Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Artif Organs. 2020 Mar;44(3):231-238. doi: 10.1111/aor.13565. Epub 2019 Oct 6.
Pump-induced thrombosis continues to be a major complication of continuous-flow left ventricular assist devices (CF-LVADs), which increases the risks of thromboembolic stroke, peripheral thromboembolism, reduced pump flow, pump failure, cardiogenic shock, and death. This is confounded by the fact that there is currently no direct measure for a proper diagnosis during pump support. Given the severity of this complication and its required treatment, the ability to accurately differentiate CF-LVAD pump thrombosis from other complications is vital. Hemolysis measured by elevated lactate dehydrogenase (LDH) enzyme levels, when there is clinical suspicion of pump-induced thrombosis, is currently accepted as an important metric used by clinicians for diagnosis; however, LDH is a relatively nonspecific finding. LDH exists as five isoenzymes in the body, each with a unique tissue distribution. CF-LVAD pump thrombosis has been associated with elevated serum LDH-1 and LDH-2, as well as decreased LDH-4 and LDH-5. Herein, we review the various isoenzymes of LDH and their utility in differentiating hemolysis seen in CF-LVAD pump thrombosis from other physiologic and pathologic conditions as reported in the literature.
泵诱导血栓仍然是连续流动左心室辅助装置（CF-LVAD）的主要并发症，这增加了血栓栓塞性中风、外周血栓栓塞、泵流量降低、泵衰竭、心源性休克和死亡的风险。由于目前在泵支持期间没有直接的适当诊断措施，这使得情况更加复杂。鉴于这种并发症的严重性及其所需的治疗，准确区分 CF-LVAD 泵血栓形成与其他并发症至关重要。当临床怀疑泵诱导血栓形成时，通过升高的乳酸脱氢酶（LDH）酶水平测量的溶血目前被临床医生接受为用于诊断的重要指标；然而，LDH 是一种相对非特异性的发现。LDH 在体内存在五种同工酶，每种同工酶都有独特的组织分布。CF-LVAD 泵血栓形成与血清 LDH-1 和 LDH-2 升高以及 LDH-4 和 LDH-5 降低有关。在此，我们回顾了 LDH 的各种同工酶及其在区分文献报道的 CF-LVAD 泵血栓形成中所见溶血与其他生理和病理情况的用途。
