TY - JOUR
T1 - Right ventricular afterload sensitivity dramatically increases after left ventricular assist device implantation
T2 - A multi-center hemodynamic analysis
AU - Houston, Brian A.
AU - Kalathiya, Rohan J.
AU - Hsu, Steven
AU - Loungani, Rahul
AU - Davis, Mary E.
AU - Coffin, Samuel T.
AU - Haglund, Nicholas
AU - Maltais, Simon
AU - Keebler, Mary E.
AU - Leary, Peter J.
AU - Judge, Daniel P.
AU - Stevens, Gerin
AU - Rickard, John
AU - Sciortino, Chris
AU - Whitman, Glenn J.
AU - Shah, Ashish S.
AU - Russell, Stuart
AU - Tedford, Ryan
N1 - Funding Information:
S.M. and M.E.D. are supported by fellowship grant funding from HeartWare. S.M. is a clinical trial educator for HeartWare. This study was supported by the National Heart, Lung, and Blood Institute (Grants 1R01HL114910 and L30 HL110304 to R.J.T.). The remaining authors report no conflicts of interest.
Publisher Copyright:
© 2016 International Society for Heart and Lung Transplantation
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background Right ventricular (RV) failure is a source of morbidity and mortality after left ventricular assist device (LVAD) implantation. In this study we sought to define hemodynamic changes in afterload and RV adaptation to afterload both early after implantation and with prolonged LVAD support. Methods We reviewed right heart catheterization (RHC) data from participants who underwent continuous-flow LVAD implantation at our institutions (n = 244), excluding those on inotropic or vasopressor agents, pulmonary vasodilators or additional mechanical support at any RHC assessment. Hemodynamic data were assessed at 5 time intervals: (1) pre-LVAD (within 6 months); (2) early post-LVAD (0 to 6 months); (3) 7 to 12 months; (4) 13 to 18 months; and (5) very late post-LVAD (18 to 36 months). Results Sixty participants met the inclusion criteria. All measures of right ventricular load (effective arterial elastance, pulmonary vascular compliance and pulmonary vascular resistance) improved between the pre- and early post-LVAD time periods. Despite decreasing load and pulmonary artery wedge pressure (PAWP), RAP remained unchanged and the RAP:PAWP ratio worsened early post-LVAD (0.44 [0.38, 0.63] vs 0.77 [0.59, 1.0], p < 0.001), suggesting a worsening of RV adaptation to load. With continued LVAD support, both RV load and RAP:PAWP decreased in a steep, linear and dependent manner. Conclusions Despite reducing RV load, LVAD implantation leads to worsened RV adaptation. With continued LVAD support, both RV afterload and RV adaptation improve, and their relationship remains constant over time post-LVAD. These findings suggest the RV afterload sensitivity increases after LVAD implantation, which has major clinical implications for patients struggling with RV failure.
AB - Background Right ventricular (RV) failure is a source of morbidity and mortality after left ventricular assist device (LVAD) implantation. In this study we sought to define hemodynamic changes in afterload and RV adaptation to afterload both early after implantation and with prolonged LVAD support. Methods We reviewed right heart catheterization (RHC) data from participants who underwent continuous-flow LVAD implantation at our institutions (n = 244), excluding those on inotropic or vasopressor agents, pulmonary vasodilators or additional mechanical support at any RHC assessment. Hemodynamic data were assessed at 5 time intervals: (1) pre-LVAD (within 6 months); (2) early post-LVAD (0 to 6 months); (3) 7 to 12 months; (4) 13 to 18 months; and (5) very late post-LVAD (18 to 36 months). Results Sixty participants met the inclusion criteria. All measures of right ventricular load (effective arterial elastance, pulmonary vascular compliance and pulmonary vascular resistance) improved between the pre- and early post-LVAD time periods. Despite decreasing load and pulmonary artery wedge pressure (PAWP), RAP remained unchanged and the RAP:PAWP ratio worsened early post-LVAD (0.44 [0.38, 0.63] vs 0.77 [0.59, 1.0], p < 0.001), suggesting a worsening of RV adaptation to load. With continued LVAD support, both RV load and RAP:PAWP decreased in a steep, linear and dependent manner. Conclusions Despite reducing RV load, LVAD implantation leads to worsened RV adaptation. With continued LVAD support, both RV afterload and RV adaptation improve, and their relationship remains constant over time post-LVAD. These findings suggest the RV afterload sensitivity increases after LVAD implantation, which has major clinical implications for patients struggling with RV failure.
KW - LVAD
KW - pulmonary effective arterial elastance
KW - pulmonary vascular compliance
KW - right ventricular adapation
KW - right ventricular load
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U2 - 10.1016/j.healun.2016.01.1225
DO - 10.1016/j.healun.2016.01.1225
M3 - Article
C2 - 27041496
AN - SCOPUS:84961886533
VL - 35
SP - 868
EP - 876
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
IS - 7
ER -