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Beneyto M, Martins R, Galand V, Kindo M, Schneider C, Sebestyen A, Boignard A, Sebbag L, Pozzi M, Genet T, Bourguignon T, Martin AC, Achouh P, Vanhuyse F, Blangy H, Henri C, Michel M, Anselme F, Litzler PY, Jungling M, Vincentelli A, Eschalier R, D'ostrevy N, Nataf P, Para M, Garnier F, Rajinthan P, Porterie J, Faure M, Picard F, Gaudard P, Rouvière P, Babatasi G, Blanchart K, Gariboldi V, Porto A, Flecher E, Delmas C. Right ventriculoarterial coupling surrogates and long-term survival in LVAD recipients: Results of the ASSIST-ICD multicentric registry. J Card Fail 2024:S1071-9164(24)00195-7. [PMID: 38851449 DOI: 10.1016/j.cardfail.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/09/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Prediction of outcomes remains an unmet need in LVAD candidates. Development of right heart failure portends an excess in mortality but imaging parameters of right ventricular systolic function have failed to demonstrate a prognostic role. By integrating pulmonary pressure, right ventriculoarterial coupling could fill this gap. METHODS The ASSIST-ICD registry was used to test right ventriculoarterial coupling surrogate parameters at implantation for the prediction of all-cause mortality. RESULTS The ratio of the tricuspid annular plane systolic excursion over the estimated systolic pulmonary pressure (TAPSE/sPAP) was not associated with long-term survival in univariate analysis (p = 0.89), neither was the pulmonary artery pulsatility index (PAPi) (p = 0.13). Conversely, the ratio of the right atrial pressure over the pulmonary capillary wedge pressure (RAP/PCWP) was associated with all-cause mortality (p <0.01). After taking tricuspid regurgitation severity, LVAD indication, LVAD model, age, blood urea nitrogen, and pulmonary vascular resistance into account, RAP/PCWP remained associated with survival (HR 1.35 [1.10 - 1.65], p <0.01). CONCLUSION Among pre-implant RVAC surrogates, only RAP/PCWP was associated with long-term all-cause mortality in LVAD recipients. This association was independent of established risk factors.
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Affiliation(s)
- Maxime Beneyto
- Cardiology Department, Toulouse University Hospital, Toulouse, France.
| | - Raphaël Martins
- Cardiology Department, Rennes University Hospital, Rennes, France
| | - Vincent Galand
- Cardiology Department, Rennes University Hospital, Rennes, France
| | - Michel Kindo
- Strasbourg University Hospital, Strasbourg, France
| | | | | | | | | | | | | | | | | | | | | | - Hugues Blangy
- Nancy University Hospital, Villeneuve les Nancy, France
| | - Charles Henri
- Institut du Thorax, Nantes University Hospital, nantes, France
| | - Magali Michel
- Institut du Thorax, Nantes University Hospital, nantes, France
| | | | | | | | | | | | | | | | - Marylou Para
- Bichat University Hospital, AP-HP, Paris, France
| | - Fabien Garnier
- Department of Cardiology, Dijon University Hospital, Dijon, France
| | | | - Jean Porterie
- Cardiovascular Surgery department, Toulouse University Hospital, Toulouse, France
| | - Maxime Faure
- Cardiology department, Bordeaux University Hospital, Pessac, France
| | - François Picard
- Cardiology department, Bordeaux University Hospital, Pessac, France
| | - Philippe Gaudard
- Department of anesthesiology and critical care medicine Arnaud de Villeneuve, CHU Montpellier, University of Montpellier, PhyMedExp, INSERN, CNRS, Montpellier, France
| | - Philippe Rouvière
- Department of cardiac surgery, CHU Montpellier, University of Montpellier, Montpellier, France
| | | | | | - Vlad Gariboldi
- Cardiac Surgery Department, La Timone University Hospital, AP-HM, Marseille, France
| | - Alizée Porto
- Cardiac Surgery Department, La Timone University Hospital, AP-HM, Marseille, France
| | - Erwan Flecher
- Cardiac Surgery Department, Rennes University Hospital, Rennes, France
| | - Clement Delmas
- Cardiology Department, Toulouse University Hospital, Toulouse, France; REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France
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Farshadmand J, Lowy Z, Hai O, Zeltser R, Makaryus AN. Utility of Cardiac Power Hemodynamic Measurements in the Evaluation and Risk Stratification of Cardiovascular Conditions. Healthcare (Basel) 2022; 10:2417. [PMID: 36553940 PMCID: PMC9777954 DOI: 10.3390/healthcare10122417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
