Low Blood Pressure Threshold for Adverse Outcomes During Left Ventricular Assist Device Support

Himabindu Vidula, Onur Altintas, Scott McNitt, Adam D. DeVore, Edo Y. Birati, Michael V. Genuardi, Farooq H. Sheikh, Bronislava Polonsky, Jeffrey D. Alexis, Igor Gosev, John D. Bisognano, Valentina Kutyifa, Abraham Seidmann, Ilan Goldenberg

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

It has been suggested that maintaining low mean arterial pressure (MAP) in left ventricular assist device (LVAD) recipients is associated with a reduced risk of stroke/death. However, the lower limit of the optimal MAP range has not been established. We aimed to identify this lower limit in a contemporary cohort of LVAD recipients with frequent longitudinal MAP measurements. We analyzed 86,651 MAP measurements in 309 patients with an LVAD (32% LVADs with full magnetic levitation of the impeller) at a tertiary medical center during a mean follow-up of 1.7 ± 1.1 years. Cox proportional hazards regression modeling was used to study the association of serial MAP measurements with stroke/death within 3 years after index discharge. Multivariate analysis identified MAP ≤75 mm Hg, compared with MAP >75 mm Hg, as the low MAP threshold associated with increased risk of death (hazard ratio [HR] 4.74, 95% confidence interval [CI] 2.85 to 7.87, p <0.001), stroke (HR 2.72;, 95% CI 1.39 to 5.33, p = 0.01), and stroke/death (HR 4.45, 95% CI 2.83 to 6.99, p <0.001). The risk associated with MAP ≤75 mm Hg was consistent in subgroups categorized by age, gender, race, device type, renal function, right-sided heart failure, and blood pressure medications. In conclusion, our findings suggest that maintaining MAP ≤75 mm Hg during long-term follow-up in LVAD recipients is associated with increased risk of stroke/death regardless of risk factors or medical management.

Original languageEnglish
Pages (from-to)78-85
Number of pages8
JournalAmerican Journal of Cardiology
Volume169
DOIs
StatePublished - 15 Apr 2022

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Inc.

Funding

Dr. Vidula has research support from Abbott Laboratories and the National Institutes of Health. Dr. Gosev is a consultant for Abbott Laboratories. Dr. Birati has research support from Medtronic. Dr. Farooq H. Sheikh has received consulting fees/honoraria and research support from Abbott Laboratories and honoraria from Medtronic. Dr. DeVore reports research funding through his institution from the American Heart Association, National Heart, Lung, and Blood Institute, and Patient-Centered Outcomes Research Institute. He has also received nonfinancial support from Abbott Laboratories for educational activities. The remaining authors have no conflicts of interest to declare. Dr. Himabindu Vidula is supported by National Institutes of Health (Bethesda, Maryland) grants 1R01HL155201-01 and 1R01HL159401-01 and has received a research grant from Abbott Laboratories (Abbott Park, Illinois).

FundersFunder number
National Institutes of Health1R01HL159401-01
National Heart, Lung, and Blood InstituteR01HL155201
Abbott Laboratories

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