AIMS Recurrence of heart failure emerged as the main cause of long-term mortality in patients implanted with the HeartMate 3 (HM3) left ventricular assist device (LVAD). We aimed at deriving a possible mechanistic rationale of clinical outcomes and analyzed longitudinal changes in pump parameters over prolonged HM3 support to investigate long-term effects of pump settings on left ventricular mechanics. METHODS Data on pump parameters (i.e. pump speed, estimated flow, and pulsatility index) were prospectively recorded in consecutive HM3 patients following postoperative rehabilitation (baseline) and then at 6, 12, 24, 36, 48, and 60 months of support. RESULTS Data of 43 consecutive patients were analyzed. Pump parameters were set according to regular patients' follow-up, including clinical and echocardiographic assessment. We recorded a significant progressive increase in pump speed over the course of support: from 5200 (5050-5300) rpm at baseline to 5400 (5300-5600) rpm at 60 months of support ( P  = 0.0007). Consistently with the increase in pump speed, a significant increase in pump flow ( P  = 0.007) and a decrease in pulsatility index ( P  = 0.005) were also recorded. CONCLUSION Our results reveal unique features of the HM3 on left ventricular activity. The need for progressive increase in pump support suggests indeed a lack of recovery and worsening of left ventricular function, which emerge as a possible mechanistic rationale of heart failure related mortality in HM3 patients. New algorithms to optimize pump settings should be envisioned to further improve LVAD-LV interaction and, ultimately, clinical outcomes in the HM3 population. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT03255928. CLINICALTRIALSGOV IDENTIFIER NCT03255928.

中文翻译：

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通过 HeartMate 3 左心室辅助装置的长期支持对泵参数进行纵向分析。

目的 心力衰竭复发成为植入 HeartMate 3 (HM3) 左心室辅助装置 (LVAD) 的患者长期死亡的主要原因。我们的目的是推导临床结果的可能机制原理，并分析长期 HM3 支持下泵参数的纵向变化，以研究泵设置对左心室力学的长期影响。方法 连续 HM3 患者在术后康复（基线）后以及支持后第 6、12、24、36、48 和 60 个月前瞻性记录泵参数数据（即泵速、估计流量和搏动指数）。结果 分析了 43 名连续患者的数据。根据定期患者随访情况设置泵参数，包括临床和超声心动图评估。我们记录了在支持过程中泵速显着逐渐增加：从基线时的 5200 (5050-5300) rpm 到 60 个月支持时的 5400 (5300-5600) rpm (P = 0.0007)。与泵速的增加一致，还记录到泵流量显着增加（P = 0.007）和脉动指数下降（P = 0.005）。结论 我们的结果揭示了 HM3 对左心室活动的独特特征。泵支持逐渐增加的需要确实表明左心室功能缺乏恢复和恶化，这可能是 HM3 患者心力衰竭相关死亡率的机械原理。应设想优化泵设置的新算法，以进一步改善 LVAD-LV 相互作用，并最终改善 HM3 人群的临床结果。临床试验注册 https://clinicaltrials.gov/ct2/show/NCT03255928。临床试验GOV 标识符 NCT03255928。