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Physical Activity Guided by Pulse Pressure in Patients With Continuous Flow Left Ventricular Assist Devices: A Pilot Study.

Continuous flow left ventricular assist devices (cfLVADs) are increasingly used as bridge to cardiac transplantation or destination therapy in patients with end-stage heart failure. 1 Patients implanted with cfLVADs exhibit marked arterial pulse pressure (PP) reductions which could adversely affect cardiovascular health. Indeed, a pulsatile blood pressure provides stimuli for vascular smooth muscle cell growth and arterial baroreceptor functions. 2, 3 LVAD designs attempting to simulate PP have been developed recently with the hope to improve clinical outcomes. 4 Perhaps, physiological PP could be augmented through regular physical exercise in non-pulsatile patients implanted with cfLVADs. Yet, specific recommendations guiding exercise intervention following cfLVAD implantation do not exist. We reasoned that a standardized exercise training regimen could be developed based upon a reference of exercise-induced pulse pressure. In this pilot study, we tested the hypothesis that the in-laboratory evaluation of PP during exercise by photoplethysmography could serve as a guide for home-based walking and cycling exercise prescriptions.