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. 2020 Dec 26:2020:5826176.
doi: 10.1155/2020/5826176. eCollection 2020.

Early sST2 Liberation after Implantation of a Left Ventricular Assist Device in Patients with Advanced Heart Failure

Philipp Opfermann  1 , Elisabeth Simader  2 , Alessia Felli  1 , Michele Bevilacqua  1 , Caroline Holaubek  1 , Martin Dworschak  1 , Mohamed Mouhieddine  1 , Daniel Zimpfer  3 , Jan Hendrik Ankersmit  2 , Barbara Steinlechner  1
Affiliations

Early sST2 Liberation after Implantation of a Left Ventricular Assist Device in Patients with Advanced Heart Failure

Philipp Opfermann et al. J Immunol Res. .

Abstract

Background: The use of left ventricular assist device (LVAD) has increased considerably over the past decade; however, there is limited literature to assist in patient selection and monitoring. The frequency of adverse events remains high. We examined the early expression of circulating soluble ST2 (sST2), a biomarker with immunosuppressive and profibrotic activity, and assessed the risk of death at 1 year in patients receiving LVAD implant.

Methods: We prospectively enrolled 20 heart failure patients and measured sST2, IL-33, and IL-6 serum concentrations over three weeks after LVAD implantation. We compared the kinetics of IL-6, sST2, and IL-33 release in survivors with those of nonsurvivors using mixed model two-way analysis of variance for repeated measures. We also collected data on hemodynamic parameters (i.e., cardiac output) and frequency of infections during the hospital stay.

Results: LVAD therapy led to an immediate and significant improvement of the hemodynamic parameters in 1-year survivors and nonsurvivors alike. The 1-year survival rate was 65%. IL-6 concentrations showed a significant (p = 0.03) peak at admission to the intensive care unit following LVAD implantation, whereas sST2 levels were massively increased (p < 0.0003) on day 1. While 1-year survivors had persistently lower sST2 values compared to nonsurvivors during the first 3 weeks after LVAD implantation (p = 0.012), no differences were observed in the temporal pattern of IL-6 or IL-33. The odds of detecting Candida species in the bronchoalveolar lavage fluid were 14 times higher in nonsurvivors than in survivors (OR 13.7, CI 1.4-127, p = 0.02).

Conclusion: In patients implanted with LVAD, circulating sST2 levels and frequency of Candida colonisation were associated with higher mortality. Awareness of this early immune response can guide physicians in risk-benefit analysis.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Patient flow chart. VAD = ventricular assist device; BIVAD = biventricular assist device; EXCOR®, Berlin Heart® GmbH, Berlin Germany; HeartMate II, Thoratec® Corporation, Pleasanton, CA; HeartWare® (HVAD), HeartWare International, Inc., Framingham, MA.
Figure 2
Figure 2
Temporal course of hemodynamic parameters during the early postoperative course in 1-year survivors and 1-year nonsurvivors. CO = cardiac output; PAP syst. = systolic pulmonal arterial pressure; SvO2 = mixed venous saturation. Hemodynamic data were obtained from the routinely utilized continuous-cardiac-output (CCO) Swan-Ganz Catheter (Edwards Vigilanz II®). Given are the results of the ANOVA mixed model analysis for repeated measures.
Figure 3
Figure 3
Temporal pattern of sST2 levels in 1-year survivors and 1-year nonsurvivors. Given are the results of mixed model analysis ANOVA for repeated measures.
Figure 4
Figure 4
Temporal pattern of IL-33 in 1-year survivors and 1-year nonsurvivors. Given are the results of the ANOVA mixed model analysis for repeated measures.
Figure 5
Figure 5
Temporal pattern of IL-6 levels in 1-year survivors and 1-year nonsurvivors. Given are the results of the ANOVA mixed model analysis for repeated measures.
See this image and copyright information in PMC

References

    1. Singhvi A., Trachtenberg B. Left ventricular assist devices 101: shared care for general cardiologists and primary care. Journal of Clinical Medicine . 2019;8(10) doi: 10.3390/jcm8101720. - DOI - PMC - PubMed
    1. Kormos R. L., Cowger J., Pagani F. D., et al. The Society of Thoracic Surgeons Intermacs database annual report: evolving indications, outcomes, and scientific partnerships. The Journal of Heart and Lung Transplantation . 2019;38(2):114–126. doi: 10.1016/j.healun.2018.11.013. - DOI - PubMed
    1. Caruso R., Verde A., Cabiati M., et al. Association of pre-operative interleukin-6 levels with Interagency Registry for Mechanically Assisted Circulatory Support profiles and intensive care unit stay in left ventricular assist device patients. The Journal of Heart and Lung Transplantation . 2012;31(6):625–633. doi: 10.1016/j.healun.2012.02.006. - DOI - PubMed
    1. Ankersmit H. J., Tugudea S., Spanier T., et al. Activation-induced T-cell death and immune dysfunction after implantation of left-ventricular assist de vice. Lancet . 1999;354(9178):550–555. doi: 10.1016/S0140-6736(98)10359-8. - DOI - PubMed
    1. Topkara V. K., Kondareddy S., Malik F., et al. Infectious complications in patients with left ventricular assist device: etiology and outcomes in the continuous-flow era. The Annals of Thoracic Surgery . 2010;90(4):1270–1277. doi: 10.1016/j.athoracsur.2010.04.093. - DOI - PubMed

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