Open AccessDecoupling Between Diastolic Pulmonary Artery and Pulmonary Capillary Wedge Pressures Is Associated With Right Ventricular Dysfunction and Hemocompatibility‐Related Adverse Events in Patients With Left Ventricular Assist Devices
Author(s) -
Imamura Teruhiko,
Narang Nikhil,
Kim Gene,
Raikhelkar Jayant,
Chung Ben,
Nguyen Ann,
Holzhauser Luise,
Rodgers Daniel,
Kalantari Sara,
Smith Bryan,
Ota Takeyoshi,
Song Tae,
Juricek Colleen,
Burkhoff Daniel,
Jeevanandam Valluvan,
Sayer Gabriel,
Uriel Nir
Publication year - 2020
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.119.014801
Subject(s) - medicine , pulmonary wedge pressure , cardiology , pulmonary artery , adverse effect , heart failure , blood pressure , pulmonary hypertension , hemodynamics , diastole
Background Decoupling between diastolic pulmonary artery pressure and pulmonary capillary wedge pressure is an index of pulmonary vascular damage. This study assessed the impact of decoupling on right heart function and hemocompatibility‐related adverse events. Methods and Results In this prospective study, patients underwent invasive hemodynamic tests following left ventricular assist device implantation. Decoupling was defined as a difference of >5 mm Hg between diastolic pulmonary artery pressure and pulmonary capillary wedge pressure. Among 92 patients with left ventricular assist devices (median age, 61 years; 57% male), 44 patients (48%) had decoupling. Right heart function and size by echocardiographic assessment worsened during a 1‐year observational period in the decoupling group as compared with the control group ( P <0.05). The decoupling group had significantly lower 1‐year freedom from any hemocompatibility‐related adverse events (49% versus 79%; P =0.005), as well as a higher hemocompatibility score (2.14 versus 0.67; P =0.004). The scoring system depicts the severity of hemocompatibility‐related adverse events using 4 escalating tiers. Increased tier I scores (1–2 gastrointestinal bleedings or medically managed pump thrombosis; P =0.027) and tier IIIB scores (disabling stroke or hemocompatibility‐related adverse event–related death; P =0.041) occurred more frequently in the decoupling group. Conclusions The presence of decoupling between diastolic pulmonary artery pressure and pulmonary capillary wedge pressure was associated with worsening of right heart function and hemocompatibility‐related adverse events in patients with left ventricular assist devices.