Details
| Original language | English |
|---|---|
| Pages (from-to) | 396-405 |
| Number of pages | 10 |
| Journal | Journal of Heart and Lung Transplantation |
| Volume | 38 |
| Issue number | 4 |
| Early online date | 15 Nov 2018 |
| Publication status | Published - Apr 2019 |
| Externally published | Yes |
Abstract
BACKGROUND: Elevated blood pressure (BP) has been linked to adverse events during left ventricular assist device support. In this study we investigated the association between outpatient BP and stroke or suspected pump thrombosis among HeartMate II (HMII) recipients. METHODS: We retrospectively studied 220 HMII patients. Serial outpatient BP measurements were averaged. Patients were categorized by: (1) mean arterial pressure (MAP), high (>90 mm Hg) vs intermediate (80 mm Hg ≤ MAP ≤ 90 mm Hg) vs low (<80 mm Hg); (2) systolic BP (SBP), high (≥101 mm Hg, median) vs low; and (3) pulse pressure (PP), high (≥22 mm Hg, median) vs low. To assess visit-to-visit BP variability, patients were divided in quartiles of standard deviation of MAP and SBP. The primary end-point was the composite of stroke or suspected pump thrombosis. RESULTS: The risk for the primary end-point was increased in the high MAP group (adjusted hazard ratio [HR] 2.75, 95% confidence interval [CI] 1.49 to 5.05, vs intermediate MAP; and 6.73, 1.9 to 23.9, vs low MAP). MAP had higher predictive value for the primary end-point compared with SBP (p = 0.05). Patients with high SBP had a higher rate of stroke (HR 2.8, 95% CI 1.09 to 7.17, vs low SBP). The combination of high SBP and low PP was associated with the highest risk for stroke. The lowest quartile of visit-to-visit MAP variability was associated with the highest risk for the primary end-point. CONCLUSIONS: Elevated outpatient BP is associated with increased risk for stroke or suspected pump thrombosis in HMII recipients. Reduced PP and low visit-to-visit BP variability may confer additional risk.
Keywords
- Blood Pressure, LVAD, MCS, Pulsatility, Pump Thrombosis, Stroke
ASJC Scopus subject areas
- Medicine(all)
- Surgery
- Medicine(all)
- Pulmonary and Respiratory Medicine
- Medicine(all)
- Cardiology and Cardiovascular Medicine
- Medicine(all)
- Transplantation
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In: Journal of Heart and Lung Transplantation, Vol. 38, No. 4, 04.2019, p. 396-405.
Research output: Contribution to journal › Article › Research › peer review
}
TY - JOUR
T1 - Prognostic implications of serial outpatient blood pressure measurements in patients with an axial continuous-flow left ventricular assist device
AU - Pinsino, Alberto
AU - Castagna, Francesco
AU - Zuver, Amelia M.
AU - Royzman, Eugene A.
AU - Nasiri, Mojdeh
AU - Stöhr, Eric J.
AU - Cagliostro, Barbara
AU - McDonnell, Barry
AU - Cockcroft, John R.
AU - Garan, A. Reshad
AU - Topkara, Veli K.
AU - Schulze, P. Christian
AU - Takeda, Koji
AU - Takayama, Hiroo
AU - Naka, Yoshifumi
AU - Demmer, Ryan T.
AU - Willey, Joshua Z.
AU - Yuzefpolskaya, Melana
AU - Colombo, Paolo C.
N1 - Funding Information: P.C.C. is recipient of a research grant from Abbott; he also serves as a consultant (with no honoraria) for the same company. Y.N. serves as a consultant for Abbott. The remaining authors have no conflicts of interest to disclose. This research has been supported by funds from the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York‒Presbyterian Hospital/Columbia University.
PY - 2019/4
Y1 - 2019/4
N2 - BACKGROUND: Elevated blood pressure (BP) has been linked to adverse events during left ventricular assist device support. In this study we investigated the association between outpatient BP and stroke or suspected pump thrombosis among HeartMate II (HMII) recipients. METHODS: We retrospectively studied 220 HMII patients. Serial outpatient BP measurements were averaged. Patients were categorized by: (1) mean arterial pressure (MAP), high (>90 mm Hg) vs intermediate (80 mm Hg ≤ MAP ≤ 90 mm Hg) vs low (<80 mm Hg); (2) systolic BP (SBP), high (≥101 mm Hg, median) vs low; and (3) pulse pressure (PP), high (≥22 mm Hg, median) vs low. To assess visit-to-visit BP variability, patients were divided in quartiles of standard deviation of MAP and SBP. The primary end-point was the composite of stroke or suspected pump thrombosis. RESULTS: The risk for the primary end-point was increased in the high MAP group (adjusted hazard ratio [HR] 2.75, 95% confidence interval [CI] 1.49 to 5.05, vs intermediate MAP; and 6.73, 1.9 to 23.9, vs low MAP). MAP had higher predictive value for the primary end-point compared with SBP (p = 0.05). Patients with high SBP had a higher rate of stroke (HR 2.8, 95% CI 1.09 to 7.17, vs low SBP). The combination of high SBP and low PP was associated with the highest risk for stroke. The lowest quartile of visit-to-visit MAP variability was associated with the highest risk for the primary end-point. CONCLUSIONS: Elevated outpatient BP is associated with increased risk for stroke or suspected pump thrombosis in HMII recipients. Reduced PP and low visit-to-visit BP variability may confer additional risk.
AB - BACKGROUND: Elevated blood pressure (BP) has been linked to adverse events during left ventricular assist device support. In this study we investigated the association between outpatient BP and stroke or suspected pump thrombosis among HeartMate II (HMII) recipients. METHODS: We retrospectively studied 220 HMII patients. Serial outpatient BP measurements were averaged. Patients were categorized by: (1) mean arterial pressure (MAP), high (>90 mm Hg) vs intermediate (80 mm Hg ≤ MAP ≤ 90 mm Hg) vs low (<80 mm Hg); (2) systolic BP (SBP), high (≥101 mm Hg, median) vs low; and (3) pulse pressure (PP), high (≥22 mm Hg, median) vs low. To assess visit-to-visit BP variability, patients were divided in quartiles of standard deviation of MAP and SBP. The primary end-point was the composite of stroke or suspected pump thrombosis. RESULTS: The risk for the primary end-point was increased in the high MAP group (adjusted hazard ratio [HR] 2.75, 95% confidence interval [CI] 1.49 to 5.05, vs intermediate MAP; and 6.73, 1.9 to 23.9, vs low MAP). MAP had higher predictive value for the primary end-point compared with SBP (p = 0.05). Patients with high SBP had a higher rate of stroke (HR 2.8, 95% CI 1.09 to 7.17, vs low SBP). The combination of high SBP and low PP was associated with the highest risk for stroke. The lowest quartile of visit-to-visit MAP variability was associated with the highest risk for the primary end-point. CONCLUSIONS: Elevated outpatient BP is associated with increased risk for stroke or suspected pump thrombosis in HMII recipients. Reduced PP and low visit-to-visit BP variability may confer additional risk.
KW - Blood Pressure
KW - LVAD
KW - MCS
KW - Pulsatility
KW - Pump Thrombosis
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85058385308&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2018.11.003
DO - 10.1016/j.healun.2018.11.003
M3 - Article
C2 - 30559034
AN - SCOPUS:85058385308
VL - 38
SP - 396
EP - 405
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
IS - 4
ER -