Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA.
Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
ESC Heart Fail. 2022 Oct;9(5):3496-3504. doi: 10.1002/ehf2.14099. Epub 2022 Jul 26.
Cardiopulmonary stress test (CPX) is routinely performed when evaluating patient candidacy for left ventricular assist device (LVAD) implantation. The predictive value of hypotensive systolic blood pressure (SBP) response during CPX on clinical outcomes is unknown. This study aims to determine the effect of hypotensive SBP response during to clinical outcomes among patients who underwent LVAD implantation.
This was a retrospective single center study enrolling consecutive patients implanted with a continuous flow LVAD between 2011 and 2022. Hypotensive SBP response was defined as peak exercise SBP below the resting value. Multivariable Cox-regression analysis was performed to evaluate the relationship between hypotensive SBP response and all-cause mortality within 30 and 90 days of LVAD implantation. A subgroup analysis was performed for patients implanted with a HeartMate III (HM III) device. Four hundred thirty-two patients underwent LVAD implantation during the pre-defined period and 156 with INTERMACS profiles 3-6 met our inclusion criteria. The median age was 63 years (IQR 54-69), and 52% had ischaemic cardiomyopathy. Hypotensive SBP response was present in 35% of patients and was associated with increased 90 day all-cause mortality (unadjusted HR 9.16, 95% CI 1.98-42; P = 0.0046). Hazard ratio remained significant after adjusting for age, INTERMACS profile, serum creatinine, and total bilirubin. Findings were similar in the HM III subgroup.
Hypotensive SBP response on pre-LVAD CPX is associated with increased perioperative and 90 day mortality after LVAD implantation. Additional studies are needed to determine the mechanism of increased mortality observed.
在评估患者左心室辅助装置 (LVAD) 植入候选资格时，通常会进行心肺压力测试 (CPX)。CPX 期间低血压收缩压 (SBP) 反应对临床结局的预测价值尚不清楚。本研究旨在确定 LVAD 植入患者 CPX 期间低血压 SBP 反应对临床结局的影响。
这是一项回顾性单中心研究，纳入了 2011 年至 2022 年间连续植入连续血流 LVAD 的患者。低血压 SBP 反应定义为峰值运动 SBP 低于静息值。多变量 Cox 回归分析用于评估 CPX 期间低血压 SBP 反应与 LVAD 植入后 30 天和 90 天内全因死亡率之间的关系。对植入 HeartMate III (HM III) 装置的患者进行了亚组分析。在规定的时间段内，432 名患者接受了 LVAD 植入，其中 156 名患者符合 INTERMACS 分级 3-6 标准，符合我们的纳入标准。患者的中位年龄为 63 岁（IQR 54-69），52%有缺血性心肌病。低血压 SBP 反应在 35%的患者中存在，与 90 天全因死亡率增加相关（未调整的 HR 9.16，95%CI 1.98-42；P=0.0046）。调整年龄、INTERMACS 分级、血清肌酐和总胆红素后，危险比仍然显著。在 HM III 亚组中也有相似的发现。
LVAD 前 CPX 时的低血压 SBP 反应与 LVAD 植入后围手术期和 90 天死亡率增加相关。需要进一步研究确定观察到的死亡率增加的机制。
