1
|
Tucanova Z, Ivak P, Wohlfahrt P, Pol M, Hlavacek D, Konarik M, Szarszoi O, Netuka I, Pitha J. Increased pulsatility index is associated with adverse outcomes in left ventricular assist device recipients. ESC Heart Fail 2021; 8:4288-4295. [PMID: 34346192 PMCID: PMC8497202 DOI: 10.1002/ehf2.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/30/2021] [Accepted: 07/08/2021] [Indexed: 11/20/2022] Open
Abstract
Aims Recipients of left ventricular assist devices (LVAD) are exposed to increased risk of adverse clinical events. One of the potential contributing factors is non‐pulsatile flow generated by LVAD. We evaluated the association of flow patterns in carotid arteries and of increased arterial stiffness with death and cerebrovascular events in LVAD recipients. Methods and results We analysed data from 83 patients [mean age 54 ± 15 years; 12 women; HeartMate II (HMII), n = 34; HeartMate 3 (HM3), n = 49]. Pulsatile and resistive indexes, atherosclerotic changes in carotid arteries (measured by duplex ultrasound), and arterial stiffness [measured by Endo‐PAT 2000 as the augmentation index standardized for heart rate (AI@75)] were evaluated 3 and 6 months after LVAD implantation. Sixteen patients died during follow‐up (27.3 months; interquartile range 15.7–44.3). After adjusting for the main variables examined, the pulsatility index measured at 3 months was positively associated with increased hazard ratios (HR) for death and cerebrovascular events [HR 9.8, 95% confidence interval (CI) 1.62–59.42], with HR increasing after adding AI@75 to the model (HR 18.8, 95% CI 2.44–145.50). In HM3 recipients, HR was significantly lower than in HMII recipients (HR 0.31, 95% CI 0.11–0.91), but the significance disappeared after adding AI@75 to the model (HR 0.33, 95% CI 0.09–1.18). Conclusions The risk of death and cerebrovascular events in LVAD recipients is associated with increased pulsatility index in carotid arteries and potentiated by increased arterial stiffness. The same risk is attenuated by HM3 LVAD implantation, but this effect is weakened by increased arterial stiffness.
Collapse
Affiliation(s)
- Zuzana Tucanova
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague, 140 21, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Ivak
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague, 140 21, Czech Republic.,Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Second Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Wohlfahrt
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marek Pol
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague, 140 21, Czech Republic
| | - Daniel Hlavacek
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague, 140 21, Czech Republic.,Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Miroslav Konarik
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague, 140 21, Czech Republic.,Institute of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ondrej Szarszoi
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague, 140 21, Czech Republic.,Department of Pathophysiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague, 140 21, Czech Republic.,Second Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Pitha
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Centre for Experimental Medicine, Laboratory for Atherosclerosis Research, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| |
Collapse
|
2
|
Dlouha D, Ivak P, Netuka I, Novakova S, Konarik M, Tucanova Z, Lanska V, Hlavacek D, Wohlfahrt P, Hubacek JA, Pitha J. The effect of long-term left ventricular assist device support on flow-sensitive plasma microRNA levels. Int J Cardiol 2021; 339:138-143. [PMID: 34197842 DOI: 10.1016/j.ijcard.2021.06.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Implantation of current generation left ventricular assist devices (LVADs) in the treatment of end-stage heart failure (HF), not only improves HF symptoms and end-organ perfusion, but also leads to cellular and molecular responses, presumably in response to the continuous flow generated by these devices. MicroRNAs (miRNAs) are important post-transcriptional regulators of gene expression in multiple biological processes, including the pathogenesis of HF. In our study, we examined the influence of long-term LVAD support on changes in flow-sensitive miRNAs in plasma. MATERIALS AND METHODS Blood samples from patients with end-stage heart failure (N = 33; age = 55.7 ± 11.6 years) were collected before LVAD implantation and 3, 6, 9, and 12 months after implantation. Plasma levels of the flow-sensitive miRNAs; miR-10a, miR-10b, miR-146a, miR-146b, miR-663a, miR-663b, miR-21, miR-155, and miR-126 were measured using quantitative PCR. RESULTS Increasing quantities of miR-126 (P < 0.03) and miR-146a (P < 0.02) was observed at each follow-up visit after LVAD implantation. A positive association between miR-155 and Belcaro score (P < 0.04) and an inverse correlation between miR-126 and endothelial function, measured as the reactive hyperemia index (P < 0.05), was observed. CONCLUSIONS Our observations suggest that after LVAD implantation, low pulsatile flow up-regulates plasma levels of circulating flow-sensitive miRNAs, contributing to endothelial dysfunction and vascular remodeling.
