TY  - BOOK
AU  - Sheikh, Farooq
TI  - Low Blood Pressure Threshold for Adverse Outcomes During Left Ventricular Assist Device Support
PY  - 2022///
KW  - *Heart Failure
KW  - *Heart-Assist Devices
KW  - *Hypotension
KW  - *Stroke
KW  - Blood Pressure
KW  - Heart Failure/co [Complications]
KW  - Heart Failure/ep [Epidemiology]
KW  - Heart Failure/th [Therapy]
KW  - Heart-Assist Devices/ae [Adverse Effects]
KW  - Humans
KW  - Hypotension/et [Etiology]
KW  - Retrospective Studies
KW  - Stroke/et [Etiology]
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - 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
UR  - https://dx.doi.org/10.1016/j.amjcard.2021.12.045
ER  -