Attenuation in peripheral endothelial function after continuous flow left ventricular assist device therapy is associated with cardiovascular adverse events

Tal Hasin, Yasushi Matsuzawa, Raviteja R. Guddeti, Tatsuo Aoki, Taek Geun Kwon, Sarah Schettle, Ryan J. Lennon, Ramesh G. Chokka, Amir Lerman, Sudhir S. Kushwaha

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Patients with heart failure (HF) have abnormal endothelial function. Although use of a continuous flow left ventricular assist device (CF-LVAD) results in significant hemodynamic improvement, the effects on systemic endothelial function are unclear. Methods and Results: Eighteen HF patients with CF-LVAD implantation were included in this prospective observational study. We measured reactive hyperemia index (RHI) before and after CF-LVAD implantation to evaluate sequential changes in endothelial function. Patients were followed clinically for the occurrence of adverse cardiovascular events, a composite of death, thrombosis, bleeding, HF, renal failure, and arrhythmia. Preoperative RHI was 1.77± 0.39. Early in the postoperative period (7–14 days after operation) RHI significantly decreased to 1.19± 0.31 (P<0.001, compared with preoperative RHI). At first and second follow-up (4–6 weeks and 3–7 months after operation) RHI remained lower at 1.48± 0.50 (P=0.030) and 1.26± 0.37 (P=0.002), respectively, compared with preoperative RHI. The decrease in early postoperative RHI relative to preoperative RHI was significantly associated with adverse cardiovascular events after CF-LVAD (age-adjusted risk ratio for 0.25 decrease in RHI, 1.35; 95% confidence interval: 1.13–1.62, P=0.001). Conclusions: Peripheral endothelial function had a significant and persistent decline up to 5 months following implantation of CF-LVAD, and this decline was associated with adverse cardiovascular events. These findings may provide insight into some of the vascular complications following CF-LVAD in HF patients.

Original languageEnglish (US)
Pages (from-to)770-777
Number of pages8
JournalCirculation Journal
Volume79
Issue number4
DOIs
StatePublished - 2015

Fingerprint

Heart-Assist Devices
Hyperemia
Heart Failure
Therapeutics
Postoperative Period
Observational Studies
Renal Insufficiency
Blood Vessels
Cardiac Arrhythmias
Thrombosis
Hemodynamics
Odds Ratio
Prospective Studies
Confidence Intervals
Hemorrhage

Keywords

  • Endothelial function
  • Heart failure
  • Ventricular assist device

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Attenuation in peripheral endothelial function after continuous flow left ventricular assist device therapy is associated with cardiovascular adverse events. / Hasin, Tal; Matsuzawa, Yasushi; Guddeti, Raviteja R.; Aoki, Tatsuo; Kwon, Taek Geun; Schettle, Sarah; Lennon, Ryan J.; Chokka, Ramesh G.; Lerman, Amir; Kushwaha, Sudhir S.

In: Circulation Journal, Vol. 79, No. 4, 2015, p. 770-777.

Research output: Contribution to journalArticle

Hasin, Tal ; Matsuzawa, Yasushi ; Guddeti, Raviteja R. ; Aoki, Tatsuo ; Kwon, Taek Geun ; Schettle, Sarah ; Lennon, Ryan J. ; Chokka, Ramesh G. ; Lerman, Amir ; Kushwaha, Sudhir S. / Attenuation in peripheral endothelial function after continuous flow left ventricular assist device therapy is associated with cardiovascular adverse events. In: Circulation Journal. 2015 ; Vol. 79, No. 4. pp. 770-777.
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abstract = "Background: Patients with heart failure (HF) have abnormal endothelial function. Although use of a continuous flow left ventricular assist device (CF-LVAD) results in significant hemodynamic improvement, the effects on systemic endothelial function are unclear. Methods and Results: Eighteen HF patients with CF-LVAD implantation were included in this prospective observational study. We measured reactive hyperemia index (RHI) before and after CF-LVAD implantation to evaluate sequential changes in endothelial function. Patients were followed clinically for the occurrence of adverse cardiovascular events, a composite of death, thrombosis, bleeding, HF, renal failure, and arrhythmia. Preoperative RHI was 1.77± 0.39. Early in the postoperative period (7–14 days after operation) RHI significantly decreased to 1.19± 0.31 (P<0.001, compared with preoperative RHI). At first and second follow-up (4–6 weeks and 3–7 months after operation) RHI remained lower at 1.48± 0.50 (P=0.030) and 1.26± 0.37 (P=0.002), respectively, compared with preoperative RHI. The decrease in early postoperative RHI relative to preoperative RHI was significantly associated with adverse cardiovascular events after CF-LVAD (age-adjusted risk ratio for 0.25 decrease in RHI, 1.35; 95{\%} confidence interval: 1.13–1.62, P=0.001). Conclusions: Peripheral endothelial function had a significant and persistent decline up to 5 months following implantation of CF-LVAD, and this decline was associated with adverse cardiovascular events. These findings may provide insight into some of the vascular complications following CF-LVAD in HF patients.",
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T1 - Attenuation in peripheral endothelial function after continuous flow left ventricular assist device therapy is associated with cardiovascular adverse events

