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Right heart failure (RHF) following left ventricular assist device (LVAD) implantation is a major complication which significantly impairs exercise capacity (EC) and quality of life (QoL). Patients with smaller body surface area (BSA) (< 1.5 m2) has been identified as a risk factor of RHF and often excluded as a candidates for implantable LVAD. However, detailed analysis of hemodynamic exercise response among small BSA patients with recent LVAD remains relatively unknown. The aim of this study was to explore the hemodynamic parameters observed during rest and maximal exercise in LVAD patients and investigate how small patient size affects right ventricular (RV) function, EC and QoL. We prospectively examined 25 consecutive LVAD patients who were admitted to our hospital between June 2020 and November 2021. All patients underwent invasive exercise right heart catheterization with simultaneous echocardiography. RV stroke work index (RVSWI) was calculated at rest and during exercise. EC and QoL were assessed by 6-minute walk distance (6MWD) and peak oxygen consumption (VO 2) in cardiopulmonary exercise testing, and the EuroQol visual analogue scale (EQ-VAS), respectively. The patients were divided into two groups according to their BSA measurements: small BSA (< 1.5 m2, n = 5) and non-small BSA (≥ 1.5m2, n = 20). Patients were predominantly male (72%), and the median age was 47 (IQR 38 - 59) years. There were no significant differences in age, gender, primary etiology of heart failure, type of LVAD devices, echocardiographic parameters and RVSWI at rest and peak between the groups. ΔRVSWI (RVSWI change from rest to peak exercise) during exercise were positively correlated with BSA (R = 0.42, p = 0.038), however, 6MWT, peak VO 2 and EQ-VAS were comparable between the groups (p = 0.25, p = 0.50, p = 0.123, respectively). Kaplan-Meier analysis revealed no differences in adverse events between the groups (p = 0.78). ΔRVSWI during exercise was positively correlated with BSA in LVAD patients. However, EC and QOL demonstrated similar results between the patients with small BSA and non-small BSA. These findings suggest that small BSA might not be an exclusion criterion in recent practice. Further studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Despite advances in maintenance immunosuppressive regimens and strategies, cardiac allograft vasculopathy (CAV) continues to be a limiting factor for long-term cardiac graft survival. Intravascular ultrasound is known as a sensitive diagnostic tool for early detection of CAV, however, its utility of assessing the therapeutic effect is controversial. Here we report a case of CAV assessed by serial near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS), a novel tool for intravascular coronary imaging. The patient was a 47-year-old male who was diagnosed as dilated phase of hypertrophic cardiomyopathy. He received heart transplantation (HTx) at the age of 43. Coronary angiography after HTx showed no significant stenosis, however, IVUS revealed the maximal intimal thickness (MIT) of the left anterior descending branch (LAD) progressed from 0.63 mm (1 month) to 1.15 mm (2 years). Moreover, the NIRS-IVUS showed yellow signals with maximum lipid core burden index in a 4-mm segment (max-LCBI) of 71 in the LAD. From these findings, we converted immunosuppressive agent from mycophenolate mofetil to everolimus for suppressing endometrial hyperplasia. IVUS at 3 years after HTx revealed MIT regression in LAD from 1.15 mm (2 years) to 0.89 mm (3 years). NIRS-IVUS demonstrated a marked reduction in yellow signals (max-LCBI, 0) in the LAD. Following IVUS at 4 years did not show any CAV progression (Figure). NIRS-IVUS has been developed to assess the composition of atherosclerotic plaques and provides an automated quantitative assessment of lipid burden. Previous studies have reported that NIRS-derived LCBI is associated with adverse clinical outcomes in patients with coronary artery disease, however, there are few reports in patients after HTx. In this case, improvement of LCBI result in favorable outcome on following IVUS. NIRS-IVUS might be useful as a prognostic indicator for plaque progression with CAV. [ABSTRACT FROM AUTHOR]