Effects of Interatrial Shunt on Pulmonary Vascular Function in Heart Failure With Preserved Ejection Fraction

Masaru Obokata, Yogesh N.V. Reddy, Sanjiv J. Shah, David M. Kaye, Finn Gustafsson, Gerd Hasenfuβ, Elke Hoendermis, Sheldon E. Litwin, Jan Komtebedde, Carolyn Lam, Daniel Burkhoff, Barry A. Borlaug

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Implantation of an interatrial shunt device (IASD) in patients with heart failure (HF) reduces left atrial hypertension by shunting oxygenated blood to the right heart and lungs. The attendant increases in pulmonary blood flow (Qp) and oxygen content may alter pulmonary vascular function, while left-to-right shunting might compromise systemic perfusion. Objectives: The authors hypothesized that IASD would improve indexes of pulmonary artery (PA) function at rest and during exercise in HF patients without reducing systemic blood flow (Qs). Methods: This is a pooled analysis from 2 trials assessing the effects of the IASD on resting and exercise hemodynamics in HF patients (n = 79) with EF ≥40% with baseline and repeated hemodynamic evaluation between 1 and 6 months. Patients with pulmonary vascular resistance (PVR) >4 WU or right ventricular dysfunction were excluded. Results: Qp and PA oxygen content increased by 27% and 7% following IASD. These changes were associated with salutary effects on pulmonary vascular function (17% reduction in PVR, 12% reduction in PA elastance [pulmonary Ea], and 24% increase in PA compliance). Qp increased during exercise to a greater extent following IASD compared with baseline, which was associated with reductions in exercise PVR and pulmonary Ea. Patients with increases in PA compliance following IASD experienced greater improvements in supine exercise duration. There was no reduction in Qs following IASD at rest or during exercise. Conclusions: Implantation of an IASD improves pulmonary vascular function at rest and during exercise in selected patients with HF and EF ≥40%, without compromising systemic perfusion. Further study is warranted to identify underlying mechanisms and long-term pulmonary hemodynamic effects of IASD. (REDUCE LAP-HF Trial [REDUCE LAP-HF]; NCT01913613; and REDUCE LAP-HF Randomized Trial I [REDUCE LAP-HF I]; NCT02600234)

Original languageEnglish (US)
Pages (from-to)2539-2550
Number of pages12
JournalJournal of the American College of Cardiology
Volume74
Issue number21
DOIs
StatePublished - Nov 26 2019

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Blood Vessels
Heart Failure
Equipment and Supplies
Lung
Exercise
Pulmonary Artery
Vascular Resistance
Lung Compliance
Hemodynamics
Perfusion
Oxygen
Right Ventricular Dysfunction
Hypertension

Keywords

  • exercise
  • hemodynamics
  • pulmonary vasodilation
  • shunt

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effects of Interatrial Shunt on Pulmonary Vascular Function in Heart Failure With Preserved Ejection Fraction. / Obokata, Masaru; Reddy, Yogesh N.V.; Shah, Sanjiv J.; Kaye, David M.; Gustafsson, Finn; Hasenfuβ, Gerd; Hoendermis, Elke; Litwin, Sheldon E.; Komtebedde, Jan; Lam, Carolyn; Burkhoff, Daniel; Borlaug, Barry A.

In: Journal of the American College of Cardiology, Vol. 74, No. 21, 26.11.2019, p. 2539-2550.

