The role of exercise hemodynamics in assessing patients with chronic heart failure and left ventricular assist devices

ABSTRACT

Introduction: Chronic heart failure is characterized by reduced exercise capacity. Invasive exercise hemodynamics are not routinely performed unless patients undergo transplant or left ventricular assist devices (LVAD) assessment, though now with readily available noninvasive devices, exercise hemodynamics are easily obtained. Our contention is that this is a valuable opportunity to acquire a more accurate measure of cardiac status in heart failure. Exercise hemodynamic measures such as cardiac power output can be carried out cheaply and effectively. Recent studies have highlighted the added value of exercise hemodynamics in prognostication of heart failure, and their role in assessing myocardial recovery in LVADs.

Areas covered: In this review, we explore the literature available on Medline until 2019 focusing on resting and exercise hemodynamics alongside the methods of assessment (invasive and noninvasive) in heart failure with reduced ejection fraction and patients with implanted LVADs.

Expert opinion: Hemodynamics measured both at rest and exercise are expected to play a significant role in the work up of transplant and LVAD patients. Furthermore, there is the potential to utilize noninvasive assessment in a complimentary fashion to support patient selection and improve the monitoring of response to treatment across the full cohort of heart failure patients.

KEYWORDS:

• Heart failure
• left ventricular assist device
• exercise hemodynamics
• noninvasive assessment

Article Highlights

• Exercise hemodynamics appear to be superior to resting values as a marker of functional capacity and prognosis for both CHF and LVAD patients.

• Invasive hemodynamic measures are expected to be more routinely used to assess this cohort of patients, particularly for transplant or LVAD assessment.

• Neurohormonal regulation significantly influences hemodynamics in both CHF and LVAD patients and should be studied in future trials to improve outcomes such as functional capacity

• Noninvasive hemodynamic assessment is available and increasingly validated in both CHF and LVAD patients.

• Further exercise studies in LVADs are required to understand the hemodynamic changes with an aim for further device development and optimization.

Declaration of interest

S Schueler has received research funding from HeartWare and has served as an advisor and proctor for HeartWare. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.