Publish in this journal
Journal Information
La versión en español de este artículo estará disponible en breve
Share
Share
Download PDF
More article options
ePub
Visits
Not available
Original article
DOI: 10.1016/j.rec.2021.06.012
Available online 22 July 2021
Clinical findings associated with incomplete hemodynamic left ventricular unloading in patients with a left ventricular assist device
Hallazgos clínicos asociados con una descarga hemodinámica del ventrículo izquierdo incompleta en pacientes con asistencia ventricular izquierda
Visits
...
María J. Ruiz-Cano
Corresponding author
majorcardio@yahoo.es

Corresponding author: Herz-und Diabeteszentrum NRW. Ruhr-Universität Bochum. Georgstraße 11. D-32545-Bad Oeynhausen, Germany.
, René Schramm, Lech Paluszkiewicz, Lilit Ramazyan, Sebastián V. Rojas, Volker Lauenroth, Adriana Krenz, Jan Gummert, Michiel Morshuis
Division of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW Bad Oeynhausen, Ruhr-University Bochum, Germany
Received 22 January 2021. Accepted 11 June 2021
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (4)
Show moreShow less
Tables (4)
Table 1. Preoperative clinical, hemodynamic and echocardiographic characteristics stratified by hemodynamic left ventricular unloading during left ventricular assist device support
Table 2. Clinical characteristics, hemodynamics, echocardiographic variables and complications after left ventricular assist device implantation stratified by hemodynamic left ventricular unloading
Table 3. Unadjusted univariable and multivariable regression analysis for outcome of hPCWP after LVAD implantation
Table 4. Causes of death and heart failure hospitalizations stratified by hemodynamic left ventricular unloading
Show moreShow less
Abstract
Introduction and objectives

The effect of a centrifugal continuous-flow left ventricular assist device (cfLVAD) on hemodynamic left ventricular unloading (HLVU) and the clinical conditions that interfere with hemodynamic optimization are not well defined.

Methods

We retrospectively evaluated the likelihood of incomplete HLVU, defined as high pulmonary capillary wedge pressure (hPCWP)> 15mmHg in 104 ambulatory cfLVAD patients when the current standard recommendations for cfLVAD rotor speed setting were applied. We also evaluated the ability of clinical, hemodynamic and echocardiographic variables to predict hPCWP in ambulatory cfLVAD patients.

Results

Twenty-eight percent of the patients showed hPCWP. The variables associated with a higher risk of hPCWP were age, central venous pressure, absence of treatment with renin-angiotensin-aldosterone system inhibitors, and brain natriuretic peptide levels. Patients with optimal HLVU had a 15.2±14.7% decrease in postoperative indexed left ventricular end-diastolic diameter compared with 8.9±11.8% in the group with hPCWP (P=.041). Independent predictors of hPCWP included brain natriuretic peptide and age. Brain natriuretic peptide <300 pg/mL predicted freedom from hPCWP with a negative predictive value of 86% (P <.0001).

Conclusions

An optimal HLVU can be achieved in up to 72% of the ambulatory cfLVAD patients when the current standard recommendations for rotor speed setting are applied. Age, central venous pressure and therapy with renin-angiotensin-aldosteron system inhibitors had a substantial effect on achieving this goal. Brain natriuretic peptide levels and the magnitude of reverse left ventricular remodeling seem to be useful noninvasive tools to evaluate HLVU in patients with functioning cfLVAD.

Keywords:
Left ventricular assist device
Hemodynamics
Heart failure
Abbreviations:
BNP
cfLVAD
HLVUh
hPCWP
LVEDD
Rsp
Resumen
Introducción y objetivos

Los efectos hemodinámicos del dispositivo de asistencia ventricular izquierda de flujo continuo (DAVI-fc) en la descarga hemodinámica del ventrículo izquierdo (DHVI) y los factores clínicos que interfieren en su optimización no están bien definidos.

Métodos

Se estudió de manera retrospectiva la prevalencia de altas presiones capilares enclavadas (hPCWP) del ventrículo izquierdo en 104 pacientes cuyos parámetros del DAVI-fc se optimizaron siguiendo las actuales recomendaciones clínicas. Asimismo se analizó el valor de diferentes variables clínicas, hemodinámicas y ecocardiográficas para predecir el grado de DHVI en pacientes ambulatorios portadores de un DAVI-fc.

Resultados

El 28% de los pacientes presentaron hPCWP. La edad, la presión venosa central y la ausencia de tratamiento con inhibidores del sistema renina-angiotesiona-aldosterona y péptido natriurético cerebral se asociaron con mayor riesgo de hPCWP. Los pacientes con DHVI óptima presentaron una disminución del diámetro indexado del ventrículo izquierdo del 15,2±14,7% en comparación con el 8,9±11,8% del grupo con hPCWP (p=0,041). El péptido natriurético cerebral <300 pg/ml predijo la ausencia de hPCWP con un valor predictivo negativo del 86% (p <0,0001).

Conclusiones

Una DHVI óptima es posible hasta en el 72% de los pacientes portadores de DAVI-fc cuando se siguen las actuales recomendaciones para la optimización de los parámetros del DAVI-fc. La edad, la presión venosa central y el tratamiento con inhibidores del sistema renina-angiotesiona-aldosterona tienen un efecto importante a la hora de lograr este objetivo. La concentración de péptido natriurético cerebral y la magnitud del remodelado inverso del ventrículo izquierdo son métodos no invasivos útiles para evaluar la DHVI.

Palabras clave:
Asistencia ventricular izquierda
Hemodinámica
Insuficiencia cardiaca

Article

These are the options to access the full texts of the publication Revista Española de Cardiología (English Edition)
Member
Members of SEC
Use the Society's website login and password here
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Revista Española de Cardiología (English Edition)

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
Email
Idiomas
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?