Research output: Contribution to journalArticle

Obokata, M, Reddy, YNV, Shah, SJ, Kaye, DM, Gustafsson, F, Hasenfuβ, G, Hoendermis, E, Litwin, SE, Komtebedde, J, Lam, C, Burkhoff, D & Borlaug, BA 2019, 'Effects of Interatrial Shunt on Pulmonary Vascular Function in Heart Failure With Preserved Ejection Fraction', Journal of the American College of Cardiology, vol. 74, no. 21, pp. 2539-2550. https://doi.org/10.1016/j.jacc.2019.08.1062
Obokata, Masaru ; Reddy, Yogesh N.V. ; Shah, Sanjiv J. ; Kaye, David M. ; Gustafsson, Finn ; Hasenfuβ, Gerd ; Hoendermis, Elke ; Litwin, Sheldon E. ; Komtebedde, Jan ; Lam, Carolyn ; Burkhoff, Daniel ; Borlaug, Barry A. / Effects of Interatrial Shunt on Pulmonary Vascular Function in Heart Failure With Preserved Ejection Fraction. In: Journal of the American College of Cardiology. 2019 ; Vol. 74, No. 21. pp. 2539-2550.
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abstract = "Background: Implantation of an interatrial shunt device (IASD) in patients with heart failure (HF) reduces left atrial hypertension by shunting oxygenated blood to the right heart and lungs. The attendant increases in pulmonary blood flow (Qp) and oxygen content may alter pulmonary vascular function, while left-to-right shunting might compromise systemic perfusion. Objectives: The authors hypothesized that IASD would improve indexes of pulmonary artery (PA) function at rest and during exercise in HF patients without reducing systemic blood flow (Qs). Methods: This is a pooled analysis from 2 trials assessing the effects of the IASD on resting and exercise hemodynamics in HF patients (n = 79) with EF ≥40{\%} with baseline and repeated hemodynamic evaluation between 1 and 6 months. Patients with pulmonary vascular resistance (PVR) >4 WU or right ventricular dysfunction were excluded. Results: Qp and PA oxygen content increased by 27{\%} and 7{\%} following IASD. These changes were associated with salutary effects on pulmonary vascular function (17{\%} reduction in PVR, 12{\%} reduction in PA elastance [pulmonary Ea], and 24{\%} increase in PA compliance). Qp increased during exercise to a greater extent following IASD compared with baseline, which was associated with reductions in exercise PVR and pulmonary Ea. Patients with increases in PA compliance following IASD experienced greater improvements in supine exercise duration. There was no reduction in Qs following IASD at rest or during exercise. Conclusions: Implantation of an IASD improves pulmonary vascular function at rest and during exercise in selected patients with HF and EF ≥40{\%}, without compromising systemic perfusion. Further study is warranted to identify underlying mechanisms and long-term pulmonary hemodynamic effects of IASD. (REDUCE LAP-HF Trial [REDUCE LAP-HF]; NCT01913613; and REDUCE LAP-HF Randomized Trial I [REDUCE LAP-HF I]; NCT02600234)",
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AU - Reddy, Yogesh N.V.

AU - Shah, Sanjiv J.

AU - Kaye, David M.

AU - Gustafsson, Finn

AU - Hasenfuβ, Gerd

AU - Hoendermis, Elke

AU - Litwin, Sheldon E.

AU - Komtebedde, Jan

AU - Lam, Carolyn

AU - Burkhoff, Daniel

AU - Borlaug, Barry A.

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N2 - Background: Implantation of an interatrial shunt device (IASD) in patients with heart failure (HF) reduces left atrial hypertension by shunting oxygenated blood to the right heart and lungs. The attendant increases in pulmonary blood flow (Qp) and oxygen content may alter pulmonary vascular function, while left-to-right shunting might compromise systemic perfusion. Objectives: The authors hypothesized that IASD would improve indexes of pulmonary artery (PA) function at rest and during exercise in HF patients without reducing systemic blood flow (Qs). Methods: This is a pooled analysis from 2 trials assessing the effects of the IASD on resting and exercise hemodynamics in HF patients (n = 79) with EF ≥40% with baseline and repeated hemodynamic evaluation between 1 and 6 months. Patients with pulmonary vascular resistance (PVR) >4 WU or right ventricular dysfunction were excluded. Results: Qp and PA oxygen content increased by 27% and 7% following IASD. These changes were associated with salutary effects on pulmonary vascular function (17% reduction in PVR, 12% reduction in PA elastance [pulmonary Ea], and 24% increase in PA compliance). Qp increased during exercise to a greater extent following IASD compared with baseline, which was associated with reductions in exercise PVR and pulmonary Ea. Patients with increases in PA compliance following IASD experienced greater improvements in supine exercise duration. There was no reduction in Qs following IASD at rest or during exercise. Conclusions: Implantation of an IASD improves pulmonary vascular function at rest and during exercise in selected patients with HF and EF ≥40%, without compromising systemic perfusion. Further study is warranted to identify underlying mechanisms and long-term pulmonary hemodynamic effects of IASD. (REDUCE LAP-HF Trial [REDUCE LAP-HF]; NCT01913613; and REDUCE LAP-HF Randomized Trial I [REDUCE LAP-HF I]; NCT02600234)

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