Decoupling Between Diastolic Pulmonary Arterial Pressure and Pulmonary Arterial Wedge Pressure at Incremental Left Ventricular Assist Device (LVAD) Speeds Is Associated With Worse Prognosis After LVAD Implantation.
J Card Fail
; 24(9): 575-582, 2018 Sep.
Article
em En
| MEDLINE
| ID: mdl-30103020
ABSTRACT
BACKGROUND:
Decoupling between diastolic pulmonary arterial pressure (dPAP) and pulmonary arterial wedge pressure (PAWP) is an index of pulmonary vasculature remodeling and provides prognostic information. Furthermore, decoupling may change during incremental left ventricular assist device (LVAD) speed changes. METHODS ANDRESULTS:
In this prospective study, patients underwent an echocardiographic and hemodynamic ramp test after LVAD implantation and were followed for 1 year. The change in decoupling (dPAPâ¯-â¯PAWP) between the lowest and highest LVAD speeds during the ramp test was calculated. Survival and heart failure admission rates were assessed by means of Kaplan-Meier analysis. Eighty-seven patients were enrolled in the study 54 had a Heartmate II LVAD (60.8 ± 9.3 years of age and 34 male) and 33 had an HVAD LVAD (58.6 ± 13.2 years of age and 20 male). Patients who experienced greater changes in decoupling (Δdecoupling >3 mm Hg) had a persistently elevated dPAP at incremental LVAD speed and had worse 1-year heart failure readmission-free survival compared with the group without significant changes in the degree of decoupling (41% vs 75%; Pâ¯=â¯.001).CONCLUSIONS:
An increase in decoupling between dPAP and PAWP at incremental LVAD speed changes was associated with worse prognosis in LVAD patients.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Pressão Propulsora Pulmonar
/
Coração Auxiliar
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Função Ventricular Esquerda
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Insuficiência Cardíaca
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Ventrículos do Coração
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article