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

Alberto Pinsino, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
Francesco Castagna, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA; Department of Medicine, Yale New Haven Bridgeport Hospital, Bridgeport, Connecticut, USA.
Amelia M. Zuver, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
Eugene A. Royzman, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
Mojdeh Nasiri, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
Eric J. Stöhr, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA; Cardiff Metropolitan University, Cardiff, UK.
Barbara Cagliostro, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
Barry McDonnell, Cardiff Metropolitan University, Cardiff, UK.
John R. Cockcroft, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
A Reshad Garan, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
Veli K. Topkara, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
P Christian Schulze, Department of Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Friedrich Schiller University Jena, University Hospital Jena, Jena, Germany.
Koji Takeda, Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA.
Hiroo Takayama, Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA.
Yoshifumi Naka, Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA.
Ryan T. Demmer, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
Joshua Z. Willey, Department of Neurology, Columbia University, New York, New York, USA.
Melana Yuzefpolskaya, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
Paolo C. Colombo, Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA. Electronic address: pcc2001@cumc.columbia.edu.

Document Type

Article

Publication Title

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

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.

First Page

396

Last Page

405

DOI

10.1016/j.healun.2018.11.003

Publication Date

4-1-2019

Identifier

30559034 (pubmed); 10.1016/j.healun.2018.11.003 (doi); S1053-2498(18)31737-6 (pii)

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