Blood pressure and adverse events during continuous flow left ventricular assist device support

Omar Saeed, Rita Jermyn, Faraj Kargoli, Shivank Madan, Santhosh Mannem, Sampath Gunda, Cecilia Nucci, Sarah Farooqui, Syed Hassan, Allison Mclarty, Michelle Bloom, Ronald Zolty, Jooyoung (Julia) Shin, David D'Alessandro, Daniel J. Goldstein, Snehal R. Patel

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

BACKGROUND: Adverse events (AEs), such as intracranial hemorrhage, thromboembolic event, and progressive aortic insufficiency, create substantial morbidity and mortality during continuous flow left ventricular assist device support yet their relation to blood pressure control is underexplored.

METHODS AND RESULTS: A multicenter retrospective review of patients supported for at least 30 days and ≤18 months by a continuous flow left ventricular assist device from June 2006 to December 2013 was conducted. All outpatient Doppler blood pressure (DOPBP) recordings were averaged up to the time of intracranial hemorrhage, thromboembolic event, or progressive aortic insufficiency. DOPBP was analyzed as a categorical variable grouped as high (>90 mm Hg; n=40), intermediate (80-90 mm Hg; n=52), and controlled (<80 mm Hg; n=31). Cumulative survival free from an AE was calculated using Kaplan-Meier curves and Cox hazard ratios were derived. Patients in the high DOPBP group had worse baseline renal function, lower angiotensin-converting enzyme inhibitor or angiotensin receptor blocker usage during continuous flow left ventricular assist device support, and a more prevalent history of hypertension. Twelve (30%) patients in the high DOPBP group had an AE, in comparison with 7 (13%) patients in the intermediate DOPBP group and only 1 (3%) in the controlled DOPBP group. The likelihood of an AE increased in patients with a high DOPBP (adjusted hazard ratios [95% confidence interval], 16.4 [1.8-147.3]; P=0.012 versus controlled and 2.6 [0.93-7.4]; P=0.068 versus intermediate). Overall, a similar association was noted for the risk of intracranial hemorrhage (P=0.015) and progressive aortic insufficiency (P=0.078) but not for thromboembolic event (P=0.638). Patients with an AE had a higher DOPBP (90±10 mm Hg) in comparison with those without an AE (85±10 mm Hg; P=0.05).

CONCLUSIONS: In a population at risk, higher DOPBP during continuous flow left ventricular assist device support was significantly associated with a composite of AEs.

Original languageEnglish (US)
Pages (from-to)551-556
Number of pages6
JournalCirculation. Heart failure
Volume8
Issue number3
DOIs
StatePublished - May 1 2015

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Heart-Assist Devices
Blood Group Antigens
Blood Pressure
Hypertension
Intracranial Hemorrhages
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Disease-Free Survival
Outpatients
Confidence Intervals
Morbidity
Kidney
Mortality

Keywords

  • aortic valve insufficiency
  • blood pressure
  • cerebral hemorrhage
  • thrombosis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Blood pressure and adverse events during continuous flow left ventricular assist device support. / Saeed, Omar; Jermyn, Rita; Kargoli, Faraj; Madan, Shivank; Mannem, Santhosh; Gunda, Sampath; Nucci, Cecilia; Farooqui, Sarah; Hassan, Syed; Mclarty, Allison; Bloom, Michelle; Zolty, Ronald; Shin, Jooyoung (Julia); D'Alessandro, David; Goldstein, Daniel J.; Patel, Snehal R.

In: Circulation. Heart failure, Vol. 8, No. 3, 01.05.2015, p. 551-556.

Research output: Contribution to journalArticle

Saeed, O, Jermyn, R, Kargoli, F, Madan, S, Mannem, S, Gunda, S, Nucci, C, Farooqui, S, Hassan, S, Mclarty, A, Bloom, M, Zolty, R, Shin, JJ, D'Alessandro, D, Goldstein, DJ & Patel, SR 2015, 'Blood pressure and adverse events during continuous flow left ventricular assist device support', Circulation. Heart failure, vol. 8, no. 3, pp. 551-556. https://doi.org/10.1161/CIRCHEARTFAILURE.114.002000
Saeed, Omar ; Jermyn, Rita ; Kargoli, Faraj ; Madan, Shivank ; Mannem, Santhosh ; Gunda, Sampath ; Nucci, Cecilia ; Farooqui, Sarah ; Hassan, Syed ; Mclarty, Allison ; Bloom, Michelle ; Zolty, Ronald ; Shin, Jooyoung (Julia) ; D'Alessandro, David ; Goldstein, Daniel J. ; Patel, Snehal R. / Blood pressure and adverse events during continuous flow left ventricular assist device support. In: Circulation. Heart failure. 2015 ; Vol. 8, No. 3. pp. 551-556.
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AU - Saeed, Omar

AU - Jermyn, Rita

AU - Kargoli, Faraj

AU - Madan, Shivank

AU - Mannem, Santhosh

AU - Gunda, Sampath

AU - Nucci, Cecilia

AU - Farooqui, Sarah

AU - Hassan, Syed

AU - Mclarty, Allison

AU - Bloom, Michelle

AU - Zolty, Ronald

AU - Shin, Jooyoung (Julia)

AU - D'Alessandro, David

AU - Goldstein, Daniel J.

AU - Patel, Snehal R.

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N2 - BACKGROUND: Adverse events (AEs), such as intracranial hemorrhage, thromboembolic event, and progressive aortic insufficiency, create substantial morbidity and mortality during continuous flow left ventricular assist device support yet their relation to blood pressure control is underexplored.METHODS AND RESULTS: A multicenter retrospective review of patients supported for at least 30 days and ≤18 months by a continuous flow left ventricular assist device from June 2006 to December 2013 was conducted. All outpatient Doppler blood pressure (DOPBP) recordings were averaged up to the time of intracranial hemorrhage, thromboembolic event, or progressive aortic insufficiency. DOPBP was analyzed as a categorical variable grouped as high (>90 mm Hg; n=40), intermediate (80-90 mm Hg; n=52), and controlled (<80 mm Hg; n=31). Cumulative survival free from an AE was calculated using Kaplan-Meier curves and Cox hazard ratios were derived. Patients in the high DOPBP group had worse baseline renal function, lower angiotensin-converting enzyme inhibitor or angiotensin receptor blocker usage during continuous flow left ventricular assist device support, and a more prevalent history of hypertension. Twelve (30%) patients in the high DOPBP group had an AE, in comparison with 7 (13%) patients in the intermediate DOPBP group and only 1 (3%) in the controlled DOPBP group. The likelihood of an AE increased in patients with a high DOPBP (adjusted hazard ratios [95% confidence interval], 16.4 [1.8-147.3]; P=0.012 versus controlled and 2.6 [0.93-7.4]; P=0.068 versus intermediate). Overall, a similar association was noted for the risk of intracranial hemorrhage (P=0.015) and progressive aortic insufficiency (P=0.078) but not for thromboembolic event (P=0.638). Patients with an AE had a higher DOPBP (90±10 mm Hg) in comparison with those without an AE (85±10 mm Hg; P=0.05).CONCLUSIONS: In a population at risk, higher DOPBP during continuous flow left ventricular assist device support was significantly associated with a composite of AEs.

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