ReviewThe determinants of functional capacity in left ventricular assist device patients: many actors with not well defined rolesLilliu, Marzia; Onorati, Francesco; Luciani, Giovanni Battista; Faggian, GiuseppeAuthor Information Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy Correspondence to Marzia Lilliu, MD, Division of Cardiac Surgery, Department of Surgery, University of Verona, Piazzale Aristide Stefani, 1, 37126 Verona VR, Italy Tel: +39 3281383539; fax: +39 458123308; e-mail: email@example.com Received 30 June, 2019 Revised 23 September, 2019 Accepted 21 October, 2019 Journal of Cardiovascular Medicine: July 2020 - Volume 21 - Issue 7 - p 472-480 doi: 10.2459/JCM.0000000000000958 Buy Metrics Abstract Improvement in hemodynamic parameters is routinely demonstrated in patients implanted with continuous-flow left ventricular assist devices (CF-LVADs). However, functional capacity assessed by cardiopulmonary exercise test (CPET), following LVAD implantation, remains considerably restricted. In this review, we analyzed the current knowledge on the causes of the persistent limitation in exercise capacity in CF-LVAD patients. Limitation to exercise is multifactorial and involves: LVAD factors (fixed CF-LVAD pump speed), native cardiac factors (residual function of native left ventricle, right ventricular dysfunction, aortic valve abnormalities), comorbidities (abnormal skeletal muscle metabolism, low skeletal muscle mass, anemia), patient's characteristics (age, physical deconditioning). In addition, we emphasize the role of some potential therapeutic strategies like the increase in CF-LVAD pump speed according to the patient's activity, the echo-optimization of the device (paying attention to right ventricular function and aortic valve opening), the implementation of physical rehabilitation and the treatment of potentially reversible extracardiac factors (anemia, muscle deconditioning, obesity). © 2020 Italian Federation of Cardiology - I.F.C. All rights reserved.