Collapse
Affiliation(s)
- Dana Dlouha
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Peter Ivak
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.; Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Second Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.; Second Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sarka Novakova
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Miroslav Konarik
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Zuzana Tucanova
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vera Lanska
- Statistical Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Daniel Hlavacek
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.; Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Wohlfahrt
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslav A Hubacek
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.; 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Pitha
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| |
Collapse
|
3
|
Thromboembolic Events in Patients With Left Ventricular Assist Devices Are Related to Microparticle-Induced Coagulation. ASAIO J 2021; 67:59-66. [PMID: 33346991 DOI: 10.1097/mat.0000000000001200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Thromboembolic events (TEs) are a feared complication in patients supported by a continuous-flow left ventricular assist device (LVAD). The aim of the study was to analyze the role of circulating microparticles (MPs) in activating the coagulation system in LVAD patients, which might contribute to the occurrence of TEs. First, we analyzed the effect of LVAD support on endothelial function, on the levels of endothelial MPs (EMPs) and platelet MPs (PMPs), and on the procoagulative activity of circulating MPs (measured as MP-induced thrombin formation) before LVAD implantation, post-implantation, and at a 3 month follow-up (n = 15). Second, these parameters were analyzed in 43 patients with ongoing LVAD support who were followed up for the occurrence of TEs in the following 12 months. In patients undergoing LVAD implantation, the levels of PMPs and MP-induced thrombin formation increased post-LVAD implantation. The flow-mediated vasodilation (FMD) decreased, while the levels of EMPs increased post-LVAD implantation. TEs occurred in eight patients with ongoing LVAD support despite adequate coagulation. The levels of PMPs and MP-induced thrombin formation were higher in LVAD patients with TEs than in LVAD patients without TEs and were independent predictors for the risk of TEs under LVAD support. As conclusion, implantation of LVAD enhanced MP-induced coagulation, which was independently associated with the occurrence of TEs. These parameters may serve in risk stratification for early transplantation and individualized modification of standard LVAD therapy.
Collapse
|
4
|
Ivak P, Netuka I, Kralova-Lesna I, Wohlfahrt P, Pitha J. Changes in circulating stem cells and endothelial progenitor cells over a 12-month period after implantation of a continuous-flow left ventricular assist device. Arch Med Sci 2020; 16:1440-1443. [PMID: 33224344 PMCID: PMC7667410 DOI: 10.5114/aoms.2020.100306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 06/10/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Changes in circulating CD34+CD45low stem cells (SC) and CD34+CD45low+KDR+ endothelial progenitor cells (EPC) may reflect pathological endothelial activation. Non-pulsatile/continuous-flow left ventricular assist devices (CF-LVAD) can enhance this process. The aim of this study was to analyse the impact of 12-month CF-LVAD treatment on SC and EPC. METHODS We analysed changes in SC and EPC from the pre-implantation period up until 12 months after implantation over 3-month intervals in 14 patients. Data from 12 patients with heart failure (HF) and from 13 healthy volunteers were used as controls. RESULTS Baseline EPC were significantly higher in CF-LVAD and HF patients than in healthy controls, substantially decreasing 3 months after CF-LVAD implantation and then returning to high baseline values at 12 months. CONCLUSIONS Changes in circulating SC and EPC may reflect pathological endothelial activation after CF-LVAD implantation.
Collapse
Affiliation(s)
- Peter Ivak
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Second Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Second Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ivana Kralova-Lesna
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Peter Wohlfahrt
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Pitha
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, Czech Republic
| |
Collapse
|
5
|
McVey MJ, Kuebler WM. Extracellular vesicles: biomarkers and regulators of vascular function during extracorporeal circulation. Oncotarget 2018; 9:37229-37251. [PMID: 30647856 PMCID: PMC6324688 DOI: 10.18632/oncotarget.26433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022] Open
Abstract
Extracellular vesicles (EVs) are generated at increased rates from parenchymal and circulating blood cells during exposure of the circulation to abnormal flow conditions and foreign materials associated with extracorporeal circuits (ExCors). This review describes types of EVs produced in different ExCors and extracorporeal life support (ECLS) systems including cardiopulmonary bypass circuits, extracorporeal membrane oxygenation (ECMO), extracorporeal carbon dioxide removal (ECCO2R), apheresis, dialysis and ventricular assist devices. Roles of EVs not only as biomarkers of adverse events during ExCor/ECLS use, but also as mediators of vascular dysfunction are explored. Manipulation of the number or subtypes of circulating EVs may prove a means of improving vascular function for individuals requiring ExCor/ECLS support. Strategies for therapeutic manipulation of EVs during ExCor/ECLS use are discussed such as accelerating their clearance, preventing their genesis or pharmacologic options to reduce or select which and how many EVs circulate. Strategies to reduce or select for specific types of EVs may prove beneficial in preventing or treating other EV-related diseases such as cancer.
