{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T15:46:01Z","timestamp":1769096761844,"version":"3.49.0"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T00:00:00Z","timestamp":1696982400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Dynamic respiratory maneuvers induce heterogenous changes to flow\u2010pulsatility in continuous\u2010flow left ventricular assist device patients. We evaluated the association of these pulsatility responses with patient hemodynamics and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Responses obtained from HVAD (Medtronic) outpatients during successive weekly clinics were categorized into three ordinal groups according to the percentage reduction in flow\u2010waveform pulsatility (<jats:italic>peak\u2010trough flow<\/jats:italic>) upon inspiratory\u2010breath\u2010hold, (%\u2206P): (1) minimal change (%\u2206P\u2009\u2264\u200950), (2) reduced pulsatility (%\u2206P\u2009&gt;\u200950 but &lt;100), (3) flatline (%\u2206P\u2009=\u2009100). Same\u2010day echocardiography and right\u2010heart\u2010catheterization were performed. Readmissions were compared between patients with \u22651 flatline response (F\u2010group) and those without (NF\u2010group).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 712 responses were obtained from 55 patients (82% male, age 56.4\u2009\u00b1\u200911.5). When compared to minimal change, reduced pulsatility and flatline responses were associated with lower central venous pressure (14.2 vs. 11.4 vs. 9.0\u2009mm\u2009Hg, <jats:italic>p<\/jats:italic>\u2009=\u20090.08) and pulmonary capillary wedge pressure (19.8 vs. 14.3 vs. 13.0\u2009mm\u2009Hg, <jats:italic>p<\/jats:italic>\u2009=\u20090.03), lower rates of \u2265moderate mitral regurgitation (48% vs. 13% vs. 10%, <jats:italic>p<\/jats:italic>\u2009=\u20090.01), lower rates of \u2265moderate right ventricular impairment (62% vs. 25% vs. 27%, <jats:italic>p<\/jats:italic>\u2009=\u20090.03), and increased rates of aortic valve opening (32% vs. 50% vs. 75%, <jats:italic>p<\/jats:italic>\u2009=\u20090.03). The F\u2010group (<jats:italic>n<\/jats:italic>\u2009=\u200928) experienced numerically lower all\u2010cause readmissions (1.51 vs. 2.79 events\u2010per\u2010patient\u2010year [EPPY], hazard\u2010ratio [HR]\u2009=\u20090.67, <jats:italic>p<\/jats:italic>\u2009=\u20090.12), reduced heart failure readmissions (0.07 vs. 0.57 EPPY, HR\u2009=\u20090.15, <jats:italic>p<\/jats:italic>\u2009=\u20090.008), and superior readmission\u2010free survival (HR\u2009=\u20090.47, log\u2010rank <jats:italic>p<\/jats:italic>\u2009=\u20090.04). Syncopal readmissions occurred exclusively in the F\u2010group (0.20 vs. 0 EPPY, <jats:italic>p<\/jats:italic>\u2009=\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Responses to inspiratory\u2010breath\u2010hold predicted hemodynamics and readmission risk. The impact of inspiratory\u2010breath\u2010hold on pulsatility can non\u2010invasively guide hemodynamic management decisions, patient optimization, and readmission risk stratification.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aor.14644","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T05:33:14Z","timestamp":1697088794000},"page":"70-82","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Using pulsatility responses to breath\u2010hold maneuvers to predict readmission rates in continuous\u2010flow left ventricular assist device patients"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0774-2184","authenticated-orcid":false,"given":"Rohan Joshua","family":"Krishnaswamy","sequence":"first","affiliation":[{"name":"Heart and Lung Transplant Unit St Vincent's Hospital  Darlinghurst New South Wales Australia"},{"name":"Faculty of Medicine University of 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