# Echogeleide LVAD-snelheidsoptimalisatie voor betere inspanningstolerantie

*geplaatst 2022-06-10 · Hartfalen · Heart (British Cardiac Society) · doi 10.1136/heartjnl-2021-320495 · https://hartvaat.nl/2022/06/10/echogeleide-lvad-snelheidsoptimalisatie-voor-betere-inspanningstolerantie/*

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.

## English: Echo-guided left ventricular assist device speed optimisation for exercise maximisation.

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.

## Abstract (original, from the publication)

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.

Auteurs: Maciej Stapor, Adam Pilat, Andrzej Gackowski, Agnieszka Misiuda, Izabela Gorkiewicz-Kot, Michal Kaleta, Pawel Kleczynski, Krzysztof Zmudka, Jacek Legutko, Boguslaw Kapelak, Karol Wierzbicki

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Bron: Heart (British Cardiac Society), https://doi.org/10.1136/heartjnl-2021-320495. Bijgewerkt 2026-07-03T13:28:54Z. 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.