Cerebral blood flow during exercise in heart failure: Impact of ventricular assist devices

Kurt J Smith, Ignacio M Suarez, Anna Scheer, Lauren C Chasland, Hannah J Thomas, Marilia A Correia, Lawrence G Dembo, Louise H Naylor, Andrew J Maiorana, Daniel J Green

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: In healthy individuals cerebral blood flow (CBF) increases during exercise, but few studies have compared changes in CBF during exercise in patients with heart failure (HF) to healthy controls (CTRL), or assessed the effects of left ventricular assist devices (LVADs). We hypothesised that subjects implanted with LVADs would exhibit impaired cerebrovascular responses to cycle exercise when compared to age- and sex-matched healthy CTRL subjects, but enhanced responses relative to subjects with HF.

METHODS: Internal carotid artery [ICA] blood flow, and intra-cranial middle [MCAv] and posterior cerebral [PCAv] artery velocities were measured continuously using Doppler ultrasound, alongside cardiorespiratory measures at rest and in response to an incremental submaximal cycle ergometer exercise protocol in 9 LVAD participants (58±15yrs; 87±16kg; 172±8 cm, 6♂), 9 age- and sex-matched subjects with HF (58±8yrs; 84±11kg;177±6cm), and 9 CTRL (55±14yrs; 74±16kg;168±10cm).

RESULTS: At rest, ICA hemodynamics (velocity, shear rate and flow) were greater in CTRLs and LVADs than HF (p<0.05). Higher MCAv (+5.52±1.59 cm.s, p=0.003) and PCAv (+5.82±1.41 cm.s, p=0.001) were also observed in LVAD subjects than healthy CTRLs. During exercise, ICA flow increased at all workloads in CTRL, but not in HF or LVAD groups. MCAv increased from baseline in both HF and CTRL participants (p=0.0001), but not in LVAD subjects. Nonetheless, CTRLs and LVADs showed higher MCAv (p=0.006) and PCAv (p<0.0001) values throughout exercise than HF.

CONCLUSION: Our findings indicate that LVAD subjects exhibit higher cerebral blood flows at rest and during exercise than matched HF participants, but attenuated brain blood flows during exercise when compared to healthy subjects. Cerebral blood flows should be considered when designing exercise training interventions in patients with HF and LVADs.

Original languageEnglish
Pages (from-to)1372-1379
Number of pages8
JournalMedicine and Science in Sports and Exercise
Volume51
Issue number7
DOIs
Publication statusUnpublished - 1 Jul 2019

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Cerebrovascular Circulation
Heart-Assist Devices
Heart Failure
Exercise
Internal Carotid Artery
Healthy Volunteers
Equipment Failure
Posterior Cerebral Artery
Doppler Ultrasonography
Workload

Cite this

Smith, K. J., Suarez, I. M., Scheer, A., Chasland, L. C., Thomas, H. J., Correia, M. A., ... Green, D. J. (2019). Cerebral blood flow during exercise in heart failure: Impact of ventricular assist devices. Unpublished. https://doi.org/10.1249/MSS.0000000000001904
Smith, Kurt J ; Suarez, Ignacio M ; Scheer, Anna ; Chasland, Lauren C ; Thomas, Hannah J ; Correia, Marilia A ; Dembo, Lawrence G ; Naylor, Louise H ; Maiorana, Andrew J ; Green, Daniel J. / Cerebral blood flow during exercise in heart failure : Impact of ventricular assist devices. In: Medicine and Science in Sports and Exercise. 2019 ; Vol. 51, No. 7. pp. 1372-1379.
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abstract = "INTRODUCTION: In healthy individuals cerebral blood flow (CBF) increases during exercise, but few studies have compared changes in CBF during exercise in patients with heart failure (HF) to healthy controls (CTRL), or assessed the effects of left ventricular assist devices (LVADs). We hypothesised that subjects implanted with LVADs would exhibit impaired cerebrovascular responses to cycle exercise when compared to age- and sex-matched healthy CTRL subjects, but enhanced responses relative to subjects with HF.METHODS: Internal carotid artery [ICA] blood flow, and intra-cranial middle [MCAv] and posterior cerebral [PCAv] artery velocities were measured continuously using Doppler ultrasound, alongside cardiorespiratory measures at rest and in response to an incremental submaximal cycle ergometer exercise protocol in 9 LVAD participants (58±15yrs; 87±16kg; 172±8 cm, 6♂), 9 age- and sex-matched subjects with HF (58±8yrs; 84±11kg;177±6cm), and 9 CTRL (55±14yrs; 74±16kg;168±10cm).RESULTS: At rest, ICA hemodynamics (velocity, shear rate and flow) were greater in CTRLs and LVADs than HF (p<0.05). Higher MCAv (+5.52±1.59 cm.s, p=0.003) and PCAv (+5.82±1.41 cm.s, p=0.001) were also observed in LVAD subjects than healthy CTRLs. During exercise, ICA flow increased at all workloads in CTRL, but not in HF or LVAD groups. MCAv increased from baseline in both HF and CTRL participants (p=0.0001), but not in LVAD subjects. Nonetheless, CTRLs and LVADs showed higher MCAv (p=0.006) and PCAv (p<0.0001) values throughout exercise than HF.CONCLUSION: Our findings indicate that LVAD subjects exhibit higher cerebral blood flows at rest and during exercise than matched HF participants, but attenuated brain blood flows during exercise when compared to healthy subjects. Cerebral blood flows should be considered when designing exercise training interventions in patients with HF and LVADs.",
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Smith, KJ, Suarez, IM, Scheer, A, Chasland, LC, Thomas, HJ, Correia, MA, Dembo, LG, Naylor, LH, Maiorana, AJ & Green, DJ 2019, 'Cerebral blood flow during exercise in heart failure: Impact of ventricular assist devices' Medicine and Science in Sports and Exercise, vol. 51, no. 7, pp. 1372-1379. https://doi.org/10.1249/MSS.0000000000001904

Cerebral blood flow during exercise in heart failure : Impact of ventricular assist devices. / Smith, Kurt J; Suarez, Ignacio M; Scheer, Anna; Chasland, Lauren C; Thomas, Hannah J; Correia, Marilia A; Dembo, Lawrence G; Naylor, Louise H; Maiorana, Andrew J; Green, Daniel J.

