Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.
JACC Heart Fail. 2015 Dec;3(12):956-64. doi: 10.1016/j.jchf.2015.09.009. Epub 2015 Nov 11.
This study sought to determine whether severe right ventricular (RV) dysfunction in the pre-operative setting is associated with an increased risk of gastrointestinal bleeding (GIB) post-left ventricular assist device (LVAD).
GIB is a significant complication in patients supported with continuous-flow LVADs. The impact of RV dysfunction on the risk of GIB has not been investigated.
We retrospectively identified 212 patients who survived index hospitalization after implantation of HeartMate II (Thoratec Corp., Pleasanton, California) or Heartware HVAD (HeartWare Corp., Framingham, Massachusetts) from June 2009 to April 2013. Patients with severe RV dysfunction on pre-LVAD echocardiogram (n = 37) were compared to patients without severe RV dysfunction (n = 175). The primary outcome was freedom from GIB.
The majority of patients were male (79%) with a median INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile of 2 at LVAD implantation. There were no significant differences between cohorts with respect to demographics, comorbidities, device type, international normalization ratio, or aspirin strategy. During follow-up, 81 patients had GIB events: 23 of 37 (62%) in the severe RV dysfunction group versus 58 of 175 (33%) in the control group (p = 0.001). After adjustment for age and ischemic cardiomyopathy, severe RV dysfunction was associated with increased risk of GIB (hazard ratio: 1.799, 95% confidence interval: 1.089 to 2.973, p = 0.022).
In this single-center sample of patients supported with continuous-flow LVADs, severe RV dysfunction on pre-LVAD echocardiogram was associated with an increased risk of GIB. Further studies are needed to investigate possible mechanisms by which RV dysfunction increases the risk of GIB and to identify patient populations who may benefit from alterations in antithrombotic strategies.
本研究旨在确定术前严重右心室（RV）功能障碍是否与左心室辅助装置（LVAD）后胃肠道出血（GIB）的风险增加相关。
GIB 是接受连续血流 LVAD 支持的患者的一个重要并发症。RV 功能障碍对 GIB 风险的影响尚未得到研究。
我们回顾性地确定了 2009 年 6 月至 2013 年 4 月期间植入 HeartMate II（Thoratec 公司，加利福尼亚州普莱森顿）或 Heartware HVAD（HeartWare 公司，马萨诸塞州弗雷明汉）后存活的 212 名患者的住院指数。在 LVAD 前超声心动图上有严重 RV 功能障碍的患者（n=37）与没有严重 RV 功能障碍的患者（n=175）进行比较。主要结果是无 GIB 事件。
大多数患者为男性（79%），LVAD 植入时 INTERMACS（机械辅助循环支持机构间注册）谱中位数为 2。两组患者在人口统计学、合并症、设备类型、国际标准化比值或阿司匹林策略方面无显著差异。在随访期间，81 例患者发生 GIB 事件：严重 RV 功能障碍组 23 例（62%），对照组 58 例（33%）（p=0.001）。在调整年龄和缺血性心肌病后，严重 RV 功能障碍与 GIB 风险增加相关（风险比：1.799，95%置信区间：1.089 至 2.973，p=0.022）。
在本单中心连续血流 LVAD 支持患者样本中，LVAD 前超声心动图上的严重 RV 功能障碍与 GIB 风险增加相关。需要进一步研究以探讨 RV 功能障碍增加 GIB 风险的可能机制，并确定可能从抗血栓治疗策略改变中获益的患者人群。
