{"id":"9e95afda3d57","type":"article","url":"https://hartvaat.nl/2022/06/10/echogeleide-lvad-snelheidsoptimalisatie-voor-betere-inspanningstolerantie/","title":"Echogeleide LVAD-snelheidsoptimalisatie voor betere inspanningstolerantie","title_en":"Echo-guided left ventricular assist device speed optimisation for exercise maximisation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["aortainsufficiëntie","aortastenose","echocardiografie","klepprothese","perifeer-vaatlijden","slaapapneu","ventrikelfibrilleren"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-320495","source_url":"https://doi.org/10.1136/heartjnl-2021-320495","authors":["Maciej Stapor","Adam Pilat","Andrzej Gackowski","Agnieszka Misiuda","Izabela Gorkiewicz-Kot","Michal Kaleta","Pawel Kleczynski","Krzysztof Zmudka","Jacek Legutko","Boguslaw Kapelak","Karol Wierzbicki"],"significance":6,"published":"2022-06-10","source_date":"2022-06-10","image":"","kennis":[],"congress":"","summary_en":"This study explored whether echo-guided LVAD speed optimization during exercise improves exercise capacity, testing individualized hemodynamic programming as a strategy to overcome the fixed-speed limitation of current devices.","created":"2026-07-03T10:29:48Z","updated":"2026-07-03T13:28:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht of echogeleide aanpassing van de LVAD-pompsnelheid tijdens inspanning de inspanningscapaciteit kan verbeteren. Optimalisatie op basis van aortaklepopening bleek haalbaar en verbeterde de hemodynamische respons, wat de weg opent voor adaptieve LVAD-algoritmen.","abstract_original":"OBJECTIVE: Current generation left ventricular assist devices (LVADs) operate with a fixed rotation speed and no automated speed adjustment function. This study evaluates the concept of physiological pump speed optimisation based on aortic valve opening (AVO) imaging during a cardiopulmonary exercise test (CPET). METHODS: This prospective crossover study (NCT05063006) enrolled patients with implanted third-generation LVADs with hydrodynamic bearing. After resting speed optimisation, patients were randomised to a fixed-modified speed or modified-fixed speed CPET sequence. Fixed speed CPET maintained baseline pump settings. During the modified speed CPET, the LVAD speed was continuously altered to preserve periodic AVO. RESULTS: We included 22 patients, the mean age was 58.4±7 years, 4.5% were women and 54.5% had ischaemic cardiomyopathy. Exertional AVO assessment was feasible in all subjects. Maintaining periodic AVO allowed to safely raise the pump speed from 2900 (IQR 2640-3000) to 3440 revolutions per minute (RPM) (IQR 3100-3700; p<0.001). As a result, peak oxygen consumption increased from 11.1±2.4 to 12.8±2.8 mL/kg/min (p<0.001) and maximum workload from 1.1 (IQR 0.9-1.5) to 1.2 W/kg (IQR 0.9-1.7; p=0.028). The Borg scale exertion level decreased from 15.2±1.5 to 13.5±1.2 (p=0.005). CONCLUSIONS: Transthoracic AVO imaging is possible during CPETs in patients with LVAD. Dynamic echo-guided pump speed adjustment based on the AVO improves exercise tolerance and augments peak oxygen consumption and maximum workload."}