In: Medicine and Science in Sports and Exercise, Vol. 51, No. 7, 01.07.2019, p. 1372-1379.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cerebral blood flow during exercise in heart failure

T2 - Impact of ventricular assist devices

AU - Smith, Kurt J

AU - Suarez, Ignacio M

AU - Scheer, Anna

AU - Chasland, Lauren C

AU - Thomas, Hannah J

AU - Correia, Marilia A

AU - Dembo, Lawrence G

AU - Naylor, Louise H

AU - Maiorana, Andrew J

AU - Green, Daniel J

PY - 2019/7/1

Y1 - 2019/7/1

N2 - INTRODUCTION: In healthy individuals cerebral blood flow (CBF) increases during exercise, but few studies have compared changes in CBF during exercise in patients with heart failure (HF) to healthy controls (CTRL), or assessed the effects of left ventricular assist devices (LVADs). We hypothesised that subjects implanted with LVADs would exhibit impaired cerebrovascular responses to cycle exercise when compared to age- and sex-matched healthy CTRL subjects, but enhanced responses relative to subjects with HF.METHODS: Internal carotid artery [ICA] blood flow, and intra-cranial middle [MCAv] and posterior cerebral [PCAv] artery velocities were measured continuously using Doppler ultrasound, alongside cardiorespiratory measures at rest and in response to an incremental submaximal cycle ergometer exercise protocol in 9 LVAD participants (58±15yrs; 87±16kg; 172±8 cm, 6♂), 9 age- and sex-matched subjects with HF (58±8yrs; 84±11kg;177±6cm), and 9 CTRL (55±14yrs; 74±16kg;168±10cm).RESULTS: At rest, ICA hemodynamics (velocity, shear rate and flow) were greater in CTRLs and LVADs than HF (p<0.05). Higher MCAv (+5.52±1.59 cm.s, p=0.003) and PCAv (+5.82±1.41 cm.s, p=0.001) were also observed in LVAD subjects than healthy CTRLs. During exercise, ICA flow increased at all workloads in CTRL, but not in HF or LVAD groups. MCAv increased from baseline in both HF and CTRL participants (p=0.0001), but not in LVAD subjects. Nonetheless, CTRLs and LVADs showed higher MCAv (p=0.006) and PCAv (p<0.0001) values throughout exercise than HF.CONCLUSION: Our findings indicate that LVAD subjects exhibit higher cerebral blood flows at rest and during exercise than matched HF participants, but attenuated brain blood flows during exercise when compared to healthy subjects. Cerebral blood flows should be considered when designing exercise training interventions in patients with HF and LVADs.

AB - INTRODUCTION: In healthy individuals cerebral blood flow (CBF) increases during exercise, but few studies have compared changes in CBF during exercise in patients with heart failure (HF) to healthy controls (CTRL), or assessed the effects of left ventricular assist devices (LVADs). We hypothesised that subjects implanted with LVADs would exhibit impaired cerebrovascular responses to cycle exercise when compared to age- and sex-matched healthy CTRL subjects, but enhanced responses relative to subjects with HF.METHODS: Internal carotid artery [ICA] blood flow, and intra-cranial middle [MCAv] and posterior cerebral [PCAv] artery velocities were measured continuously using Doppler ultrasound, alongside cardiorespiratory measures at rest and in response to an incremental submaximal cycle ergometer exercise protocol in 9 LVAD participants (58±15yrs; 87±16kg; 172±8 cm, 6♂), 9 age- and sex-matched subjects with HF (58±8yrs; 84±11kg;177±6cm), and 9 CTRL (55±14yrs; 74±16kg;168±10cm).RESULTS: At rest, ICA hemodynamics (velocity, shear rate and flow) were greater in CTRLs and LVADs than HF (p<0.05). Higher MCAv (+5.52±1.59 cm.s, p=0.003) and PCAv (+5.82±1.41 cm.s, p=0.001) were also observed in LVAD subjects than healthy CTRLs. During exercise, ICA flow increased at all workloads in CTRL, but not in HF or LVAD groups. MCAv increased from baseline in both HF and CTRL participants (p=0.0001), but not in LVAD subjects. Nonetheless, CTRLs and LVADs showed higher MCAv (p=0.006) and PCAv (p<0.0001) values throughout exercise than HF.CONCLUSION: Our findings indicate that LVAD subjects exhibit higher cerebral blood flows at rest and during exercise than matched HF participants, but attenuated brain blood flows during exercise when compared to healthy subjects. Cerebral blood flows should be considered when designing exercise training interventions in patients with HF and LVADs.

U2 - 10.1249/MSS.0000000000001904

DO - 10.1249/MSS.0000000000001904

M3 - Article

VL - 51

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EP - 1379

JO - Medicine & Science in Sports & Exercise

JF - Medicine & Science in Sports & Exercise

SN - 0195-9131

IS - 7

ER -