Key result
In a computer model, HeartMate 3 LVAD pump speeds above 4k rpm reduced right ventricular chamber contractility (by ~3% at 6k rpm and ~10% at 9k rpm), exacerbated by thinner septal walls.
Why the study?
LVAD implantation is associated with a high incidence of RV failure hypothesized to stem from interventricular interactions during LV unloading, but contributing factors remain unknown.
Does the HeartMate 3 LVAD affect right ventricular function and inter-ventricular interaction in a computer model of heart failure?
Does the HeartMate 3 LVAD affect right ventricular function and inter-ventricular interaction in a computer model of heart failure?
Computer modeling demonstrates that higher LVAD pump speeds reduce RV chamber contractility, especially with thinner septal walls or lower regional contractility, providing mechanistic insight into LVAD-induced RV failure.
Modeling identifies LVAD-RV interaction factors; leaves open clinical validation before practice change.
Background Left ventricular assist device (LVAD) is associated with a high incidence of right ventricular (RV) failure, which is hypothesized to be caused by the occurring inter‐ventricular interactions when the LV is unloaded. Factors contributing to these interactions are unknown. Methods We used computer modeling to investigate the impact of the HeartMate 3 LVAD on RV functions. The model was first calibrated against pressure–volume (PV) loops associated with a heart failure (HF) patient and validated against measurements of inter‐ventricular interactions in animal experiments. The model was then applied to investigate the effects of LVAD on (1) RV chamber contractility indexed by derived from its end‐systolic PV relationship, and (2) RV diastolic function indexed by derived from its end‐diastolic PV relationship. We also investigated how septal wall thickness and regional contractility affect the impact of LVAD on RV function. Results The impact of LVAD on RV chamber contractility is small at a pump speed lower than 4k rpm. At a higher pump speed between 4k and 9k rpm, however, RV chamber contractility is reduced (by ~3% at 6k rpm and ~10% at 9k rpm). The reduction of RV chamber contractility is greater with a thinner septal wall or with a lower myocardial contractility at the LV free wall, septum, or RV free wall. Conclusion RV chamber contractility is reduced at a pump speed higher than 4k rpm, and this reduction is greater with a thinner septal wall or lower regional myocardial contractility. Findings here may have clinical implications in identifying LVAD patients who may suffer from RV failure.
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Fan et al. (2023) studied Heart failure. HeartMate 3 LVAD vs. Pump speed <4k rpm was evaluated on Right ventricular chamber contractility and diastolic function. In a computer model, HeartMate 3 LVAD pump speeds above 4k rpm reduced right ventricular chamber contractility (by ~3% at 6k rpm and ~10% at 9k rpm), exacerbated by thinner septal walls.
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