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Imamura T, Chung B, Nguyen A, Rodgers D, Sayer G, Adatya S, Sarswat N, Kim G, Raikhelkar J, Ota T, Song T, Juricek C, Kagan V, Jeevanandam V, Mehra M, Burkhoff D, Uriel N. Decoupling Between Diastolic Pulmonary Artery Pressure and Pulmonary Capillary Wedge Pressure as a Prognostic Factor After Continuous Flow Ventricular Assist Device Implantation. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.003882. [PMID: 28912260 DOI: 10.1161/circheartfailure.117.003882] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 08/02/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND A cohort of heart failure (HF) patients receiving left ventricular assist devices (LVADs) has decoupling of their diastolic pulmonary artery pressure and pulmonary capillary wedge pressure. However, the clinical implications of this decoupling remain unclear. METHODS AND RESULTS In this prospective study, patients with LVADs underwent routine invasive hemodynamic ramp testing with right heart catheterization, during which LVAD speeds were adjusted. Inappropriate decoupling was defined as a >5 mm Hg difference between diastolic pulmonary artery pressure and pulmonary capillary wedge pressure. The primary outcomes of survival and heart failure readmission rates after ramp testing were assessed. Among 63 LVAD patients (60±12 years old and 25 female [40%]), 27 patients (43%) had inappropriate decoupling at their baseline speed. After adjustment of their rotation speed during ramp testing, 30 patients (48%) had inappropriate decoupling. Uni/multivariable Cox analyses demonstrated that decoupling was the only significant predictor for the composite end point of death and heart failure readmission during the 1 year following the ramp study (total of 18 events; hazards ratio, 1.09; 95% confidence interval, 1.04-1.24; P<0.05). Furthermore, normalization of decoupling (n=8) during ramp testing was significantly associated with higher 1-year heart failure readmission-free survival rate compared with the non-normalized group (n=19, 100% versus 53%; P=0.035). CONCLUSIONS The presence of inappropriate decoupling was associated with worse outcomes in patients with LVADs. Prospective, large-scale multicenter studies to validate the result are warranted.
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Affiliation(s)
- Teruhiko Imamura
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Ben Chung
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Ann Nguyen
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Daniel Rodgers
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Gabriel Sayer
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Sirtaz Adatya
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Nitasha Sarswat
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Gene Kim
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Jayant Raikhelkar
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Takeyohi Ota
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Tae Song
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Colleen Juricek
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Viktoriya Kagan
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Valluvan Jeevanandam
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Mandeep Mehra
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Daniel Burkhoff
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.)
| | - Nir Uriel
- From the Department of Medicine (T.I., B.C., A.N., D.R., G.S., S.A., N.S., G.K., J.R., N.U.) and Department of Surgery (T.O., T.S., C.J., V.K., V.J.), University of Chicago Medical Center, IL; Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.); and Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (D.B.).
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