Hypotension on cardiopulmonary stress test predicts 90 day mortality after LVAD implantation in INTERMACS 3–6 patients

Valmiki Maharaj, Arianne Clare C Agdamag, Sue Duval, Jonathan Edmiston, Victoria R Charpentier, Meg Fraser, Alexandra Hall, Jessica N Schultz, Ranjit John, Andrew Shaffer, Cindy M Martin, Thenappan Thenappan, Gary S. Francis, Rebecca Cogswell, Tamas Alexy

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Cardiopulmonary stress test (CPX) is routinely performed when evaluating patient candidacy for left ventricular assist device (LVAD) implantation. The predictive value of hypotensive systolic blood pressure (SBP) response during CPX on clinical outcomes is unknown. This study aims to determine the effect of hypotensive SBP response during to clinical outcomes among patients who underwent LVAD implantation. Methods and results: This was a retrospective single center study enrolling consecutive patients implanted with a continuous flow LVAD between 2011 and 2022. Hypotensive SBP response was defined as peak exercise SBP below the resting value. Multivariable Cox-regression analysis was performed to evaluate the relationship between hypotensive SBP response and all-cause mortality within 30 and 90 days of LVAD implantation. A subgroup analysis was performed for patients implanted with a HeartMate III (HM III) device. Four hundred thirty-two patients underwent LVAD implantation during the pre-defined period and 156 with INTERMACS profiles 3–6 met our inclusion criteria. The median age was 63 years (IQR 54–69), and 52% had ischaemic cardiomyopathy. Hypotensive SBP response was present in 35% of patients and was associated with increased 90 day all-cause mortality (unadjusted HR 9.16, 95% CI 1.98–42; P = 0.0046). Hazard ratio remained significant after adjusting for age, INTERMACS profile, serum creatinine, and total bilirubin. Findings were similar in the HM III subgroup. Conclusions: Hypotensive SBP response on pre-LVAD CPX is associated with increased perioperative and 90 day mortality after LVAD implantation. Additional studies are needed to determine the mechanism of increased mortality observed.

Original languageEnglish (US)
Pages (from-to)3496-3504
Number of pages9
JournalESC Heart Failure
Volume9
Issue number5
DOIs
StatePublished - Oct 2022

Bibliographical note

Funding Information:
V. Maharaj: None. A. Agdamag: None. S. Duval: None. J. Edmiston: None. V. Charpentier: None. M. Fraser: None. J. Schultz: None. A. Hall: None. R. John: Consultant; Current/Ongoing ‐ Payment Made to Me; Abbott Lab, Medtronic. Grant/Research Support; Current/Ongoing ‐ Payment Made to Me; Abbott Lab, Medtronic. A. Shafer: None. C. Martin: None. T. Thenappan: None. G. Francis: NIH (research grant), NOVARTIS/MyoKardia DSMBs.R. Cogswell: Consultant; Current/Ongoing ‐ Payment Made to Me; Abbott Lab, Medtronic. Speaker's Bureau; Current/Ongoing ‐ Payment Made to Me; Abbott Lab, Medtronic. Other Advisory Board Member; Current/Ongoing ‐ Payment Made to Me; Medtronic. Other Financial or Material Support; Current/Ongoing ‐ Payment Made to Me; Medtronic. T. Alexy: Speaker's Bureau; Current/Ongoing ‐ Payment Made to Me; Abbott Lab. Other Financial or Material Support; Current/Ongoing ‐ Payment Made to Me; Boston Scientific.

Publisher Copyright:
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Keywords

  • Cardiopulmonary exercise stress test
  • Heart failure
  • Hypotension
  • Left ventricular assist device

PubMed: MeSH publication types

  • Journal Article

Fingerprint

Dive into the research topics of 'Hypotension on cardiopulmonary stress test predicts 90 day mortality after LVAD implantation in INTERMACS 3–6 patients'. Together they form a unique fingerprint.

Cite this