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1.
J Card Fail ; 27(7): 777-785, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33640481

RESUMO

BACKGROUND: The pulmonary artery pulsatility index (PAPi) has been studied to predict right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation, but only as a single time point before LVAD implantation. Multiple clinical factors and therapies impact RV function in pre-LVAD patients. Thus, we hypothesized that serial PAPi measurements during cardiac intensive care unit (CICU) optimization before LVAD implantation would provide incremental risk stratification for early RVF after LVAD implantation. METHODS AND RESULTS: Consecutive patients who underwent sequential pulmonary artery catherization with cardiac intensive care optimization before durable LVAD implantation were included. Serial hemodynamics were reviewed retrospectively across the optimization period. The optimal PAPi was defined by the initial PAPi + the PAPi at optimized hemodynamics. RVF was defined as need for a right ventricular assist device or prolonged inotrope use (>14 days postoperatively). Patients with early RVF had significantly lower mean optimal PAPi (3.5 vs 7.5, P < .001) compared with those who did not develop RVF. After adjusting for established risk factors of early RVF after LVAD implantation, the optimal PAPi was independently and incrementally associated with early RVF after LVAD implantation (odds ratio 0.64, 95% confidence interval 0.532-0.765, P < .0001). CONCLUSIONS: Optimal PAPi achieved during medical optimization before LVAD implantation provides independent and incremental risk stratification for early RVF, likely identifying dynamic RV reserve.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Disfunção Ventricular Direita , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Artéria Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia
2.
Pacing Clin Electrophysiol ; 37(6): 740-4, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24471992

RESUMO

BACKGROUND: Many patients eligible for cardiac resynchronization therapy (CRT) are over 80 years of age. Survival in this population and how it compares to the general octogenarian population has not been established. METHODS: We extracted clinical data on a cohort of 800 consecutive patients undergoing the new implantation of a CRT device between April 15, 2004 and August 6, 2007. Patients over age 80, with class III-IV New York Heart Association heart failure symptoms on optimal medical therapy undergoing initial CRT implantation, were included in the final cohort. Using the United States Social Security Period Life Table for 2006, fractional survival for octogenarians in the general population was calculated and matched to our cohort based on age and gender. A comparison was then made between octogenarians undergoing CRT compared to the general population. RESULTS: A total of 95 octogenarians who met inclusion criteria were identified, of whom 86.3% received a biventricular defibrillator and the remainder a biventricular pacemaker. Over a mean follow-up of 3.6 ± 1.5 years, there were 47 deaths (47.4%). The mean survival time was 4.1 years (95% CI 3.7-4.5), and survival at 2 years was 78.9%. Compared to the general octogenarian population, octogenarians receiving CRT had only modestly worse survival over the duration of follow-up with the survival curves diverging at 2 years of follow-up (P = 0.03). CONCLUSIONS: Octogenarians with advanced heart failure have a reasonable mean survival time following CRT. All-cause mortality in this patient population is only modestly worse compared to the general octogenarian population. Therefore, in octogenarians deemed to be reasonable candidates, CRT should not be withheld based on age alone.


Assuntos
Terapia de Ressincronização Cardíaca/mortalidade , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/prevenção & controle , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Ohio/epidemiologia , Prevalência , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida
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