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Purpose After the implantation of a left ventricular assist device (LVAD), many patients continue to experience exercise intolerance. LVAD echo guided optimization (EO) determines a more favorable hemodynamic profile and could provide an improvement on functional capacity (FC). VAFRACT is a prospective randomized trial to evaluate the additional benefit of an EO approach on FC, measured by cardiopulmonary exercise test (CPET) in LVAD optimization free population. Methods Patients were randomized in a 1:1 ratio to EO (EO group) versus standard setting (CONTROL group) after at least 3 months from LVAD implant. Optimal device speed is defined as the one that allows intermittent aortic valve opening and neutral position of the interventricular septum without increasing aortic or tricuspidal regurgitation and preserving right ventricular (RV) function. The primary end point is peak oxygen uptake (VO2 peak) change at 3 months after the EO. The secondary end points are: RV function (fractional area change - FAC); hospital admissions device related; NT pro BNP levels; CPET exercise time (ET); changes in quality of life (QoL) perceived by EuroQoL Scale. At the interim analysis 15 patients have been enrolled and 10 have completed the study. Assuming α = 0.05 and an 80% power, the sample size estimation is 18 patients per group. Results No statistically significant differences have been found in basal characteristics of the two groups. Time of LVAD implantation was about 2.5 years and the most common indication to implant was Bridge to Transplant. Preliminary analysis of data concerning patients who have already completed the study shows a tendential positive impact of EO on VO 2 peak, ventilatory anaerobic threshold (VAT), ET and on the QoL (Table 1). Conclusion This is the first prospective randomized trial to evaluate the additional benefit of EO on FC; final results could demonstrate that this approach could lead to improvements in exercise capacity in LVAD supported patients. [ABSTRACT FROM AUTHOR]