Collapse
Affiliation(s)
- Mark J McVey
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, SickKids, Toronto, ON, Canada
| | - Wolfgang M Kuebler
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Heart Institute, Berlin, Germany
| |
Collapse
|
6
|
LVAD Pulsatility Assesses Cardiac Contractility: In Vitro Model Utilizing the Total Artificial Heart and Mock Circulation. ASAIO J 2018; 65:580-586. [PMID: 30074963 DOI: 10.1097/mat.0000000000000861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
There is a need for a consistent, reproducible, and cost-effective method of determining cardiac recovery in patients who receive emerging novel therapeutics for advanced and end-stage heart failure (HF). With the increasing use of ventricular assist devices (VADs) in end-stage HF, objective device diagnostics are available for analysis. Pulsatility, one of the accessible diagnostic measures, is a variable gage of the differential between peak systolic and minimum diastolic flow during a single cardiac cycle. Following implantation of the VAD, HeartWare's HVAD records pulsatility regularly. Thus, we hypothesize that this measurement relates to the contractility of the heart and could be utilized as a metric for determining patient response to various therapeutics. In this study, therefore, we develop a translatable and effective predictive model characterizing pulsatility to determine HF status and potential HF recovery using the SynCardia Total Artificial Heart (TAH) in conjunction with a Donovan Mock Circulation System to create a simulation platform for the collection of pulsatility data. We set the simulation platform to patient conditions ranging from critical heart failure to a normal operating condition through the variation preload, afterload, and left ventricular (LV) pumping force or TAH "contractility." By manipulating these variables, pulsatility was found to accurately indicate significant (p < 0.05) improvements in LV contractility at every recorded afterload and preload, suggesting that it is a valuable parameter for the assessment of cardiac recovery in patients.
Collapse
|
7
|
Pías-Peleteiro J, Campos F, Castillo J, Sobrino T. Endothelial progenitor cells as a therapeutic option in intracerebral hemorrhage. Neural Regen Res 2017; 12:558-561. [PMID: 28553326 PMCID: PMC5436344 DOI: 10.4103/1673-5374.205085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Intracerebral hemorrhage (ICH) is the most severe cerebrovascular disease, which represents a leading cause of death and disability in developed countries. However, therapeutic options are limited, so is mandatory to investigate repairing processes after stroke in order to develop new therapeutic strategies able to promote brain repair processes. Therapeutic angiogenesis and vasculogenesis hold promise to improve outcome of ICH patients. In this regard, circulating endothelial progenitor cells (EPCs) have recently been suggested to be a marker of vascular risk and endothelial function. Moreover, EPC levels have been associated with good neurological and functional outcome as well as reduced residual hematoma volume in ICH patients. Finally, experimental and clinical studies indicate that EPC might mediate endothelial cell regeneration and neovascularization. Therefore, EPC-based therapy could be an excellent therapeutic option in ICH. In this mini-review, we discuss the present status of knowledge about the possible therapeutic role of EPCs in ICH, molecular mechanisms, and the future perspectives and strategies for their use in clinical practice.
