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

JOURNAL OF CARDIAC FAILURE

卷:24

Article

Imamura, Teruhiko¹  Kim, Gene¹  Raikhelkar, Jayant¹  Sarswat, Nitasha¹  Kalantari, Sara¹  Smith, Bryan¹  Rodgers, Daniel¹  Chung, Ben¹  Ann Nguyen¹  Ota, Takeyoshi²  Song, Tae²  Juricek, Colleen²  Jeevanandam, Valluvan²  Burkhoff, Daniel^3,4  Sayer, Gabriel¹  Uriel, Nir¹ 

[1] Univ Chicago, Med Ctr, Dept Med, 5841 S Maryland Ave, Chicago, IL 60637 USA

[2] Univ Chicago, Med Ctr, Dept Surg, Chicago, IL 60637 USA

[3] Columbia Univ, Med Ctr, New York, NY USA

[4] Cardiovasc Res Fdn, New York, NY USA

关键词: Ramp;    hemodynamics;    unloading;    pulmonary hypertension;   

DOI  :  10.1016/j.cardfail.2018.08.003

来源: Elsevier

【 摘 要 】

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 (Delta decoupling >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.

【 授权许可】

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