Evaluation of the Effect of Artificial Pulsatility in Continuous Flow Assist Device on Peripheral Vascular Reactivity

Purpose Heart failure is associated with impaired endothelial function including peripheral vessels. A pulsatility decrement once continuous flow left ventricular assist device (CF-LVAD) implanted has been consistently corroborated as an additive factor further compromising peripheral vascular function in such patients. EndoPAT 2000 is a FDA approved, operator independent device for assessment of endothelial function allowing for serial examination of reactive hyperemia index (RHI; as a measure of endothelial responsiveness; cutoff Methods Thirty-two patients implanted with HeartMate3 LVAS (5 females; mean age 55±13.8 years, ischemic cardiomyopathy 43.75%) were longitudinally examined by EndoPAT 2000 prior to the procedure and subsequently at 3 rd and 6 th month after implantation. Results Mean RHI was substantially impaired and below the norm already at a baseline (1.33±0.63). Temporal analysis revealed highly significant worsening at 3 rd (RHI = 0.5±0.64) and 6 th (RHI = 0.67±0.59) month post implantation (both p rd [(-3.4)±27.1] and 6 th [(-0.9)±34.5] month after implantation relative to baseline [(-32.2)±25.2]; (p = 0.003 and p Conclusion The study provides additional evidence on a negative effect of suppressed physiologic pulsatility amplitude in CF-LVAD patients. Despite restored central hemodynamics, peripheral vascular function after implantation is further compromised based on serial assessment by EndoPAT 2000. Our observations suggest that a novel feature of programmed artificial pulsatility in HeartMate3 does not provide a sufficient pulse amplitude to avert further progression of peripheral vascular dysfunction due to continuous flow circulatory pattern. Larger scale adverse events matched clinical trials are warranted.