| Arterial-wave reflections are increased in heart failure patients with a left-ventricular assist device. | |
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MedLine Citation:
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PMID: 17531918 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Chronic heart failure (HF) is associated with increased central arterial pulse-wave reflections, which may contribute to increased myocardial oxygen demand. Although the treatment of HF via left-ventricular assist device (LVAD) placement has recently become widespread, the effects of LVAD therapy on central arterial pulse-wave reflections are unknown. METHODS: Central aortic pulse-wave analysis was performed on patients with end-stage HF awaiting cardiac transplantation and on healthy age-matched controls using the SphygmoCor (Akor Medical, Sydney, Australia) system. Arterial pulse-wave data were compared between patients receiving LVAD support versus those receiving intravenous inotropic drugs and healthy control patients. RESULTS: Five patients on LVAD support were compared with 10 patients on inotropic drugs and 10 healthy control patients. Aortic augmented pressure and the aortic augmentation index (AI(a)) were higher in LVAD patients compared with inotrope and control patients, despite similar brachial and aortic blood pressures between groups. The AI(a) was significantly higher in LVAD patients than in patients on inotropic drugs (28.2% +/- 10% v 7.9% +/- 9%, P < or = .01). Additionally, there was a significantly higher aortic systolic tension time index, an index of left-ventricular myocardial oxygen demand, in the LVAD group compared with the inotrope group (2655 +/- 298 mm Hg/sec/min v 1748 +/- 303 mm Hg/sec/min, P < .01). CONCLUSIONS: Central arterial pressure-wave reflection is increased in end-stage HF patients on LVAD support compared with those on inotropic drugs, leading to an increase in aortic augmented pressure, AI(a), and systolic tension time index. The AI(a) is also higher in LVAD patients than in healthy controls. This increased central arterial-wave reflection places an additional hemodynamic load on the LVAD device and may have relevance to the medical management of patients after LVAD placement and to the longevity of the LVAD device itself. |
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Authors:
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Richard S Schofield; Gary L Pierce; Wilmer W Nichols; Charles T Klodell; Juan M Aranda; Daniel F Pauly; James A Hill; Randy W Braith |
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Publication Detail:
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Type: Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: American journal of hypertension Volume: 20 ISSN: 0895-7061 ISO Abbreviation: Am. J. Hypertens. Publication Date: 2007 Jun |
Date Detail:
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Created Date: 2007-05-28 Completed Date: 2007-07-26 Revised Date: 2009-02-24 |
Medline Journal Info:
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Nlm Unique ID: 8803676 Medline TA: Am J Hypertens Country: United States |
Other Details:
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Languages: eng Pagination: 622-8 Citation Subset: IM |
Affiliation:
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Department of Veterans Affairs Medical Center, Gainesville, Florida, USA. schofrs@medicine.ufl.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aorta / physiology* Blood Pressure / drug effects, physiology Brachial Artery / physiology* Cardiac Output, Low / physiopathology* Cardiotonic Agents / therapeutic use Dobutamine / therapeutic use Female Heart Ventricles / physiopathology* Heart-Assist Devices* Humans Male Middle Aged Milrinone / therapeutic use Regional Blood Flow / drug effects, physiology |
| Chemical | |
Reg. No./Substance:
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0/Cardiotonic Agents; 34368-04-2/Dobutamine; 78415-72-2/Milrinone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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