Ventricular assist devices (VADs) offer mechanical support for patients with cardiogenic shock by unloading the impaired ventricle and increasing cardiac outflow and subsequent tissue perfusion. Their ability to adjust ventricular assistance allows for rapid and safe dynamic changes in cardiac load, which can be used with direct measures of chamber pressures to quantify cardiac pathophysiologic state, predict response to interventions, and unmask vulnerabilities such as limitations of left-sided support efficacy due to intolerance of the right heart. We defined hemodynamic metrics in five pigs with dynamic peripheral transvalvular VAD (pVAD) support to the left ventricle. Metrics were obtained across a spectrum of disease states, including left ventricular ischemia induced by titrated microembolization of a coronary artery and right ventricular strain induced by titrated microembolization of the pulmonary arteries. A sweep of different pVAD speeds confirmed mechanisms of right heart decompensation after left-sided support and revealed intolerance. In contrast to the systemic circulation, pulmonary vascular compliance dominated in the right heart and defined the ability of the right heart to adapt to left-sided pVAD unloading. We developed a clinically accessible metric to measure pulmonary vascular compliance at different pVAD speeds that could predict right heart efficiency and tolerance to left-sided pVAD support. Findings in swine were validated with retrospective hemodynamic data from eight patients on pVAD support. This methodology and metric could be used to track right heart tolerance, predict decompensation before right heart failure, and guide titration of device speed and the need for biventricular support.

中文翻译：

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动态负荷调节预测左心室心血管的右心耐受性有助于猪心源性休克模型

心室辅助装置 (VAD) 通过减轻受损心室负荷并增加心脏流出和随后的组织灌注，为心源性休克患者提供机械支持。它们调节心室辅助的能力可以实现心脏负荷的快速、安全的动态变化，这可以与心室压力的直接测量一起使用，以量化心脏病理生理状态，预测对干预的反应，并揭示诸如左侧支持功效的限制等漏洞由于右心不耐受。我们定义了五只猪的血流动力学指标，这些猪的左心室具有动态外周跨瓣膜 VAD (pVAD) 支持。指标是在一系列疾病状态下获得的，包括冠状动脉滴定微栓塞引起的左心室缺血和肺动脉滴定微栓塞引起的右心室应变。对不同 pVAD 速度的扫描证实了左侧支撑后右心失代偿的机制并揭示了不耐受。与体循环相反，肺血管顺应性在右心占主导地位，并决定了右心适应左侧 pVAD 卸载的能力。我们开发了一种临床上可用的指标来测量不同 pVAD 速度下的肺血管顺应性，可以预测右心效率和对左侧 pVAD 支持的耐受性。猪的研究结果通过 8 名接受 pVAD 支持的患者的回顾性血流动力学数据进行了验证。这种方法和指标可用于跟踪右心耐受性、预测右心衰竭前的失代偿情况，并指导设备速度的滴定和双心室支持的需求。