Despite numerous advancements in prevention, diagnosis and treatment, cardiovascular disease has remained the leading cause of mortality globally for the past 20 years. Part of the explanation for this trend is persistent difficulty in determining the severity of cardiac conditions in order to allow for the deployment of prompt therapies. This review seeks to determine the prognostic importance of cardiac power (CP) measurements, including cardiac power output (CPO) and cardiac power index (CPI), in various cardiac pathologies. CP was evaluated across respective disease-state categories which include cardiogenic shock (CS), septic shock, transcatheter aortic valve replacement (TAVR), heart failure (HF), post-myocardial infarction (MI), critical cardiac illness (CCI) and an "other" category. Literature review was undertaken of articles discussing CP in various conditions and this review found utility and prognostic significance in the evaluation of TAVR patients with a significant correlation between one-year mortality and CPI; in HF patients showing CPI and CPO as valuable tools to assess cardiac function in the acute setting; and, additionally, CPO was found to be an essential tool in patients with CCI, as the literature showed that CPO was statistically correlated with mortality. Cardiac power and the derived measures obtained from this relatively easily obtained variable can allow for essential estimations of prognostic outcomes in cardiac patients.
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Affiliation(s)
- Jonathan Farshadmand
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, 500 Hofstra Blvd., Hempstead, NY 11549, USA; (J.F.); (Z.L.); (R.Z.)
| | - Zachary Lowy
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, 500 Hofstra Blvd., Hempstead, NY 11549, USA; (J.F.); (Z.L.); (R.Z.)
| | - Ofek Hai
- Department of Cardiology, Nassau University Medical Center, Hempstead, NY 11554, USA;
| | - Roman Zeltser
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, 500 Hofstra Blvd., Hempstead, NY 11549, USA; (J.F.); (Z.L.); (R.Z.)
- Department of Cardiology, Nassau University Medical Center, Hempstead, NY 11554, USA;
| | - Amgad N. Makaryus
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, 500 Hofstra Blvd., Hempstead, NY 11549, USA; (J.F.); (Z.L.); (R.Z.)
- Department of Cardiology, Nassau University Medical Center, Hempstead, NY 11554, USA;
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Shah P, Yuzefpolskaya M, Hickey GW, Breathett K, Wever-Pinzon O, Ton VK, Hiesinger W, Koehl D, Kirklin JK, Cantor RS, Jacobs JP, Habib RH, Pagani FD, Goldstein DJ. Twelfth Interagency Registry for Mechanically Assisted Circulatory Support Report: Readmissions After Left Ventricular Assist Device. Ann Thorac Surg 2022; 113:722-737. [PMID: 35007505 PMCID: PMC8854346 DOI: 10.1016/j.athoracsur.2021.12.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023]
Abstract
The twelfth annual report from The Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) highlights outcomes for 26 688 continuous-flow left ventricular assist device (LVAD) patients over the past decade (2011-2020). In 2020, we observed the largest drop in yearly LVAD implant volumes since the registry's inception, which reflects the effects of the COVID-19 pandemic on cardiac surgical volumes in the United States. The 2018 heart transplant allocation policy change in the United States continues to affect LVAD implantation volumes and device strategy, with 78.1% of patients now receiving LVAD implants as destination therapy. Despite an older and sicker patient cohort, survival in the recent era (2016-2020) at 1 and 2 years continues to improve at 82.8% and 74.1%. Patient adverse event profile has also improved in the recent era, with significant reductions in stroke, gastrointestinal bleeding, infection, and device malfunction/pump thrombosis. Finally, we review the burden of readmissions after LVAD implant and highlight an opportunity to improve patient outcomes by reducing this frequent and vexing problem.
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Affiliation(s)
- Palak Shah
- Heart Failure, Mechanical Circulatory Support and Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia.
| | - Melana Yuzefpolskaya
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York City, New York
| | - Gavin W Hickey
- Division of Cardiovascular Medicine, UPMC Heart and Vascular Institute, Pittsburgh, Pennsylvania
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona
| | - Omar Wever-Pinzon
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Van-Khue Ton
- Advanced Heart Failure, Mechanical Circulatory Support and Heart Transplant, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - William Hiesinger
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - James K Kirklin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | | | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Goldstein
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York
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