in cardiopulmonary exercise testing, and the EuroQol visual analog scale (EQ-VAS), respectively. The patients were divided into two groups according to the median ΔRVSWI (change from rest to peak exercise). Patients with lower ΔRVSWI had significantly lower changes in cardiac index and absolute value of RV dP/d than those with higher ΔRVSWI. The ΔRVSWI was positively correlated with 6 MWD ( = 0.59, = 0.003) and peak V̇o ( = 0.56, = 0.006). In addition, ΔRVSWI was positively correlated with the EQ-VAS ( = 0.44, = 0.030). In contrast, there was no significant correlation between RVSWI at rest and 6 MWD ( = -0.34, = 0.88), peak V̇o ( = 0.074, = 0.74), or EQ-VAS ( = 0.127, = 0.56). Our findings suggest that the assessment of RV reserve function is useful for risk stratification in patients with LVAD. The change in right ventricular stroke work index (RVSWI) during exercise, not RVSWI at rest, was associated with exercise capacity and HRQoL. Our findings suggest that the assessment of change in RVSWI during exercise as a surrogate of RV reserve function may aid in risk stratification of patients with LVAD.