Collapse
Affiliation(s)
- Juan Pías-Peleteiro
- Clinical Neurosciences Research Laboratory, Department of Neurology, Stroke Unit, University Clinical Hospital, Universidade de Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Department of Neurology, Stroke Unit, University Clinical Hospital, Universidade de Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Department of Neurology, Stroke Unit, University Clinical Hospital, Universidade de Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Department of Neurology, Stroke Unit, University Clinical Hospital, Universidade de Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| |
Collapse
|
8
|
Ivak P, Pitha J, Netuka I. Circulating microparticles as a predictor of vascular properties in patients on mechanical circulatory support; hype or hope? Physiol Res 2016; 65:727-735. [PMID: 27429109 DOI: 10.33549/physiolres.933246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Microparticles are small circulating vesicles originating from circulatory system and vascular wall cells released during their activation or damage. They possess different roles in regulation of endothelial function, inflammation, thrombosis, angiogenesis, and in general, cellular stress. Microparticles are the subject of intensive research in pulmonary hypertension, atherosclerotic disease, and heart failure. Another recently emerging role is the evaluation of the status of vasculature in end-stage heart failure patients treated with implantable ventricular assist devices. In patients implanted as destination therapy, assessment of the long-term effect of currently used continuous-flow left ventricular assist devices (LVADs) on vasculature might be of critical importance. However, unique continuous flow pattern generated by LVADs makes it difficult to assess reliably the vascular function with most currently used methods, based mainly on ultrasound detection of changes of arterial dilatation during pulsatile flow. In this respect, the measurement of circulating microparticles as a marker of vascular status may help to elucidate both short- and long-term effects of LVADs on the vascular system. Because data regarding this topic are very limited, this review is focused on the advantages and caveats of the circulating microparticles as markers of vascular function in patients on continuous-flow LVADs.
Collapse
Affiliation(s)
- P Ivak
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
| | | | | |
Collapse
|
9
|
PIŤHA J, KRÁLOVÁ LESNÁ I, STÁVEK P, MAHROVÁ A, RACEK J, SEKERKOVÁ A, TEPLAN V, ŠTOLLOVÁ M. Effect of Exercise on Markers of Vascular Health in Renal Transplant Recipients. Physiol Res 2015; 64:945-9. [DOI: 10.33549/physiolres.933123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The cornerstone of cardiovascular risk management is lifestyle intervention including exercise which could exert favorable impact also in renal transplant recipients. Nevertheless, reliable assessment of the effect of lifestyle interventions is complicated and the available data in this population are not consistent. The aim of the study was to evaluate the effect of physical activity on selected laboratory markers of vascular health including circulating stem cells, endothelial progenitor cells, microparticles, and plasma asymmetric dimethyl arginine in renal transplant recipients. Nineteen men and 7 women were recruited in 6-month program of standardized and supervised exercise. Control group consisted of 23 men and 13 women of similar age and body mass index not included into the program. One year after the transplantation, the main difference between intervention and control group was found in the change of endothelial progenitor cells (p=0.006). Surprisingly, more favorable change was seen in the control group in which endothelial progenitor cells significantly increased compared to the intervention group. The explanation of this finding might be a chronic activation of reparative mechanisms of vascular system in the population exposed to multiple risk factors which is expressed as relatively increased number of endothelial progenitor cells. Therefore, their decrease induced by exercise might reflect stabilization of these processes.
Collapse
Affiliation(s)
- J. PIŤHA
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | | | | | | | | | | |
Collapse
|
10
|
IVAK P, PITHA J, WOHLFAHRT P, KRALOVA LESNA I, STAVEK P, DORAZILOVA Z, STEPANKOVA J, MALY J, POKORNY M, NETUKA I. Endothelial Dysfunction Expressed as Endothelial Microparticles in Patients With End-Stage Heart Failure. Physiol Res 2014; 63:S369-73. [DOI: 10.33549/physiolres.932866] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Left ventricular assist devices (LVAD), currently used in treatment of terminal heart failure, are working on principle of rotary pump, which generates continuous blood flow. Non-pulsatile flow is supposed to expose endothelial cells to high stress and potential damage. Therefore, we investigated longitudinal changes in concentration of circulating endothelial microparticles (EMP) as a possible marker of endothelial damage before and after implantation of LVAD. Study population comprised 30 patients with end-stage heart failure indicated for implantation of the Heart Mate II LVAD. Concentrations of microparticles were measured as nanomoles per liter relative to phosphatidylserine before and 3 months after implantation. At 3 months after implantation we observed significant decrease in concentration of EMP [5.89 (95 % CI 4.31-8.03) vs. 3.69 (95 % CI 2.70-5.03), p=0.03] in the whole group; there was no difference observed between patients with ischemic etiology of heart failure (n=18) and with heart failure of non-ischemic etiology (n=12). In addition, heart failure etiology had no effect on the rate of EMP concentration decrease with time. These results indicate possibility that LVAD do not cause vascular damage 3 months after implantation. Whether these results suggest improvement of vascular wall function and of endothelium is to be proved in long-term studies.
Collapse
Affiliation(s)
| | - J. PITHA
- Laboratory for Atherosclerosis Research, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | | | | | | | | | | | | |
Collapse
|