Arterial stiffness, hemodynamics, and microvascular complications in conditions characterized by low arterial pulsatility

It is widely accepted that increased pulse pressure and flow pulsatility are detrimental to peripheral end-organ structure and function. However, humans who have extremely low pulse pressure and flow pulsatility, such as patients implanted with a left ventricular assist device, also suffer severe end-organ complications. Consequently, studying these unique patients enables us to investigate the basic principles that govern regulation of the cardiovascular system across the full range of pulsatility. This chapter will highlight the unique arterial hemodynamics of heart failure patients living with nonpulsatile, continuous flow in their arterial system, after implantation with a left ventricular assist device. A description of the typical patient hemodynamics will form the basis of discussion and provide novel insights into how unique and extremely low pulsatile hemodynamics affect macro- and microcirculatory health. The study of low pulsatility hemodynamics can substantially enhance our understanding of arterial physiology and circulatory regulation.