TY - JOUR
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.
N1 - Publisher Copyright:
© 2015, Japanese Circulation Society. All rights reserved.
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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U2 - 10.1253/circj.CJ-14-1079
DO - 10.1253/circj.CJ-14-1079
M3 - Article
C2 - 25739569
AN - SCOPUS:84925597897
SN - 1346-9843
VL - 79
SP - 770
EP - 777
JO - Circulation Journal
JF - Circulation Journal
IS - 4
ER -