Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Exercise oscillatory ventilation (EOV) in patients with advanced heart failure with and without left ventricular assist device (LVAD)
S. Wernhart1, M. Papathanasiou1, J. Hoffmann1, A. Ruhparwar2, M. Schulze3, T. Rassaf1, P. Lüdike1
1Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Essen; 2Klinik für Thorax- und Kardiovaskuläre Chirurgie, Universitätsklinikum Essen, Essen; 3Abteilung für Physiotherapie, Universitätsklinikum Essen, Essen;

Background:
Exercise oscillatory ventilation (EOV) has emerged as a potential prognosticator in patients with heart failure with reduced ejection fraction (HFrEF) indicating pathological fluctuations of pulmonary arterial pressure. If ventricular unloading in advanced heart failure by a left ventricular assist device (LVAD) has the potential to reverse this pathophysiological interaction and thus might serve as an early outcome parameter after LVAD implantation has not been investigated.

Methods:
We conducted a retrospective single-centre cross-sectional study analyzing patients with HFrEF with (n=27, LVAD +) and without (n=20, LVAD -) circulatory support undergoing cardiopulmonary exercise testing (CPET). Influencing factors on 3-months-rehospitalization (3MR) as a primary outcome, such as VO2peak, VE/VCO2, flattening of O2-pulse, EOV, and a reduced rise of PETCO2 (<3mmHg) during exercise were analyzed between the groups. As a second step, CPET variables were compared regarding the presence of EOV (+/-) and LVAD (+/-).

Results:
3MR was associated with significantly lower VO2peak (11.8±5.0ml/kg/min vs. 14.5±4.4ml/kg/min, p=0.043), and with a non-significantly lower increase of PETCO2 (OR 0.232, CI= 0.051-1.052; p=0.073) and higher VE/VCO2 values (43.3±9.5 vs. 38.2± 10.3 p=0.063). EOV (OR 0.361, CI = 0.086-1.515; p=0.276), LVAD (OR 1.467, CI= 0.361-5.963; p=0.723), and flattening of O2 pulse (OR 0.682, CI= 0.168-2.772; p=0.723) had no impact on 3MR. EOV was present in 59.5% (n=28) of patients, without a significant difference on LVAD status (p=0.959). Surprisingly, in LVAD patients the presence of EOV did not have a significant impact on VO2peak (p=0.734).

Conclusions:
Ventricular unloading with chronic LVAD therapy does not reverse EOV in advanced heart failure, which may illustrate insufficient unloading during exercise and may contribute to persistently limited exercise capacity following LVAD implantation. Simultaneous CPET and right heart catheterization are needed to elucidate whether EOV may serve as a non-invasive predictor of insufficient LV unloading necessitating LVAD reprogramming.
https://dgk.org/kongress_programme/jt2022/aP1193.html