Effects of Acute Pump Speed Changes on Cerebral Hemodynamics in Patients With an Implantable Continuous-Flow Left Ventricular Assist Devices.

Mechanical circulatory support (MCS) with an implantable left ventricular assist device (LVAD) is an established therapeutic option for advanced heart failure. Most of the currently used LVADs generate a continuous stream of blood that decreases arterial pulse pressure. This study investigated whether a change of the pulse pressure during different pump speed settings would affect cerebral autoregulation and thereby affect cerebral blood flow (CBF). The study included 21 haemodynamically stable outpatients with a continuous-flow LVAD (HeartMate II, Abbott, USA) implanted a median of 6 months before the study (interquartile range 3 to 14 months). Arterial blood pressure (measured by finger plethysmography) was recorded simultaneously with CBF (measured by transcranial Doppler ultrasound) during baseline pump speed (8900 rpm [IQR 8800; 9200]) and during minimum and maximum tolerated pump speeds (8000 rpm [IQR 8000; 8200] and 9800 rpm [IQR 9800; 10 000]). An increase in LVAD pump speed by 800 rpm [IQR 800; 1000] from the baseline lead to a significant decrease in arterial pulse pressure and cerebral blood flow pulsatility (relative change ?24% and ?32%, both p < 0.01), but it did not affect mean arterial pressure and mean CBF velocity (relative change 1% and ?1.7%, p = 0.1 and 0.7). In stable patients with a continuous-flow LVAD, changes of pump speed settings within a clinically used range did not impair static cerebral autoregulation and cerebral blood flow.

[Angiotensin converting enzyme inhibitors]. / Inhibítory enzýmu konvertujúceho angiotenzín.

Angiotensin converting enzyme (ACE) is a zinc metallopeptidase which plays a key role in the regulation of important vasoactive peptides through its proteolytic activity. Effective inhibitors of ACE were until recently designed in the absence of the solved 3D structure of this enzyme. About 15 ACE inhibitors are currently commercially available, all of which nonspecifically inhibit both active domains of ACE. Vasopeptidase inhibitors are mixed inhibitors of ACE and neutral endopeptidase (NEP). They contemporarily inhibit the catalytic function of two enzymes and currently are undergoing clinical trials exhibiting better efficacy in the treatment of hypertension and cardiovascular diseases, but in the same time higher risk of adverse side effects compared to ACE inhibitors.