Hypotension on cardiopulmonary stress test predicts 90 day mortality after LVAD implantation in INTERMACS 3-6 patients.

Autor: Maharaj V; Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA., Agdamag AC; Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA., Duval S; Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA., Edmiston J; Department of Medicine, University of Minnesota, Minneapolis, MN, USA., Charpentier V; University of Minnesota Medical School, Minneapolis, MN, USA., Fraser M; Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA., Hall A; Department of Medicine, University of Minnesota, Minneapolis, MN, USA., Schultz J; Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA., John R; Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Shaffer A; Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Martin CM; Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA., Thenappan T; Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA., Francis GS; Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA., Cogswell R; Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA., Alexy T; Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA.
Jazyk: angličtina
Zdroj: ESC heart failure [ESC Heart Fail] 2022 Oct; Vol. 9 (5), pp. 3496-3504. Date of Electronic Publication: 2022 Jul 26.
DOI: 10.1002/ehf2.14099
Abstrakt: Aims: Cardiopulmonary stress test (CPX) is routinely performed when evaluating patient candidacy for left ventricular assist device (LVAD) implantation. The predictive value of hypotensive systolic blood pressure (SBP) response during CPX on clinical outcomes is unknown. This study aims to determine the effect of hypotensive SBP response during to clinical outcomes among patients who underwent LVAD implantation.
Methods and Results: This was a retrospective single center study enrolling consecutive patients implanted with a continuous flow LVAD between 2011 and 2022. Hypotensive SBP response was defined as peak exercise SBP below the resting value. Multivariable Cox-regression analysis was performed to evaluate the relationship between hypotensive SBP response and all-cause mortality within 30 and 90 days of LVAD implantation. A subgroup analysis was performed for patients implanted with a HeartMate III (HM III) device. Four hundred thirty-two patients underwent LVAD implantation during the pre-defined period and 156 with INTERMACS profiles 3-6 met our inclusion criteria. The median age was 63 years (IQR 54-69), and 52% had ischaemic cardiomyopathy. Hypotensive SBP response was present in 35% of patients and was associated with increased 90 day all-cause mortality (unadjusted HR 9.16, 95% CI 1.98-42; P = 0.0046). Hazard ratio remained significant after adjusting for age, INTERMACS profile, serum creatinine, and total bilirubin. Findings were similar in the HM III subgroup.
Conclusions: Hypotensive SBP response on pre-LVAD CPX is associated with increased perioperative and 90 day mortality after LVAD implantation. Additional studies are needed to determine the mechanism of increased mortality observed.
(© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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