Amit C Patel1, R Blair Dodson2, William K Cornwell1, Kendall S Hunter3, Joseph C Cleveland4, Andreas Brieke1, JoAnn Lindenfeld5, Amrut V Ambardekar6. 1. Division of Cardiology, University of Colorado, Aurora, Colorado. 2. Department of Bioengineering, University of Colorado, Aurora, Colorado; Division of Pediatric Surgery, University of Colorado, Aurora, Colorado. 3. Department of Bioengineering, University of Colorado, Aurora, Colorado; Department of Pediatrics, Division of Cardiology, University of Colorado, Aurora, Colorado. 4. Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colorado. 5. Vanderbilt Heart and Vascular Institute, Nashville, Tennessee. 6. Division of Cardiology, University of Colorado, Aurora, Colorado. Electronic address: Amrut.Ambardekar@ucdenver.edu.
Abstract
OBJECTIVES: The aim of this study was to measure aortic vascular stiffness from orthotopic heart transplant (OHT) patients exposed to varying types of flow as a result of the presence or absence of left ventricular assist device (LVAD) support pre-OHT. BACKGROUND: The effects of continuous-flow LVADs (CF-LVADs) on vascular properties are unknown, but may contribute to the pathophysiology of CF-LVAD complications such as stroke, hypertension, and bleeding. METHODS: Echocardiograms were reviewed from 172 OHT patients immediately before LVAD and at 3 time points post-OHT: baseline, 6 months, and 1 year. For each study, pulse pressure and aortic end-systolic and end-diastolic dimensions were used to calculate aortic strain, distensibility, and stiffness index. Patients were categorized into 3 groups based on the presence or absence of a LVAD and a pulse pre-OHT: No LVAD (n = 111), LVAD No Pulse (n = 30), and LVAD With Pulse (n = 31). RESULTS: The aortic stiffness index among LVAD No Pulse patients increased from 2.8 ± 1.1 pre-CF-LVAD to 10.9 ± 4.7 immediately post-OHT (p < 0.001). This aortic stiffness index was also significantly higher compared with No LVAD (3.4 ± 1.1; p < 0.001) and LVAD With Pulse (3.7 ± 1.4; p < 0.001) immediately post-OHT with attenuation of these differences by 1 year post-OHT. Similar findings were noted for the other indices of aortic stiffness. CONCLUSIONS: Aortic stiffness is markedly increased immediately post-OHT among patients bridged with CF-LVADs, with attenuation of this increased stiffness over the first year after transplant. These results suggest that aortic vascular properties are dynamic and may be influenced by alterations in flow pulsatility. As more patients are supported with CF-LVADs and as newer pump technology attempts to modulate pulsatility, further research examining the role of alterations in flow patterns on vascular function and the potential resultant systemic sequelae are needed.
OBJECTIVES: The aim of this study was to measure aortic vascular stiffness from orthotopic heart transplant (OHT) patients exposed to varying types of flow as a result of the presence or absence of left ventricular assist device (LVAD) support pre-OHT. BACKGROUND: The effects of continuous-flow LVADs (CF-LVADs) on vascular properties are unknown, but may contribute to the pathophysiology of CF-LVAD complications such as stroke, hypertension, and bleeding. METHODS: Echocardiograms were reviewed from 172 OHT patients immediately before LVAD and at 3 time points post-OHT: baseline, 6 months, and 1 year. For each study, pulse pressure and aortic end-systolic and end-diastolic dimensions were used to calculate aortic strain, distensibility, and stiffness index. Patients were categorized into 3 groups based on the presence or absence of a LVAD and a pulse pre-OHT: No LVAD (n = 111), LVAD No Pulse (n = 30), and LVAD With Pulse (n = 31). RESULTS: The aortic stiffness index among LVAD No Pulse patients increased from 2.8 ± 1.1 pre-CF-LVAD to 10.9 ± 4.7 immediately post-OHT (p < 0.001). This aortic stiffness index was also significantly higher compared with No LVAD (3.4 ± 1.1; p < 0.001) and LVAD With Pulse (3.7 ± 1.4; p < 0.001) immediately post-OHT with attenuation of these differences by 1 year post-OHT. Similar findings were noted for the other indices of aortic stiffness. CONCLUSIONS: Aortic stiffness is markedly increased immediately post-OHT among patients bridged with CF-LVADs, with attenuation of this increased stiffness over the first year after transplant. These results suggest that aortic vascular properties are dynamic and may be influenced by alterations in flow pulsatility. As more patients are supported with CF-LVADs and as newer pump technology attempts to modulate pulsatility, further research examining the role of alterations in flow patterns on vascular function and the potential resultant systemic sequelae are needed.
Authors: Amrut V Ambardekar; Matthew S Stratton; Evgenia Dobrinskikh; Kendall S Hunter; Philip D Tatman; Madeleine E Lemieux; Joseph C Cleveland; Rubin M Tuder; Mary C M Weiser-Evans; Karen S Moulton; Timothy A McKinsey Journal: J Am Coll Cardiol Date: 2021-11-02 Impact factor: 24.094
Authors: Amrut V Ambardekar; Mary C M Weiser-Evans; Marcella Li; Suneet N Purohit; Muhammad Aftab; T Brett Reece; Karen S Moulton Journal: Circ Heart Fail Date: 2018-05 Impact factor: 8.790
Authors: Suneet N Purohit; William K Cornwell; Jay D Pal; JoAnn Lindenfeld; Amrut V Ambardekar Journal: Circ Heart Fail Date: 2018-06 Impact factor: 8.790
Authors: Estibaliz Castillero; Ziad A Ali; Hirokazu Akashi; Nicholas Giangreco; Catherine Wang; Eric J Stöhr; Ruping Ji; Xiaokan Zhang; Nathaniel Kheysin; Joo-Eun S Park; Sheetal Hegde; Sanatkumar Patel; Samantha Stein; Carlos Cuenca; Diana Leung; Shunichi Homma; Nicholas P Tatonetti; Veli K Topkara; Koji Takeda; Paolo C Colombo; Yoshifumi Naka; H Lee Sweeney; P Christian Schulze; Isaac George Journal: Am J Physiol Heart Circ Physiol Date: 2018-08-24 Impact factor: 4.733
Authors: Eric J Stöhr; William K Cornwell; Manreet Kanwar; John R Cockcroft; Barry J McDonnell Journal: Exp Physiol Date: 2020-04-03 Impact factor: 2.858
Authors: Francesco Castagna; Eric J Stöhr; Alberto Pinsino; John R Cockcroft; Joshua Willey; A Reshad Garan; Veli K Topkara; Paolo C Colombo; Melana Yuzefpolskaya; Barry J McDonnell Journal: Curr Hypertens Rep Date: 2017-10-18 Impact factor: 5.369
Authors: Karen S Moulton; Marcella Li; Keith Strand; Shawna Burgett; Penn McClatchey; Rebecca Tucker; Seth B Furgeson; Sizhao Lu; Bruce Kirkpatrick; Joseph C Cleveland; Raphael A Nemenoff; Amrut V Ambardekar; Mary Cm Weiser-Evans Journal: JCI Insight Date: 2018-02-22