Impact of progressive aortic regurgitation on outcomes after left ventricular assist device implantation
(2022) In Heart and Vessels 37(12). p.1985-1994- Abstract
Aortic regurgitation (AR) following continuous flow left ventricular assist device implantation (cf-LVAD) may adversely impact outcomes. We aimed to assess the incidence and impact of progressive AR after cf-LVAD on prognosis, biomarkers, functional capacity and echocardiographic findings. In an analysis of the PCHF-VAD database encompassing 12 European heart failure centers, patients were dichotomized according to the progression of AR following LVAD implantation. Patients with de-novo AR or AR progression (AR_1) were compared to patients without worsening AR (AR_0). Among 396 patients (mean age 53 ± 12 years, 82% male), 153 (39%) experienced progression of AR over a median of 1.4 years on LVAD support. Before LVAD implantation, AR_1... (More)
Aortic regurgitation (AR) following continuous flow left ventricular assist device implantation (cf-LVAD) may adversely impact outcomes. We aimed to assess the incidence and impact of progressive AR after cf-LVAD on prognosis, biomarkers, functional capacity and echocardiographic findings. In an analysis of the PCHF-VAD database encompassing 12 European heart failure centers, patients were dichotomized according to the progression of AR following LVAD implantation. Patients with de-novo AR or AR progression (AR_1) were compared to patients without worsening AR (AR_0). Among 396 patients (mean age 53 ± 12 years, 82% male), 153 (39%) experienced progression of AR over a median of 1.4 years on LVAD support. Before LVAD implantation, AR_1 patients were less frequently diabetic, had lower body mass indices and higher baseline NT-proBNP values. Progressive AR did not adversely impact mortality (26% in both groups, HR 0.91 [95% CI 0.61–1.36]; P = 0.65). No intergroup variability was observed in NT-proBNP values and 6-minute walk test results at index hospitalization discharge and at 6-month follow-up. However, AR_1 patients were more likely to remain in NYHA class III and had worse right ventricular function at 6-month follow-up. Lack of aortic valve opening was related to de-novo or worsening AR (P < 0.001), irrespective of systolic blood pressure (P = 0.67). Patients commonly experience de-novo or worsening AR when exposed to continuous flow of contemporary LVADs. While reducing effective forward flow, worsening AR did not influence survival. However, less complete functional recovery and worse RV performance among AR_1 patients were observed. Lack of aortic valve opening was associated with progressive AR.
(Less)
- author
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Aortic regurgitation, Left ventricular assist device, Outcome
- in
- Heart and Vessels
- volume
- 37
- issue
- 12
- pages
- 1985 - 1994
- publisher
- Springer
- external identifiers
-
- pmid:35737119
- scopus:85132726381
- ISSN
- 0910-8327
- DOI
- 10.1007/s00380-022-02111-1
- language
- English
- LU publication?
- yes
- id
- 113bb48c-9634-4157-8f7d-d57b8a3b8997
- date added to LUP
- 2022-10-10 13:28:25
- date last changed
- 2024-04-18 07:49:09
@article{113bb48c-9634-4157-8f7d-d57b8a3b8997,
abstract = {{<p>Aortic regurgitation (AR) following continuous flow left ventricular assist device implantation (cf-LVAD) may adversely impact outcomes. We aimed to assess the incidence and impact of progressive AR after cf-LVAD on prognosis, biomarkers, functional capacity and echocardiographic findings. In an analysis of the PCHF-VAD database encompassing 12 European heart failure centers, patients were dichotomized according to the progression of AR following LVAD implantation. Patients with de-novo AR or AR progression (AR_1) were compared to patients without worsening AR (AR_0). Among 396 patients (mean age 53 ± 12 years, 82% male), 153 (39%) experienced progression of AR over a median of 1.4 years on LVAD support. Before LVAD implantation, AR_1 patients were less frequently diabetic, had lower body mass indices and higher baseline NT-proBNP values. Progressive AR did not adversely impact mortality (26% in both groups, HR 0.91 [95% CI 0.61–1.36]; P = 0.65). No intergroup variability was observed in NT-proBNP values and 6-minute walk test results at index hospitalization discharge and at 6-month follow-up. However, AR_1 patients were more likely to remain in NYHA class III and had worse right ventricular function at 6-month follow-up. Lack of aortic valve opening was related to de-novo or worsening AR (P < 0.001), irrespective of systolic blood pressure (P = 0.67). Patients commonly experience de-novo or worsening AR when exposed to continuous flow of contemporary LVADs. While reducing effective forward flow, worsening AR did not influence survival. However, less complete functional recovery and worse RV performance among AR_1 patients were observed. Lack of aortic valve opening was associated with progressive AR.</p>}},
author = {{Gasparovic, Hrvoje and Jakus, Nina and Brugts, Jasper J. and Pouleur, Anne Catherine and Timmermans, Philippe and Rubiś, Pawel and Gaizauskas, Edvinas and Van Craenenbroeck, Emeline M. and Barge-Caballero, Eduardo and Grundmann, Sebastian and Paolillo, Stefania and D’Amario, Domenico and Braun, Oscar and Meyns, Bart and Droogne, Walter and Wierzbicki, Karol and Holcman, Katarzyna and Planinc, Ivo and Lovric, Daniel and Flammer, Andreas J. and Petricevic, Mate and Biocina, Bojan and Lund, Lars H. and Milicic, Davor and Ruschitzka, Frank and Cikes, Maja}},
issn = {{0910-8327}},
keywords = {{Aortic regurgitation; Left ventricular assist device; Outcome}},
language = {{eng}},
number = {{12}},
pages = {{1985--1994}},
publisher = {{Springer}},
series = {{Heart and Vessels}},
title = {{Impact of progressive aortic regurgitation on outcomes after left ventricular assist device implantation}},
url = {{http://dx.doi.org/10.1007/s00380-022-02111-1}},
doi = {{10.1007/s00380-022-02111-1}},
volume = {{37}},
year = {{2022}},
}