Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague, 140 21, Czech Republic.
Second Faculty of Medicine, Charles University, Prague, Czech Republic.
ESC Heart Fail. 2021 Oct;8(5):4288-4295. doi: 10.1002/ehf2.13537. Epub 2021 Aug 4.
Recipients of left ventricular assist devices (LVAD) are exposed to increased risk of adverse clinical events. One of the potential contributing factors is non-pulsatile flow generated by LVAD. We evaluated the association of flow patterns in carotid arteries and of increased arterial stiffness with death and cerebrovascular events in LVAD recipients.
We analysed data from 83 patients [mean age 54 ± 15 years; 12 women; HeartMate II (HMII), n = 34; HeartMate 3 (HM3), n = 49]. Pulsatile and resistive indexes, atherosclerotic changes in carotid arteries (measured by duplex ultrasound), and arterial stiffness [measured by Endo-PAT 2000 as the augmentation index standardized for heart rate (AI@75)] were evaluated 3 and 6 months after LVAD implantation. Sixteen patients died during follow-up (27.3 months; interquartile range 15.7-44.3). After adjusting for the main variables examined, the pulsatility index measured at 3 months was positively associated with increased hazard ratios (HR) for death and cerebrovascular events [HR 9.8, 95% confidence interval (CI) 1.62-59.42], with HR increasing after adding AI@75 to the model (HR 18.8, 95% CI 2.44-145.50). In HM3 recipients, HR was significantly lower than in HMII recipients (HR 0.31, 95% CI 0.11-0.91), but the significance disappeared after adding AI@75 to the model (HR 0.33, 95% CI 0.09-1.18).
The risk of death and cerebrovascular events in LVAD recipients is associated with increased pulsatility index in carotid arteries and potentiated by increased arterial stiffness. The same risk is attenuated by HM3 LVAD implantation, but this effect is weakened by increased arterial stiffness.
接受左心室辅助装置（LVAD）的患者面临增加的不良临床事件风险。潜在的一个促成因素是 LVAD 产生的非脉动血流。我们评估了颈动脉血流模式和动脉僵硬度增加与 LVAD 接受者死亡和脑血管事件的关系。
我们分析了 83 名患者的数据[平均年龄 54±15 岁；12 名女性；HeartMate II（HMII），n=34；HeartMate 3（HM3），n=49]。在 LVAD 植入后 3 个月和 6 个月，评估了颈动脉的脉动和阻力指数、颈动脉粥样硬化变化（通过双功能超声测量）和动脉僵硬度[通过 Endo-PAT 2000 测量，作为心率标准化的增强指数（AI@75）]。16 名患者在随访期间死亡（27.3 个月；四分位间距 15.7-44.3）。在调整了主要检查变量后，3 个月时测量的脉动指数与死亡和脑血管事件的增加危险比（HR）呈正相关[HR 9.8，95%置信区间（CI）1.62-59.42]，在将 AI@75 添加到模型后，HR 增加（HR 18.8，95%CI 2.44-145.50）。在 HM3 接受者中，HR 明显低于 HMII 接受者（HR 0.31，95%CI 0.11-0.91），但在将 AI@75 添加到模型后，这种差异消失（HR 0.33，95%CI 0.09-1.18）。
LVAD 接受者的死亡和脑血管事件风险与颈动脉脉动指数增加有关，并因动脉僵硬度增加而加剧。HM3 LVAD 植入可降低相同风险，但动脉僵硬度增加会削弱这种效果。
