Prognostic implications of serial outpatient blood pressure measurements in patients with an axial continuous-flow left ventricular assist device
Author
Pinsino, Alberto
Castagna, Francesco
Zuver, Amelia
Royzman, Eugene
Nasiri, Mojdeh
Stöhr, Eric J.
Cagliostro, Barbara
McDonnell, Barry
Cockcroft, John R.
Reshad Garan, A.
Topkara, Veli K.
Schulze, Christian
Takeda, Koji
Takayama, Hiroo
Naka, Yoshifumi
Demmer, Ryan T.
Willey, Joshua Z.
Yuzefpolskaya, Melana
Colombo, Paolo C.
Date
2018-11-15Acceptance date
2018
Type
Article
Publisher
Elsevier
ISSN
1557-3117
Metadata
Show full item recordAbstract
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/conference proceeding
Journal of Heart and Lung Transplantation;
Citation
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.
Description
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.
Sponsorship
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
Collections
- Sport Research Groups [1088]
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