Grant: CIHR Fellowship

Chronic heart failure (HF) is a major cause of morbidity and mortality in North America. The American Heart Association estimates that 5.1 million people in the United States have HF, with 825 000 new cases being diagnosed each year. Despite current medical therapies, HF is one of the leading causes of hospitalization and frequently leads to heart transplantation (HTx). Unfortunately, HTx is only available for a minority of end-stage HF patients, largely due to a lack of suitable organ donors. Out over the last several decades, advances in mechanical circulatory devices have drastically improved the clinical management and outcomes of HF. Specifically, left ventricular assist devices (LVAD) are becoming a standard bridge-to-transplant therapy and recently the FDA also approved them as a destination therapy for individuals that may be ineligible for HTx. Second-generation LVADs are designed as an axial-flow pumps that provide continuous, nonpulsatile blood flow. This device tends to be smaller in size and more reliable than first-generation LVADs. However, the long-term effects of continuous, nonpulsatile blood flow, a consequence of the second-generation LVADs, on peripheral vascular function remains largely unexplored and is of clinical interest as an impaired flow-mediated vasodilatation is a marker of endothelial dysfunction and has been associated with various cardiovascular diseases. Therefore, the hypothesis of the present work is that long-term exposure to continuous blood flow induced by LVAD implantation causes detrimental changes in peripheral vascular function. It is expected that some of these unfavorable changes can potentially be reversed or halted by participating in a mechanically-induced pulsatility rehabilitation program.