AU - Hasin, Tal

AU - Matsuzawa, Yasushi

AU - Guddeti, Raviteja R.

AU - Aoki, Tatsuo

AU - Kwon, Taek Geun

AU - Schettle, Sarah

AU - Lennon, Ryan J.

AU - Chokka, Ramesh G.

AU - Lerman, Amir

AU - Kushwaha, Sudhir S.

PY - 2015

Y1 - 2015

N2 - Background: Patients with heart failure (HF) have abnormal endothelial function. Although use of a continuous flow left ventricular assist device (CF-LVAD) results in significant hemodynamic improvement, the effects on systemic endothelial function are unclear. Methods and Results: Eighteen HF patients with CF-LVAD implantation were included in this prospective observational study. We measured reactive hyperemia index (RHI) before and after CF-LVAD implantation to evaluate sequential changes in endothelial function. Patients were followed clinically for the occurrence of adverse cardiovascular events, a composite of death, thrombosis, bleeding, HF, renal failure, and arrhythmia. Preoperative RHI was 1.77± 0.39. Early in the postoperative period (7–14 days after operation) RHI significantly decreased to 1.19± 0.31 (P<0.001, compared with preoperative RHI). At first and second follow-up (4–6 weeks and 3–7 months after operation) RHI remained lower at 1.48± 0.50 (P=0.030) and 1.26± 0.37 (P=0.002), respectively, compared with preoperative RHI. The decrease in early postoperative RHI relative to preoperative RHI was significantly associated with adverse cardiovascular events after CF-LVAD (age-adjusted risk ratio for 0.25 decrease in RHI, 1.35; 95% confidence interval: 1.13–1.62, P=0.001). Conclusions: Peripheral endothelial function had a significant and persistent decline up to 5 months following implantation of CF-LVAD, and this decline was associated with adverse cardiovascular events. These findings may provide insight into some of the vascular complications following CF-LVAD in HF patients.

AB - Background: Patients with heart failure (HF) have abnormal endothelial function. Although use of a continuous flow left ventricular assist device (CF-LVAD) results in significant hemodynamic improvement, the effects on systemic endothelial function are unclear. Methods and Results: Eighteen HF patients with CF-LVAD implantation were included in this prospective observational study. We measured reactive hyperemia index (RHI) before and after CF-LVAD implantation to evaluate sequential changes in endothelial function. Patients were followed clinically for the occurrence of adverse cardiovascular events, a composite of death, thrombosis, bleeding, HF, renal failure, and arrhythmia. Preoperative RHI was 1.77± 0.39. Early in the postoperative period (7–14 days after operation) RHI significantly decreased to 1.19± 0.31 (P<0.001, compared with preoperative RHI). At first and second follow-up (4–6 weeks and 3–7 months after operation) RHI remained lower at 1.48± 0.50 (P=0.030) and 1.26± 0.37 (P=0.002), respectively, compared with preoperative RHI. The decrease in early postoperative RHI relative to preoperative RHI was significantly associated with adverse cardiovascular events after CF-LVAD (age-adjusted risk ratio for 0.25 decrease in RHI, 1.35; 95% confidence interval: 1.13–1.62, P=0.001). Conclusions: Peripheral endothelial function had a significant and persistent decline up to 5 months following implantation of CF-LVAD, and this decline was associated with adverse cardiovascular events. These findings may provide insight into some of the vascular complications following CF-LVAD in HF patients.

KW - Endothelial function

KW - Heart failure

KW - Ventricular assist device

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