1. Pre-Operative Ventilatory Inefficiency is Associated with Gastrointestinal Bleeding in Patients with Continuous-Flow Left Ventricular Assist Devices.
- Author
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Yu, M.D., Newman, J., Brailovsky, Y., Liebo, M., Zolty, R., Lowes, B., Heroux, A., and Raichlin, E.
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HEART assist devices , *EXERCISE tests - Abstract
Purpose Ventilatory efficiency (VE/VCO 2) on cardiopulmonary exercise testing (CPET) has prognostic significance in patients with chronic heart failure; however, its hemodynamic correlates and effect on outcomes following left ventricular assist device (LVAD) implantation has not been evaluated. Aim To explore the association between pre-LVAD VE/VCO 2 and the incidence of post-LVAD gastrointestinal bleeding (GIB). Methods Overall, 159 patients underwent CPET prior to LVAD implantation: 87 had VE/VCO 2 ≥36 and 72 had VE/VCO 2 <36. During 11.75 (median, IQR 4.8-26.2) months of follow up 59 developed GIB. Results Patients with a VE/VCO 2 ≥36 were older (58.4 ± 13.2 vs. 52.5 ± 15.1 years, p=0.02) and had lower BMI (28.8 ± 7.3 vs. 31.0 ± 6.2, p=0.01). On pre-LVAD evaluation, the pulmonary artery pulsatility index (4.1 ± 3.0 vs 2.97 ± 1.8, p=0.01) and echocardiographic E/E' (18.7 ± 7.3 vs. 15.5 ± 7.9, p=0.03) were significantly higher in the VE/VCO 2 ≥36 group (Table 1). Other demographic, clinical, and hemodynamic characteristics did not differ between groups. Freedom from GIB was significantly lower in the VE/VCO 2 ≥36 group (2 years post-LVAD: 47% vs. 76%, p= 0.001, log rank) (Figure 1). There was no association between GIB and other CPET measurements. On Cox proportional regression analysis VE/VCO 2 ≥36 was independently associated with increased GIB (HR 2.1; 95% CI 1.3-3.5, p=0.004). Conclusion VE/VCO 2 ≥36 on pre-LVAD CPET is associated with more frequent GIB after LVAD implantation. The mechanism of this finding requires further evaluation. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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