Watanabe Aya, Amiya Eisuke, Hatano Masaru, Watanabe Masafumi, Ozeki Atsuko, Nitta Daisuke, Maki Hisataka, Hosoya Yumiko, Tsuji Masaki, Bujo Chie, Saito Akihito, Endo Miyoko, Kagami Yukie, Nemoto Mariko, Nawata Kan, Kinoshita Osamu, Kimura Mitsutoshi, Ono Minoru, Komuro Issei
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Heart Vessels. 2020 Feb;35(2):207-213. doi: 10.1007/s00380-019-01474-2. Epub 2019 Jul 20.
The precise physiological changes associated with the use of left ventricular assist device (LVAD) are not well characterized. We examined the impact of changes in hemodynamic state using LVAD on endothelial function. We measured flow-mediated vasodilation (FMD) to evaluate endothelial vasodilator function of the brachial artery in 53 patients (dilated cardiomyopathy: 39, ischemic cardiomyopathy: 4, and others: 10) with an implanted LVAD (DuraHeart, EVAHEART, or HeartMate II). We found that FMD value in the HeartMateII LVAD group (9.3% ± 2.9%) was significantly higher than those in the other two groups (EVAHEART: 6.7% ± 2.8% and DuraHeart: 6.2% ± 4.0%). Other factors that affected the FMD value were age (r = - 0.31, p = 0.026), Brinkman index (r = - 0.30, p = 0.029); however, aortic opening, aortic regurgitation, and other hemodynamic parameters such as cardiac index or pulmonary capillary wedge pressure did not correlate with FMD. Multivariate analyses revealed that the difference among the LVAD models most significantly affected the FMD values after adjusting for age and smoking status (t = 2.6, p = 0.014). Event free survival rate of death and cerebral infarction was not significantly different according to the value of FMD. The difference among the LVAD groups most significantly affected the state of endothelial function and it had more impact than other clinical factors.
与使用左心室辅助装置（LVAD）相关的精确生理变化尚未得到充分表征。我们研究了使用LVAD引起的血流动力学状态变化对内皮功能的影响。我们测量了53例植入LVAD（DuraHeart、EVAHEART或HeartMate II）患者肱动脉的血流介导的血管舒张（FMD），以评估内皮血管舒张功能。这53例患者包括扩张型心肌病39例、缺血性心肌病4例和其他类型10例。我们发现，HeartMateII LVAD组的FMD值（9.3%±2.9%）显著高于其他两组（EVAHEART组：6.7%±2.8%和DuraHeart组：6.2%±4.0%）。影响FMD值的其他因素包括年龄（r = -0.31，p = 0.026）、布林克曼指数（r = -0.30，p = 0.029）；然而，主动脉瓣开放、主动脉瓣反流以及其他血流动力学参数，如心脏指数或肺毛细血管楔压，与FMD均无相关性。多因素分析显示，在调整年龄和吸烟状态后，LVAD模型之间的差异对FMD值的影响最为显著（t = 2.6，p = 0.014）。根据FMD值，死亡和脑梗死的无事件生存率无显著差异。LVAD组之间的差异对内皮功能状态的影响最为显著，且比其他临床因素的影响更大。
