TY - JOUR

T1 - Increased Aortic Stiffness Is Associated With Higher Rates of Stroke, Gastrointestinal Bleeding and Pump Thrombosis in Patients With a Continuous Flow Left Ventricular Assist Device

T2 - Aortic Stiffness and CF-LVAD Outcomes

AU - Rosenblum, Hannah

AU - Pinsino, Alberto

AU - Zuver, Amelia

AU - Javaid, Azka

AU - Mondellini, Giulio

AU - Ji, Ruiping

AU - Cockcroft, John R.

AU - Yuzefpolskaya, Melana

AU - Garan, A. Reshad

AU - Shames, Sofia

AU - Topkara, Veli K.

AU - Takayama, Hiroo

AU - Takeda, Koji

AU - Naka, Yoshifumi

AU - Mcdonnell, Barry J.

AU - willey, Joshua Z.

AU - Colombo, Paolo C.

AU - Stöhr, Eric J.

N1 - Funding Information: Dr. Colombo is a consultant for Abbott and is the receipt of a research grant from Abbott. Dr. Willey received consultation fee from Medtronic on causes of stroke in patients with an HVAD device. Dr. Naka reports personal fees from Abbott, personal fees from Nipro Co., during the conduct of the study; personal fees from CyroLife, personal fees from Zimmer Biomet, outside the submitted work. Dr. Garan reports personal fees from Abiomed, outside the submitted work. Funding Information: This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 705219 and from the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York-Presbyterian Hospital/Columbia University. Dr. Rosenblum is supported by NIH T32 HL007854. Publisher Copyright: © 2021 Elsevier Inc.

PY - 2021/6

Y1 - 2021/6

N2 - Background: In the general population, increased aortic stiffness is associated with an increased risk of cardiovascular events. Previous studies have demonstrated an increase in aortic stiffness in patients with a continuous flow left ventricular assist device (CF-LVAD). However, the association between aortic stiffness and common adverse events is unknown. Methods and Results: Forty patients with a HeartMate II (HMII) (51 $ 11 years; 20% female; 25% ischemic) implanted between January 2011 and September 2017 were included. Two-dimensional transthoracic echocardiograms of the ascending aorta, obtained before HMII placement and early after heart transplant, were analyzed to calculate the aortic stiffness index (AO-SI). The study cohort was divided into patients who had an increased vs decreased AO-SI after LVAD support. A composite outcome of gastrointestinal bleeding, stroke, and pump thrombosis was defined as the primary end point and compared between the groups. While median AO-SI increased significantly after HMII support (AO-SI 4.4–6.5, P =. 012), 16 patients had a lower AO-SI. Patients with increased (n = 24) AO-SI had a significantly higher rate of the composite end point (58% vs 12%, odds ratio 9.8, P <. 01). Similarly, those with increased AO-SI tended to be on LVAD support for a longer duration, had higher LVAD speed and reduced use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Conclusions: Increased aortic stiffness in patients with a HMII is associated with a significantly higher rates of adverse events. Further studies are warranted to determine the causality between aortic stiffness and adverse events, as well as the effect of neurohormonal modulation on the conduit vasculature in patients with a CF-LVAD.

AB - Background: In the general population, increased aortic stiffness is associated with an increased risk of cardiovascular events. Previous studies have demonstrated an increase in aortic stiffness in patients with a continuous flow left ventricular assist device (CF-LVAD). However, the association between aortic stiffness and common adverse events is unknown. Methods and Results: Forty patients with a HeartMate II (HMII) (51 $ 11 years; 20% female; 25% ischemic) implanted between January 2011 and September 2017 were included. Two-dimensional transthoracic echocardiograms of the ascending aorta, obtained before HMII placement and early after heart transplant, were analyzed to calculate the aortic stiffness index (AO-SI). The study cohort was divided into patients who had an increased vs decreased AO-SI after LVAD support. A composite outcome of gastrointestinal bleeding, stroke, and pump thrombosis was defined as the primary end point and compared between the groups. While median AO-SI increased significantly after HMII support (AO-SI 4.4–6.5, P =. 012), 16 patients had a lower AO-SI. Patients with increased (n = 24) AO-SI had a significantly higher rate of the composite end point (58% vs 12%, odds ratio 9.8, P <. 01). Similarly, those with increased AO-SI tended to be on LVAD support for a longer duration, had higher LVAD speed and reduced use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Conclusions: Increased aortic stiffness in patients with a HMII is associated with a significantly higher rates of adverse events. Further studies are warranted to determine the causality between aortic stiffness and adverse events, as well as the effect of neurohormonal modulation on the conduit vasculature in patients with a CF-LVAD.

KW - Aortic stiffness

KW - blood pressure

KW - heart failure

KW - left ventricular assist device

KW - vascular resistance

UR - http://www.scopus.com/inward/record.url?scp=85106323784&partnerID=8YFLogxK

U2 - 10.1016/j.cardfail.2021.02.009

DO - 10.1016/j.cardfail.2021.02.009

M3 - Article

C2 - 33639317

AN - SCOPUS:85106323784

VL - 27

SP - 696

EP - 699

JO - Journal of cardiac failure

JF - Journal of cardiac failure

SN - 1071-9164

IS - 6

ER -