Prognostic implications of serial outpatient blood pressure measurements in patients with an axial continuous-flow left ventricular assist device

Alberto Pinsino, Francesco Castagna, Amelia M. Zuver, Eugene A. Royzman, Mojdeh Nasiri, Eric J. Stöhr, Barbara Cagliostro, Barry McDonnell, John R. Cockcroft, A. Reshad Garan, Veli K. Topkara, P. Christian Schulze, Koji Takeda, Hiroo Takayama, Yoshifumi Naka, Ryan T. Demmer, Joshua Z. Willey, Melana Yuzefpolskaya, Paolo C. Colombo

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

BACKGROUND: Elevated blood pressure (BP) has been linked to adverse events during left ventricular assist device support. In this study we investigated the association between outpatient BP and stroke or suspected pump thrombosis among HeartMate II (HMII) recipients. METHODS: We retrospectively studied 220 HMII patients. Serial outpatient BP measurements were averaged. Patients were categorized by: (1) mean arterial pressure (MAP), high (>90 mm Hg) vs intermediate (80 mm Hg ≤ MAP ≤ 90 mm Hg) vs low (<80 mm Hg); (2) systolic BP (SBP), high (≥101 mm Hg, median) vs low; and (3) pulse pressure (PP), high (≥22 mm Hg, median) vs low. To assess visit-to-visit BP variability, patients were divided in quartiles of standard deviation of MAP and SBP. The primary end-point was the composite of stroke or suspected pump thrombosis. RESULTS: The risk for the primary end-point was increased in the high MAP group (adjusted hazard ratio [HR] 2.75, 95% confidence interval [CI] 1.49 to 5.05, vs intermediate MAP; and 6.73, 1.9 to 23.9, vs low MAP). MAP had higher predictive value for the primary end-point compared with SBP (p = 0.05). Patients with high SBP had a higher rate of stroke (HR 2.8, 95% CI 1.09 to 7.17, vs low SBP). The combination of high SBP and low PP was associated with the highest risk for stroke. The lowest quartile of visit-to-visit MAP variability was associated with the highest risk for the primary end-point. CONCLUSIONS: Elevated outpatient BP is associated with increased risk for stroke or suspected pump thrombosis in HMII recipients. Reduced PP and low visit-to-visit BP variability may confer additional risk.

Original languageEnglish (US)
Pages (from-to)396-405
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume38
Issue number4
DOIs
StatePublished - Apr 2019

Bibliographical note

Funding Information:
P.C.C. is recipient of a research grant from Abbott; he also serves as a consultant (with no honoraria) for the same company. Y.N. serves as a consultant for Abbott. The remaining authors have no conflicts of interest to disclose. This research has been supported by funds from the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York‒Presbyterian Hospital/Columbia University.

Publisher Copyright:
© 2018 International Society for Heart and Lung Transplantation

Keywords

  • Blood Pressure
  • LVAD
  • MCS
  • Pulsatility
  • Pump Thrombosis
  • Stroke

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