Details
| Original language | English |
|---|---|
| Pages (from-to) | 802-809 |
| Number of pages | 8 |
| Journal | Journal of Heart and Lung Transplantation |
| Volume | 41 |
| Issue number | 6 |
| Early online date | 27 Feb 2022 |
| Publication status | Published - Jun 2022 |
| Externally published | Yes |
Abstract
Background: Limited data exist on the circadian blood pressure (BP) and heart rate (HR) variations that occur in heart failure (HF) patients on left ventricular assist device (LVAD) support. Methods: We prospectively recorded clinic and 24-hour ambulatory BP and HR data in patients on HeartMate II LVAD support. Results were compared to HF patients with ejection fraction ≤30% and controls with no history of cardiovascular disease. Physiologic nocturnal BP and HR dipping was defined as a ≥10% decline compared to daytime values. Result: Twenty-nine LVAD patients (age 59 ± 15 years, 76% male, 38% ischemic etiology), 25 HF patients (age 64 ± 13 years, 84% male, 32% ischemic etiology) and 26 controls (age 56 ± 9 years, 62% male) were studied. Normal nocturnal BP dipping was less frequent in LVAD patients (10%) than in HF patients (28%) and controls (62%) and reversed BP dipping (BP increase at night) was more common in LVAD patients (24%), compared to HF (16%) and controls (8%), (p < 0.001, for all comparisons). Physiologic HR reduction was less frequent in LVAD patients (14%), compared to HF (16%) and controls (59%) (p < 0.001, for all comparisons). Among LVAD patients, 36% exhibited sustained hypertension over the 24-hours and 25% had white-coat hypertension. Conclusions: Treatment of advanced HF with an LVAD does not restore physiologic circadian variability of BP and HR; additionally, BP was not adequately controlled in more than a third of LVAD patients, and a quarter of them exhibited white-coat hypertension. Future studies are warranted to confirm these findings and investigate prognostic and management implications in this population.
Keywords
- 24-hour blood pressure, ABPM, circadian variability, LVAD, night dipping, ventricle assist device
ASJC Scopus subject areas
- Medicine(all)
- Cardiology and Cardiovascular Medicine
- Medicine(all)
- Transplantation
- Medicine(all)
- Pulmonary and Respiratory Medicine
- Medicine(all)
- Surgery
Sustainable Development Goals
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In: Journal of Heart and Lung Transplantation, Vol. 41, No. 6, 06.2022, p. 802-809.
Research output: Contribution to journal › Article › Research › peer review
}
TY - JOUR
T1 - Twenty-four-hour blood pressure and heart rate variability are reduced in patients on left ventricular assist device support
AU - Castagna , Francesco
AU - McDonnell, Barry J.
AU - Mondellini , Giulio M.
AU - Gaudig , Antonia
AU - Pinsino , Alberto
AU - McEniery , Carmel
AU - Stöhr, Eric Jean
AU - Takeda, Koji
AU - Naka, Yoshifumi
AU - Uriel, Nir
AU - Yuzefpolskaya, Melana
AU - Cockcroft, John R.
AU - Parati, Gianfranco
AU - Colombo, Paolo C.
N1 - Funding information: Dr McDonnell received an unrestricted educational grant from IEM Healthcare in 2015. Dr Cockcroft received equipment and travel grants from IEM. Dr Colombo received research grants from Abbott Laboratories. The other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr Castagna is supported by NIH grant T32HL144456 .This research has been supported by a Research Grant from Abbott Laboratories and by funds from Lisa and Mark Schwartz Program to Reverse Heart Failure at New York-Presbyterian Hospital/Columbia University .
PY - 2022/6
Y1 - 2022/6
N2 - Background: Limited data exist on the circadian blood pressure (BP) and heart rate (HR) variations that occur in heart failure (HF) patients on left ventricular assist device (LVAD) support. Methods: We prospectively recorded clinic and 24-hour ambulatory BP and HR data in patients on HeartMate II LVAD support. Results were compared to HF patients with ejection fraction ≤30% and controls with no history of cardiovascular disease. Physiologic nocturnal BP and HR dipping was defined as a ≥10% decline compared to daytime values. Result: Twenty-nine LVAD patients (age 59 ± 15 years, 76% male, 38% ischemic etiology), 25 HF patients (age 64 ± 13 years, 84% male, 32% ischemic etiology) and 26 controls (age 56 ± 9 years, 62% male) were studied. Normal nocturnal BP dipping was less frequent in LVAD patients (10%) than in HF patients (28%) and controls (62%) and reversed BP dipping (BP increase at night) was more common in LVAD patients (24%), compared to HF (16%) and controls (8%), (p < 0.001, for all comparisons). Physiologic HR reduction was less frequent in LVAD patients (14%), compared to HF (16%) and controls (59%) (p < 0.001, for all comparisons). Among LVAD patients, 36% exhibited sustained hypertension over the 24-hours and 25% had white-coat hypertension. Conclusions: Treatment of advanced HF with an LVAD does not restore physiologic circadian variability of BP and HR; additionally, BP was not adequately controlled in more than a third of LVAD patients, and a quarter of them exhibited white-coat hypertension. Future studies are warranted to confirm these findings and investigate prognostic and management implications in this population.
AB - Background: Limited data exist on the circadian blood pressure (BP) and heart rate (HR) variations that occur in heart failure (HF) patients on left ventricular assist device (LVAD) support. Methods: We prospectively recorded clinic and 24-hour ambulatory BP and HR data in patients on HeartMate II LVAD support. Results were compared to HF patients with ejection fraction ≤30% and controls with no history of cardiovascular disease. Physiologic nocturnal BP and HR dipping was defined as a ≥10% decline compared to daytime values. Result: Twenty-nine LVAD patients (age 59 ± 15 years, 76% male, 38% ischemic etiology), 25 HF patients (age 64 ± 13 years, 84% male, 32% ischemic etiology) and 26 controls (age 56 ± 9 years, 62% male) were studied. Normal nocturnal BP dipping was less frequent in LVAD patients (10%) than in HF patients (28%) and controls (62%) and reversed BP dipping (BP increase at night) was more common in LVAD patients (24%), compared to HF (16%) and controls (8%), (p < 0.001, for all comparisons). Physiologic HR reduction was less frequent in LVAD patients (14%), compared to HF (16%) and controls (59%) (p < 0.001, for all comparisons). Among LVAD patients, 36% exhibited sustained hypertension over the 24-hours and 25% had white-coat hypertension. Conclusions: Treatment of advanced HF with an LVAD does not restore physiologic circadian variability of BP and HR; additionally, BP was not adequately controlled in more than a third of LVAD patients, and a quarter of them exhibited white-coat hypertension. Future studies are warranted to confirm these findings and investigate prognostic and management implications in this population.
KW - 24-hour blood pressure
KW - ABPM
KW - circadian variability
KW - LVAD
KW - night dipping
KW - ventricle assist device
UR - http://www.scopus.com/inward/record.url?scp=85128148173&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2022.02.016
DO - 10.1016/j.healun.2022.02.016
M3 - Article
VL - 41
SP - 802
EP - 809
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
IS - 6
ER -