Prognostic implications of serial outpatient blood pressure measurements in patients with an axial continuous-flow left ventricular assist device
Stöhr, Eric J.
Cockcroft, John R.
Reshad Garan, A.
Topkara, Veli K.
Demmer, Ryan T.
Willey, Joshua Z.
Colombo, Paolo C.
MetadataShow full item record
BACKGROUND Elevated blood pressure (BP) has been linked to adverse events during left ventricular assist device support. In this study we investigated the association between outpatient BP and stroke or suspected pump thrombosis among HeartMate II (HMII) recipients. METHODS We retrospectively studied 220 HMII patients. Serial outpatient BP measurements were averaged. Patients were categorized by: (1) mean arterial pressure (MAP), high (>90 mm Hg) vs intermediate (80 mm Hg ≤ MAP ≤ 90 mm Hg) vs low (<80 mm Hg); (2) systolic BP (SBP), high (≥101 mm Hg, median) vs low; and (3) pulse pressure (PP), high (≥22 mm Hg, median) vs low. To assess visit-to-visit BP variability, patients were divided in quartiles of standard deviation of MAP and SBP. The primary end-point was the composite of stroke or suspected pump thrombosis. RESULTS The risk for the primary end-point was increased in the high MAP group (adjusted hazard ratio [HR] 2.75, 95% confidence interval [CI] 1.49 to 5.05, vs intermediate MAP; and 6.73, 1.9 to 23.9, vs low MAP). MAP had higher predictive value for the primary end-point compared with SBP (p = 0.05). Patients with high SBP had a higher rate of stroke (HR 2.8, 95% CI 1.09 to 7.17, vs low SBP). The combination of high SBP and low PP was associated with the highest risk for stroke. The lowest quartile of visit-to-visit MAP variability was associated with the highest risk for the primary end-point. CONCLUSIONS Elevated outpatient BP is associated with increased risk for stroke or suspected pump thrombosis in HMII recipients. Reduced PP and low visit-to-visit BP variability may confer additional risk.
Journal of Heart and Lung Transplantation;
Pinsino, A., Castagna, F., Zuver, A.M., Royzman, E.A., Nasiri, M., Stöhr, E.J., Cagliostro, B., McDonnell, B., Cockcroft, J.R., Garan, A.R. and Topkara, V.K. (2018) 'Prognostic implications of serial outpatient blood pressure measurements in patients with an axial continuous-flow left ventricular assist device', Journal of Heart and Lung Transplantation, 38(4), p.396-405. DOI: 10.1016/j.healun.2018.11.003.
Article published in Journal of Heart and Lung Transplantation on 15 November 2018 (online), freely available at: https://doi.org/10.1016/j.healun.2018.11.003.
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
- Sport Research Groups 
Showing items related by title, author, subject and abstract.
The changes in clot microstructure in patients with ischaemic stroke and the effects of therapeutic intervention: a prospective observational study Stanford, Sophia N.; Sabra, Ahmed; D'Silva, Lindsay; Lawrence, Matthew; Morris, Keith; Storton, Sharon; Brown, Martin R.; Evans, Vanessa; Hawkins, Karl; Williams, Phylip Rhodri; Davidson, Simon J.; Wani, Mushtaq; Potter, John F.; Evans, Phillip A. (BioMed Central, 2015-03-15)Background Stroke is the second largest cause of death worldwide. Hypercoagulability is a key feature in ischaemic stroke due to the development of an abnormally dense clot structure but techniques assessing the mechanics ...
Assessment of platelet function in patients with stroke using multiple electrode platelet aggregometry: a prospective observational study Sabra, Ahmed; Stanford, Sophia N.; Lawrence, Matthew; D'Silva, Lindsay; Morris, Keith; Evans, Vanessa; Wani, Mushtaq; Potter, John F.; Evans, Phillip A. (BioMed Cental, 2016-12-09)Background There is a link between high on-treatment platelet reactivity (HPR) and adverse vascular events in stroke. This study aimed to compare multiple electrode platelet aggregometry (MEA), in healthy subjects and ...
A multicentre, observational evaluation of the product characteristics of two absorbent foam dressings Seckam, Abdul (Mark Allen Healthcare, 2019-06-26)Wound healing is an intrinsic and dynamic process. Wound exudate is a normal feature of wound healing; however, when there is insufficient or excessive production, or the composition of the exudate is harmful, wound healing ...