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High Right Atrial Pressure and Low Pulse Pressure Predict Gastrointestinal Bleeding in Patients With Left Ventricular Assist Device.
Joly, Joanna M; El-Dabh, Ashraf; Kirklin, James K; Marshell, Ramey; Smith, Michelle G; Acharya, Deepak; Rajapreyar, Indranee N; Tallaj, José A; Tresler, Margaret; Pamboukian, Salpy V.
Afiliação
  • Joly JM; University of Alabama at Birmingham, Department of Medicine, Division of Cardiovascular Disease, Birmingham, Alabama. Electronic address: jjoly@uabmc.edu.
  • El-Dabh A; University of Alabama at Birmingham, Department of Medicine, Division of Cardiovascular Disease, Birmingham, Alabama.
  • Kirklin JK; University of Alabama at Birmingham, Department of Surgery, Division of Cardiovascular Surgery, Birmingham, Alabama.
  • Marshell R; University of Alabama at Birmingham, Department of Medicine, Division of Cardiovascular Disease, Birmingham, Alabama.
  • Smith MG; University of Alabama at Birmingham, Department of Surgery, Division of Cardiovascular Surgery, Birmingham, Alabama.
  • Acharya D; University of Alabama at Birmingham, Department of Medicine, Division of Cardiovascular Disease, Birmingham, Alabama.
  • Rajapreyar IN; University of Alabama at Birmingham, Department of Medicine, Division of Cardiovascular Disease, Birmingham, Alabama.
  • Tallaj JA; University of Alabama at Birmingham, Department of Medicine, Division of Cardiovascular Disease, Birmingham, Alabama.
  • Tresler M; University of Alabama at Birmingham, Department of Surgery, Division of Cardiovascular Surgery, Birmingham, Alabama.
  • Pamboukian SV; University of Alabama at Birmingham, Department of Medicine, Division of Cardiovascular Disease, Birmingham, Alabama.
J Card Fail ; 24(8): 487-493, 2018 08.
Article em En | MEDLINE | ID: mdl-29572191
ABSTRACT

BACKGROUND:

Gastrointestinal bleeding (GIB) remains a major morbid event during continuous flow left ventricular assist device (LVAD) support. This study investigated whether a common hemodynamic profile is associated with GIB in patients with LVADs. METHODS AND

RESULTS:

A single institution analysis reviewed all patients who underwent right heart catheterization (RHC) following LVAD implant between January 1, 2006, and December 31, 2013, with follow-up through June 2015. Kaplan-Meier and multiphase hazard statistical methods were employed. Among 108 patients with 341 RHC, 55 hospitalizations for GIB occurred within 1 year of RHC. Freedom from GIB at 6 months was 92% in patients with pulse pressure ≥35 mmHg, compared with 76% with pulse pressure <35 mmHg. By multivariable analysis, the significant predictors of GIB were older age at implant, number of prior GIB, lower pulse pressure, lower mean arterial pressure, and higher right atrial pressure (all P < .05). The magnitude of effect is influenced by pulse pressure.

CONCLUSIONS:

Greater pulsatility and less venous congestion, along with other factors, are associated with a lower risk for GIB. It is reasonable to adjust therapeutic strategies to target this hemodynamic profile in patients with a propensity for GIB.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Coração Auxiliar / Função Ventricular Direita / Pressão Atrial / Insuficiência Cardíaca / Frequência Cardíaca / Hemorragia Gastrointestinal Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Card Fail Assunto da revista: CARDIOLOGIA Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Coração Auxiliar / Função Ventricular Direita / Pressão Atrial / Insuficiência Cardíaca / Frequência Cardíaca / Hemorragia Gastrointestinal Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Card Fail Assunto da revista: CARDIOLOGIA Ano de publicação: 2018 Tipo de documento: Article