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. 2020 May;26(5):383-390.
doi: 10.1016/j.cardfail.2020.01.020. Epub 2020 Feb 3.

Longitudinal Trajectories of Hemodynamics Following Left Ventricular Assist Device Implantation

Takeo Fujino  1 , Aline Sayer  1 , Daisuke Nitta  1 , Teruhiko Imamura  1 , Nikhil Narang  1 , Ann Nguyen  1 , Daniel Rodgers  1 , Jayant Raikhelkar  2 , Bryan Smith  1 , Gene Kim  1 , Colleen LaBuhn  3 , Valluvan Jeevanandam  3 , Daniel Burkhoff  2 , Gabriel Sayer  2 , Nir Uriel  4
Affiliations

Longitudinal Trajectories of Hemodynamics Following Left Ventricular Assist Device Implantation

Takeo Fujino et al. J Card Fail. 2020 May.

Abstract

Background: Continuous-flow left ventricular assist devices (LVADs) improve the hemodynamics of patients with advanced heart failure. However, the longitudinal trajectories of hemodynamics in patients after LVAD implantation remain unknown. The aim of this study was to investigate the trends of hemodynamic parameters following LVAD implantation.

Methods and results: We retrospectively reviewed patients who underwent LVAD implantation between April 2014 and August 2018. We collected hemodynamic parameters from right heart catheterizations. Of 199 consecutive patients, we enrolled 150 patients who had both pre- and postimplant right heart catheterizations. They had 3 (2, 4) postimplant right heart catheterizations during a follow-up of 2.3 (1.3, 3.1) years. The mean age was 57 ± 13 years, and 102 patients (68%) were male. Following LVAD implantation, pulmonary arterial pressure and pulmonary capillary wedge pressure decreased, and cardiac index increased significantly, then remained unchanged throughout follow-up. Right atrial pressure decreased initially and then gradually increased to preimplant values. The pulmonary artery pulsatility index decreased initially and returned to preimplant values, then progressively decreased over longer follow-up. Subgroup analysis showed significant differences in the trajectories of the pulmonary artery pulsatility index based on gender.

Conclusions: Despite improvement in left-side filling pressures and cardiac index following LVAD implantation, right atrial pressure increased and the pulmonary artery pulsatility index decreased over time, suggesting progressive right ventricular dysfunction.

Keywords: Left ventricular assist device; heart failure; hemodynamics.

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Conflict of interest statement

Declaration of Interest

Takeo Fujino receives financial support from MSD Life Support Foundation and Mochida Memorial Foundation for Medical and Pharmaceutical Research. Nir Uriel receives grant support from Abbott and Medtronic. Gabriel Sayer is a consultant for Medtronic. Valluvan Jeevanandam is a consultant for Abbott. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.. Loess curves of RAP (A), PAP and PCWP (B), cardiac index (C), TPG (D), PVR (E), SVR (F) and PAPI (G).
LVAD indicates left ventricular assist device; RAP, right atrial pressure; sPAP, systolic pulmonary arterial pressure; mPAP, mean pulmonary arterial pressure; dPAP, diastolic pulmonary arterial pressure; PCWP, pulmonary capillary wedge pressure; TPG, transpulmonary pressure gradient; PVR, pulmonary vascular resistance; SVR, systemic vascular resistance; PAPI, pulmonary artery pulsatility index.
Figure 2.
Figure 2.. Paired comparison of consecutive change of RAP (A), mPAP (B), cardiac index (C), TPG (D), PVR (E), SVR (F) and PAPI (G).
RAP indicates right atrial pressure; mPAP, mean pulmonary arterial pressure; PCWP, pulmonary capillary wedge pressure; TPG, transpulmonary pressure gradient; PVR, pulmonary vascular resistance; SVR, systemic vascular resistance; PAPI, pulmonary artery pulsatility index.
Figure 3.
Figure 3.. Loess curves of RAP/PCWP ratio (A), RVSWI (B), PAE (C) and PAC (D).
LVAD indicates left ventricular assist device; RAP, right atrial pressure; PCWP, pulmonary capillary wedge pressure; RVSWI, right ventricular stroke work index; PEa, effective pulmonary arterial elastance; PAC, pulmonary arterial compliance.
Figure 4.
Figure 4.. Loess curves of PAPI in subgroups of gender (A), age (B), race (C), etiology (D), BSA (E) and pump type (F).
P-values represent the difference of quadratic trajectories between the two subgroups in each panel. LVAD indicates left ventricular assist device; PAPI, pulmonary artery pulsatility index; BSA, body surface area.
See this image and copyright information in PMC

Comment in

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