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

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Citation: American Journal of Cardiology. 169:78-85, 2022 Apr 15.PMID: 35063265Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Heart Failure | *Heart-Assist Devices | *Hypotension | *Stroke | Blood Pressure | Heart Failure/co [Complications] | Heart Failure/ep [Epidemiology] | Heart Failure/th [Therapy] | Heart-Assist Devices/ae [Adverse Effects] | Humans | Hypotension/et [Etiology] | Retrospective Studies | Stroke/et [Etiology] | Treatment OutcomeYear: 2022Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006Name of journal: The American journal of cardiologyAbstract: 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. Copyright (c) 2021 Elsevier Inc. All rights reserved.All authors: Alexis JD, Altintas O, Birati EY, Bisognano JD, DeVore AD, Genuardi MV, Goldenberg I, Gosev I, Kutyifa V, McNitt S, Polonsky B, Seidmann A, Sheikh FH, Vidula HOriginally published: American Journal of Cardiology. 2022 Jan 18Fiscal year: FY2022Digital Object Identifier: Date added to catalog: 2022-02-21
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Journal Article MedStar Authors Catalog Article 35063265 Available 35063265

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

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. Copyright (c) 2021 Elsevier Inc. All rights reserved.

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