Mo2020 Low Pulsatility Index Is Associated With an Increased Hazard of Gastrointestinal Bleeding in Patients With Continuous-Flow Left Ventricular Assist Devices

Edwards, Adam L.; Fitzmorris, Paul; Hairrell, Ansley; Pamboukian, Salpy V.; George, James F.; Wilcox, C. Mel; Peter, Shajan

doi:10.1016/s0016-5085(15)32629-9

Cited by 3 publications

(4 citation statements)

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“…The association between low PI and gastrointestinal bleeding has also been well described. 30 Although the main causes are thought to be arterial-venous malformations, patients with low PI also seem to have increased venous congestion, as our results suggest; in the overall group, PI at discharge correlated with the pre-implant RAP and MPAP rather than with the PCWP (Table 2). Grinstein et al recently presented data showing an association between the filling phase slope of the HeartWare II flow waveform and PCWP.…”

Section: Rap and Pcwp In Association With Pimentioning

confidence: 54%

Left ventricle assist device pulsatility index at the time of implantation is associated with follow-up pulmonary hemodynamics

et al. 2020

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HeartMate II left ventricular assist device controllers provide data including pulsatility index, reflecting the relationship between pump function and hemodynamics. We propose that a higher pulsatility index at hospital discharge following implant may be associated with less vascular congestion and improved clinical outcomes. A retrospective analysis of 40 patients (age 59.2 ± 10.3 years) supported with the HeartMate II devices was conducted. Data revealed moderate Pearson correlations between pulsatility index at discharge and right atrial pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure, respectively, post-surgery (median of 377 days), demonstrating a stronger relationship when analyzed for the EPC controller (n = 28) only (r = −.57, p < .01; r = −.38, p < .05; r = −.59, p < .01; r = −.47, p = .01 and r = −.53, p < .01, respectively). The pulsatility index derived from the EPC controller was associated with the significant risk of re-hospitalization within 1 and 2 years after the implantation of left ventricular assist device; hazard ratio = 0.557 with 95% confidence interval (0.315–0.983), p = .04 and hazard ratio = .579 (0.341–0.984), p = .04. A higher pulsatility index at discharge was associated with greater volume unloading, lower pulmonary pressures, and lower risk of all-cause re-hospitalizations within 1 and 2 years post-surgery. As such, pump-derived data may provide additional value in predicting left ventricular assist device hemodynamics.

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Section: Rap and Pcwp In Association With Pimentioning

confidence: 54%

Left ventricle assist device pulsatility index at the time of implantation is associated with follow-up pulmonary hemodynamics

et al. 2020

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“…There is growing concern over the potential for continuous-flow LVAD therapy to increase the risk of end-organ dysfunction, 6 gastrointestinal bleeding, 8–10 endothelial dysfunction, 11 autonomic dysregulation and impaired renal function 4–6,12 and pulmonary gas-exchange impairment. 7,13,14 As such, it is conceivable that longitudinal monitoring of arterial pulsatility in LVAD patients may also hold prognostic value.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] It is well known that continuous-flow LVADs adversely impact on the arterial pulse waveform, wherein arterial pulsatility Non-invasive assessment of arterial pulsatility in patients with continuousflow left ventricular assist devices declines the further that pump speed is increased. 3 Unfortunately, low arterial pulsatility may increase the risk of several negative outcomes, such as long-term end-organ dysfunction, [4][5][6][7] gastrointestinal bleeding, [8][9][10] endothelial dysfunction, 11 autonomic dysregulation and impaired renal function [4][5][6]12 and may also impair pulmonary function and gas exchange. 7,13,14 With these associated risks in mind, the question arises: Is monitoring of arterial pulsatility in LVAD patients important for ensuring their safety and longevity?…”

Section: Introductionmentioning

confidence: 99%

“…It is of note that some recent generations of LVADs offer indirect measurements of arterial pulsatility – these indices of arterial pulsatility are typically derived from ‘pulsatile-like’ changes in LVAD pump power. 20 Notwithstanding the many studies that have demonstrated an association between LVAD pump-derived indices of pulsatility and adverse clinical outcomes, 6,8,9,11,21 these measures of arterial pulsatility correlate poorly with that invasively determined from arterial blood pressure (ABP). 22 Thus, while it cannot be denied that pulsatility index (PI), pump speed and power may provide useful information for the monitoring and prevention of serious adverse outcomes, such as pump thrombosis, 23 it remains to be seen whether more accurate measures of arterial pulsatility may confer additional benefits for the clinical management of LVAD patients.…”

