Sympathetic Neural and Hemodynamic Responses to Upright Tilt in Patients With Pulsatile and Nonpulsatile Left Ventricular Assist Devices
| العنوان: | Sympathetic Neural and Hemodynamic Responses to Upright Tilt in Patients With Pulsatile and Nonpulsatile Left Ventricular Assist Devices |
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| المؤلفون: | Qi Fu, Naoki Fujimoto, Brian Bethea, Shigeki Shibata, Dan M. Meyer, Benjamin D. Levine, Jeffrey L. Hastings, M. Dean Palmer, Mark H. Drazner, David W. Markham |
| المصدر: | Circulation: Heart Failure. 6:293-299 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2013. |
| سنة النشر: | 2013 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Cardiac output, Sympathetic Nervous System, Time Factors, Supine position, Epinephrine, Dopamine, Posture, Pulsatile flow, Hemodynamics, Baroreflex, Prosthesis Design, Ventricular Function, Left, Norepinephrine, Tilt table test, Heart Rate, Tilt-Table Test, Internal medicine, Heart rate, Supine Position, medicine, Humans, Arterial Pressure, Cardiac Output, Muscle, Skeletal, Heart Failure, Analysis of Variance, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Texas, Treatment Outcome, Pulsatile Flow, Heart failure, Cardiology, Female, Vascular Resistance, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, business, Biomarkers |
| الوصف: | Background— Left ventricular assist devices (LVADs) are now widely accepted as an option for patients with advanced heart failure. First-generation devices were pulsatile, but they had poor longevity and durability. Newer generation devices are nonpulsatile and more durable, but remain associated with an increased risk of stroke and hypertension. Moreover, little is understood about the physiological effects of the chronic absence of pulsatile flow in humans. Methods and Results— We evaluated patients with pulsatile (n=6) and nonpulsatile (n=11) LVADs and healthy controls (n=9) during head-up tilt while measuring hemodynamics and muscle sympathetic nerve activity. Patients with nonpulsatile devices had markedly elevated supine and upright muscle sympathetic nerve activity (mean±SD, 43±15 supine and 60±21 bursts/min at 60° head-up tilt) compared with patients with pulsatile devices (24±7 and 35±8 bursts/min; P P P =0.34). Heart rate, mean arterial pressure, and total peripheral resistance were greater, whereas cardiac output was smaller, in LVAD patients compared with controls in both supine and upright postures. However, these hemodynamic variables were not significantly different between patients with pulsatile and nonpulsatile flow. Conclusions— Heart failure patients with continuous, nonpulsatile LVADs have marked sympathetic activation, which is likely due, at least in part, to baroreceptor unloading. We speculate that such chronic sympathetic activation may contribute to, or worsen end-organ diseases, and reduce the possibility of ventricular recovery. Strategies to provide some degree of arterial pulsatility, even in continuous flow LVADs may be necessary to achieve optimal outcomes in these patients. |
| تدمد: | 1941-3297 1941-3289 |
| DOI: | 10.1161/circheartfailure.112.969873 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4f3e3c338144a65d273912691577f2d1 https://doi.org/10.1161/circheartfailure.112.969873 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....4f3e3c338144a65d273912691577f2d1 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19413297 19413289 |
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| DOI: | 10.1161/circheartfailure.112.969873 |