Faculty Collaboration Database

Hemodynamic Assessment of Patients With and Without Heart Failure Symptoms Supported by a Continuous-Flow Left Ventricular Assist Device. Mayo Clin Proc 2018 Jul;93(7):895-903

Date

06/13/2018

Pubmed ID

29891343

DOI

10.1016/j.mayocp.2018.01.031

Scopus ID

2-s2.0-85048489708 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

OBJECTIVE: To investigate differences in invasive hemodynamic parameters and outcomes in patients with and without heart failure (HF) symptoms after left ventricular assist device (LVAD) implantation.

PATIENTS AND METHODS: We performed a single-center retrospective analysis of 51 symptomatic patients and 50 patients with resolved HF symptoms who underwent right-sided heart catheterization (RHC) after LVAD implantation from March 1, 2007, through June 30, 2016. Patient characteristics and outcomes including all-cause mortality and right ventricular (RV) failure were compared between groups.

RESULTS: Fifty-one patients had development of HF symptoms after LVAD implantation and underwent RHC a mean ± SD of 243.7±288 days postoperatively. Fifty asymptomatic LVAD recipients underwent routine RHC 278.6±205 days after implantation. Compared with patients who had resolved HF symptoms, symptomatic patients were older, more likely to be male, and more likely to have ischemic cardiomyopathy. Symptomatic patients had higher right atrial pressure (P<.001), mean pulmonary arterial pressure (P<.001), and pulmonary capillary wedge pressure (P<.001). Improvements in right atrial pressure, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure before and after LVAD implantation were less remarkable in symptomatic patients. The frequency of RV dysfunction was significantly higher among symptomatic patients than patients with resolved HF symptoms (P=.001). Symptomatic patients displayed significantly higher risk of all-cause mortality (hazard ratio, 3.0; 95% CI, 1.3-6.5; P=.007) and RV failure (hazard ratio, 6.2; 95% CI, 1.3-29.7; P=.02) independent of other predictors of outcome.

CONCLUSION: Patients with recurrent HF symptoms after LVAD implantation display more profound hemodynamic derangements, greater burden of RV failure, and increased rates of all-cause mortality compared with LVAD recipients with resolved HF symptoms.

Author List

Asleh R, Hasin T, Briasoulis A, Schettle SD, Borlaug BA, Behfar A, Pereira NL, Edwards BS, Clavell AL, Joyce LD, Maltais S, Stulak JM, Kushwaha SS

MESH terms used to index this publication - Major topics in bold

Aged
Blood Pressure
Cardiac Catheterization
Cardiac Output
Female
Heart Failure
Heart-Assist Devices
Humans
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Vascular Resistance
Ventricular Dysfunction, Right