Section: Introductionmentioning

confidence: 99%

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Non-invasive assessment of arterial pulsatility in patients with continuous-flow left ventricular assist devices

et al. 2019

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Introduction: Long-term use of continuous-flow left ventricular assist devices may have negative consequences for autonomic, cardiovascular and gastrointestinal function. It has thus been suggested that non-invasive monitoring of arterial pulsatility in patients with a left ventricular assist device is highly important for ensuring patient safety and longevity. We have developed a novel, semi-automated frequency-domain-based index of arterial pulsatility that is obtained during suprasystolic occlusions of the upper arm: the ‘cuff pulsatility index’. Purpose: The purpose of this study was to evaluate the relationship between the cuff pulsatility index and invasively determined arterial pulsatility in patients with a left ventricular assist device. Methods: Twenty-three patients with a left ventricular assist device with end-stage heart failure (six females: age = 65 ± 9 years; body mass index = 30.5 ± 3.7 kg m−2) were recruited for this study. Suprasystolic occlusions were performed on the upper arm of the patient’s dominant side, from which the cuff pressure waveform was obtained. Arterial blood pressure was obtained from the radial artery on the contralateral arm. Measurements were obtained in triplicate. The relationship between the cuff pressure and arterial blood pressure waveforms was assessed in the frequency-domain using coherence analysis. A mixed-effects approach was used to assess the relationship between cuff pulsatility index and invasively determined arterial pulsatility (i.e. pulse pressure). Results: The cuff pressure and arterial blood pressure waveforms demonstrated a high coherence up to the fifth harmonic of the cardiac frequency (heart rate). The cuff pulsatility index accurately tracked changes in arterial pulse pressure within a given patient across repeated measurements. Conclusions: The cuff pulsatility index shows promise as a non-invasive index for monitoring residual arterial pulsatility in patients with a left ventricular assist device across time.

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Noninvasive Blood Pressure Monitor Designed for Patients With Heart Failure Supported with Continuous-Flow Left Ventricular Assist Devices

et al. 2019

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The gold standard for noninvasive blood pressure (BP) measurement, the Doppler technique, does not provide systolic blood pressure (SBP) and diastolic blood pressure (DBP) and may limit therapy outcomes. To improve patient care, we tested specifically designed experimental BP (ExpBP) monitor and the Doppler technique by comparing noninvasive measures to the intraarterial (I-A) BP in 31 patients with end-stage heart failure (4 females) 2.6 ± 3.4 days post-LVAD implantation (20 HeartMate II and 11 HeartWare). Bland-Altman plots revealed that the ExpBP monitor overestimated mean arterial pressure (MAP) by 1.2 (4.8) mm Hg (mean difference [standard deviation]), whereas the Doppler by 6.7 (5.8) mm Hg. The ExpBP SBP was overestimated by 0.8 (6.1) mm Hg and DBP by 1.9 (5.3) mm Hg compared with the respective I-A pressures. Both techniques achieved similar measurement reliability. In the measurement "success rate" expressed as a frequency (percent) of readable BP values per measurement attempts, Doppler accomplished 100% vs. 97%, 97%, and 94% of successful detections of MAP, SBP, and DBP provided by the ExpBP monitor. The ExpBP monitor demonstrated higher accuracy in the MAP assessment than the Doppler in addition to providing SBP and DBP in majority of subjects. Improved BP control may help to mitigate related neurologic adverse event rates.

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Mo2020 Low Pulsatility Index Is Associated With an Increased Hazard of Gastrointestinal Bleeding in Patients With Continuous-Flow Left Ventricular Assist Devices

Cited by 3 publications

References 0 publications

Left ventricle assist device pulsatility index at the time of implantation is associated with follow-up pulmonary hemodynamics

Left ventricle assist device pulsatility index at the time of implantation is associated with follow-up pulmonary hemodynamics

Non-invasive assessment of arterial pulsatility in patients with continuous-flow left ventricular assist devices

Noninvasive Blood Pressure Monitor Designed for Patients With Heart Failure Supported with Continuous-Flow Left Ventricular Assist Devices

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