Cardiovascular Center, Tufts Medical Center; Predictive Analytics and Comparative Effectiveness Center.
Clinical and Translational Sciences Institute, Tufts Medical Center, Boston, Massachusetts.
J Card Fail. 2021 May;27(5):552-559. doi: 10.1016/j.cardfail.2021.01.004. Epub 2021 Jan 12.
Elevated pulmonary vascular resistance (PVR) is common in patients with advanced heart failure. PVR generally improves after left ventricular assist device (LVAD) implantation, but the rate of decrease has not been quantified and the patient characteristics most strongly associated with this improvement are unknown.
We analyzed 1581 patients from the Interagency Registry for Mechanically Assisted Circulatory Support registry who received a primary continuous-flow LVAD, had a baseline PVR of ≥3 Wood units (WU), and had PVR measured at least once postoperatively. Multivariable linear mixed effects modeling was used to evaluate independent associations between postoperative PVR and patient characteristics. PVR decreased by 1.53 WU (95% confidence interval [CI] 1.27-1.79 WU) per month in the first 3 months postoperatively, and by 0.066 WU (95% CI 0.060-0.070 WU) per month thereafter. Severe mitral regurgitation at any time during follow-up was associated with a 1.29 WU (95% CI 1.05-1.52 WU) higher PVR relative to absence of mitral regurgitation at that time. In a cross-sectional analysis, 15%-25% of patients had persistently elevated PVR of ≥3 WU at any given time within 36 months after LVAD implantation.
The PVR tends to decrease rapidly early after implantation, and only more gradually thereafter. Residual mitral regurgitation may be an important contributor to elevated postoperative PVR. Future research is needed to understand the implications of elevated PVR after LVAD implantation and the optimal strategies for prevention and treatment.
晚期心力衰竭患者的肺血管阻力（PVR）通常升高。左心室辅助装置（LVAD）植入后，PVR 通常会改善，但下降的速度尚未量化，与改善最相关的患者特征也未知。
我们分析了来自机械循环辅助支持机构注册中心的 1581 例接受原发性连续血流 LVAD 的患者，这些患者基线 PVR≥3 伍德单位（WU），且术后至少有一次测量了 PVR。多变量线性混合效应模型用于评估术后 PVR 与患者特征之间的独立关联。术后 3 个月内，PVR 每月降低 1.53 WU（95%置信区间 [CI] 1.27-1.79 WU），此后每月降低 0.066 WU（95% CI 0.060-0.070 WU）。在随访期间任何时间存在严重二尖瓣反流与不存在二尖瓣反流时相比，PVR 升高 1.29 WU（95% CI 1.05-1.52 WU）。在横断面分析中，15%-25%的患者在 LVAD 植入后 36 个月内的任何给定时间内，PVR 持续升高≥3 WU。
PVR 在植入后早期迅速下降，此后仅逐渐下降。残留的二尖瓣反流可能是术后 PVR 升高的一个重要因素。需要进一步研究来了解 LVAD 植入后 PVR 升高的意义以及预防和治疗的最佳策略。
