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Purpose Pulmonary artery pulsatility index (PAPi) before left ventricular assist device (LVAD) implantation is associated with postoperative right ventricular failure. This study aimed to investigate the implication of post LVAD PAPi on clinical outcomes. Methods Following LVAD implantation, invasive hemodynamic tests were performed. PAPi was calculated as (systolic pulmonary artery pressure - diastolic pulmonary artery pressure)/mean right atrial pressure. One-year mortality, gastrointestinal bleeding (GIB), heart failure (HF), pump thrombosis (PT), and stroke event rates were compared between low PAPi group and high PAPi group based on the established ROC cut-off value. Results 97 LVAD patients received hemodynamic tests at 598 ± 668 days following LVAD implantation. The mean age was 60 years old and 60 (62%) were male. Mean PAPi was 2.9 ± 2.6. We divided the subjects into a low PAPi group (PAPi<2) and a high PAPi group (PAPi≥2). More patients in the low PAPi group had a history of atrial fibrillation and ventricular tachyarrhythmia prior to LVAD implantation (p<0.05 for both). One-year survival free of HF hospitalization was worse in the low PAPi group (77.1 vs 94.0%, p=0.019)(Figure 1). Mortality, GIB, PT, and stroke rates were comparable between the two groups (p >0.05 for all). Conclusion Lower PAPi post LVAD implantation is associated with reduced survival free from HF hospitalization. PAPi may serve as a marker of right ventricular failure in this population. [ABSTRACT FROM AUTHOR]

Purpose Omega-3, an unsaturated fatty acid, reduces the risk of gastrointestinal bleeding (GIB) in patients with left ventricular assist devices (LVADs). However, its biological mechanism remains uncertain. This study aims to evaluate the impact of omega-3 on angiogenesis. Methods We measured inflammatory and angiogenesis biomarkers in plasma from LVAD patients by using Bio-plex ProTM Biomarker Assay kit and compared their levels between those with and without omega-3 therapy. GIB rates were also compared between the two groups by using binomial negative regression analysis. Results Among 38 patients (mean age 56.4 years, 66% male), 16 (42%) received 4 g/day omega-3 therapy. There was no significant difference in baseline characteristics between the two groups (p >0.05 for all). The GIB rate was significantly lower in the omega-3 group (0.100 event/year vs. 0.381 event/year, p <0.001; Figure 1A). Among 18 biomarkers, only the angiopoietin-2 level was significantly lower in the omega-3 group compared with the control group (138 [93, 291] vs. 194 [154, 355] pg/mL, p = 0.045; Table 1). Conclusion LVAD patients treated with omega-3 have significantly lower GIB rates and significantly lower angiopoietin-2 levels. The reduction in GIB rate with omega-3 may be due to the suppression of abnormal angiogenesis. [ABSTRACT FROM AUTHOR]

Purpose Left ventricular assist device (LVAD) outcomes differ between Japan and US. While GI bleeding is common in US and rare in Japan, stroke and driveline infections are more common in Japan than US. The aim of this study was to explore whether inflammatory and angiogenesis biomarkers can explain these differences. Methods Plasma levels of inflammatory and angiogenetic biomarkers were measured with Bio-plex ProTM Biomarker Assay kits. Levels were compared between US and Japanese LVAD patients. Adverse event rates were also compared between the two countries using binomial negative regression analysis. Results 61 patients were enrolled. The US cohort (N=38) was older (56.4 vs. 42.4 years; p <0.05) and had more women (34% vs. 5%; p <0.05) compared to the Japanese cohort (N=23). Plasma samples were drawn at similar time following LVAD implantation (median 470 vs. 550 days; p=0.68). GIB rate was significantly higher in the US cohort (0.286 vs. 0.023 event/year; p <0.001). Stroke rate (0.052 vs. 0.218 event/year, p <0.001) and driveline infection rate (0.071 vs. 0.184 event/year, p <0.001) were significantly lower in the US cohort. Japanese patients had elevated angiogenesis parameters including 4-fold higher angiopoietin-2 levels (823 vs. 172 pg/mL, p <0.001; Table 1A). Furthermore, Japanese patients had higher markers of inflammation with 4-fold higher IL-8 and 2-fold higher TNF-a (Table 1B). Conclusion Different rate of comorbidities between US and Japan are associated with the different expression of inflammatory and angiogenesis biomarkers. Longitudinal studies focusing on these biomarker levels are warranted. [ABSTRACT FROM AUTHOR]