Decoupling Between Diastolic Pulmonary Arterial Pressure and Pulmonary Arterial Wedge Pressure at Incremental Left Ventricular Assist Device (LVAD) Speeds Is Associated With Worse Prognosis After LVAD Implantation - PubMed (original) (raw)

. 2018 Sep;24(9):575-582.

doi: 10.1016/j.cardfail.2018.08.003. Epub 2018 Aug 10.

Gene Kim 1, Jayant Raikhelkar 1, Nitasha Sarswat 1, Sara Kalantari 1, Bryan Smith 1, Daniel Rodgers 1, Ben Chung 1, Ann Nguyen 1, Takeyoshi Ota 2, Tae Song 2, Colleen Juricek 2, Valluvan Jeevanandam 2, Daniel Burkhoff 3, Gabriel Sayer 1, Nir Uriel 4

Affiliations

Decoupling Between Diastolic Pulmonary Arterial Pressure and Pulmonary Arterial Wedge Pressure at Incremental Left Ventricular Assist Device (LVAD) Speeds Is Associated With Worse Prognosis After LVAD Implantation

Teruhiko Imamura et al. J Card Fail. 2018 Sep.

Abstract

Background: Decoupling between diastolic pulmonary arterial pressure (dPAP) and pulmonary arterial wedge pressure (PAWP) is an index of pulmonary vasculature remodeling and provides prognostic information. Furthermore, decoupling may change during incremental left ventricular assist device (LVAD) speed changes.

Methods and results: In this prospective study, patients underwent an echocardiographic and hemodynamic ramp test after LVAD implantation and were followed for 1 year. The change in decoupling (dPAP - PAWP) between the lowest and highest LVAD speeds during the ramp test was calculated. Survival and heart failure admission rates were assessed by means of Kaplan-Meier analysis. Eighty-seven patients were enrolled in the study: 54 had a Heartmate II LVAD (60.8 ± 9.3 years of age and 34 male) and 33 had an HVAD LVAD (58.6 ± 13.2 years of age and 20 male). Patients who experienced greater changes in decoupling (Δdecoupling >3 mm Hg) had a persistently elevated dPAP at incremental LVAD speed and had worse 1-year heart failure readmission-free survival compared with the group without significant changes in the degree of decoupling (41% vs 75%; P = .001).

Conclusions: An increase in decoupling between dPAP and PAWP at incremental LVAD speed changes was associated with worse prognosis in LVAD patients.

Keywords: Ramp; hemodynamics; pulmonary hypertension; unloading.

Copyright © 2018 Elsevier Inc. All rights reserved.

PubMed Disclaimer

Figures

Figure 1.

Figure 1.

Distribution of the changes in decoupling between minimum and maximal LVAD speed

Figure 2.

Figure 2.

Changes in dPAP, PAWP, and decoupling between minimum and maximal LVAD speed in Δdecoupling >3 mmHg group (A) and Δdecoupling ≤3 mmHg group (B) DC, decoupling p <0.05* by paired t-test

Figure 3.

Figure 3.

HF admission-free survival rate in Δdecoupling >3 mmHg group and Δdecoupling ≤3 mmHg group following ramp test p <0.05* by the log-rank test

References

    1. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M, Aboyans V, Vaz Carneiro A, Achenbach S, Agewall S, Allanore Y, Asteggiano R, Paolo Badano L, Albert Barbera J, Bouvaist H, Bueno H, Byrne RA, Carerj S, Castro G, Erol C, Falk V, Funck-Brentano C, Gorenflo M, Granton J, Iung B, Kiely DG, Kirchhof P, Kjellstrom B, Landmesser U, Lekakis J, Lionis C, Lip GY, Orfanos SE, Park MH, Piepoli MF, Ponikowski P, Revel MP, Rigau D, Rosenkranz S, Voller H, Luis Zamorano J. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67–119. -PubMed
    1. Aronson D, Eitan A, Dragu R, Burger AJ. Relationship between reactive pulmonary hypertension and mortality in patients with acute decompensated heart failure. Circ Heart Fail. 2011;4(5):644–650. -PubMed
    1. Pauwaa S, Bhat G, Tatooles AJ, Aggarwal A, Martin M, Kumar A, Modi H, Pappas PS. How effective are continuous flow left ventricular assist devices in lowering high pulmonary artery pressures in heart transplant candidates? Cardiol J. 2012;19(2):153–158. -PubMed
    1. Kutty RS, Parameshwar J, Lewis C, Catarino PA, Sudarshan CD, Jenkins DP, Dunning JJ, Tsui SS. Use of centrifugal left ventricular assist device as a bridge to candidacy in severe heart failure with secondary pulmonary hypertension. Eur J Cardiothorac Surg. 2013;43(6):1237–1242. -PubMed
    1. Zimpfer D, Zrunek P, Sandner S, Schima H, Grimm M, Zuckermann A, Wolner E, Wieselthaler G. Post-transplant survival after lowering fixed pulmonary hypertension using left ventricular assist devices. Eur J Cardiothorac Surg. 2007;31(4):698–702. -PubMed

MeSH terms

LinkOut - more resources