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Decoupling Between Diastolic Pulmonary Arterial Pressure and Pulmonary Arterial Wedge Pressure at Incremental Left Ventricular Assist Device (LVAD) Speeds Is Associated With Worse Prognosis After LVAD Implantation.
- Source :
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Journal of cardiac failure [J Card Fail] 2018 Sep; Vol. 24 (9), pp. 575-582. Date of Electronic Publication: 2018 Aug 10. - Publication Year :
- 2018
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Abstract
- Background: Decoupling between diastolic pulmonary arterial pressure (dPAP) and pulmonary arterial wedge pressure (PAWP) is an index of pulmonary vasculature remodeling and provides prognostic information. Furthermore, decoupling may change during incremental left ventricular assist device (LVAD) speed changes.<br />Methods and Results: In this prospective study, patients underwent an echocardiographic and hemodynamic ramp test after LVAD implantation and were followed for 1 year. The change in decoupling (dPAP - PAWP) between the lowest and highest LVAD speeds during the ramp test was calculated. Survival and heart failure admission rates were assessed by means of Kaplan-Meier analysis. Eighty-seven patients were enrolled in the study: 54 had a Heartmate II LVAD (60.8 ± 9.3 years of age and 34 male) and 33 had an HVAD LVAD (58.6 ± 13.2 years of age and 20 male). Patients who experienced greater changes in decoupling (Δdecoupling >3 mm Hg) had a persistently elevated dPAP at incremental LVAD speed and had worse 1-year heart failure readmission-free survival compared with the group without significant changes in the degree of decoupling (41% vs 75%; P = .001).<br />Conclusions: An increase in decoupling between dPAP and PAWP at incremental LVAD speed changes was associated with worse prognosis in LVAD patients.<br /> (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Subjects :
- Arterial Pressure
Disease Progression
Echocardiography
Female
Follow-Up Studies
Heart Failure diagnosis
Heart Failure therapy
Heart Ventricles diagnostic imaging
Humans
Male
Middle Aged
Prognosis
Prospective Studies
Heart Failure physiopathology
Heart Ventricles physiopathology
Heart-Assist Devices
Pulmonary Wedge Pressure physiology
Ventricular Function, Left physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8414
- Volume :
- 24
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Journal of cardiac failure
- Publication Type :
- Academic Journal
- Accession number :
- 30103020
- Full Text :
- https://doi.org/10.1016/j.cardfail.2018.08.003