title: Blood pressure and adverse events during continuous flow left ventricular assist device support.
abstract: BACKGROUND
  Adverse events (AEs), such as intracranial hemorrhage, thromboembolic event, and progressive aortic insufficiency, create substantial morbidity and mortality during continuous flow left ventricular assist device support yet their relation to blood pressure control is underexplored.
  
  
  RESULTS
  A multicenter retrospective review of patients supported for at least 30 days and ≤18 months by a continuous flow left ventricular assist device from June 2006 to December 2013 was conducted. All outpatient Doppler blood pressure (DOPBP) recordings were averaged up to the time of intracranial hemorrhage, thromboembolic event, or progressive aortic insufficiency. DOPBP was analyzed as a categorical variable grouped as high (>90 mm Hg; n=40), intermediate (80-90 mm Hg; n=52), and controlled (<80 mm Hg; n=31). Cumulative survival free from an AE was calculated using Kaplan-Meier curves and Cox hazard ratios were derived. Patients in the high DOPBP group had worse baseline renal function, lower angiotensin-converting enzyme inhibitor or angiotensin receptor blocker usage during continuous flow left ventricular assist device support, and a more prevalent history of hypertension. Twelve (30%) patients in the high DOPBP group had an AE, in comparison with 7 (13%) patients in the intermediate DOPBP group and only 1 (3%) in the controlled DOPBP group. The likelihood of an AE increased in patients with a high DOPBP (adjusted hazard ratios [95% confidence interval], 16.4 [1.8-147.3]; P=0.012 versus controlled and 2.6 [0.93-7.4]; P=0.068 versus intermediate). Overall, a similar association was noted for the risk of intracranial hemorrhage (P=0.015) and progressive aortic insufficiency (P=0.078) but not for thromboembolic event (P=0.638). Patients with an AE had a higher DOPBP (90±10 mm Hg) in comparison with those without an AE (85±10 mm Hg; P=0.05).
  
  
  CONCLUSIONS
  In a population at risk, higher DOPBP during continuous flow left ventricular assist device support was significantly associated with a composite of AEs.
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Omar
authors: O
authors: Saeed
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Rita
authors: R
authors: Jermyn
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Faraj
authors: F
authors: Kargoli
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Shivank
authors: S
authors: Madan
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Santhosh
authors: S
authors: Mannem
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Sampath
authors: S
authors: Gunda
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Cecilia
authors: C
authors: Nucci
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Sarah
authors: S
authors: Farooqui
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Syed
authors: S
authors: Hassan
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Allison
authors: A
authors: Mclarty
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Michelle
authors: M
authors: Bloom
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Ronald
authors: R
authors: Zolty
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Julia
authors: J
authors: Shin
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: David
authors: D
authors: D'Alessandro
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY.
authors: Daniel J
authors: DJ
authors: Goldstein
authors: From the Division of Cardiology, Department of Medicine (O.S., R.J., F.K., S.M., S.M., S.G., C.N., R.Z., J.S., S.R.P.) and Department of Cardiothoracic Surgery (D.D'A., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Division of Cardiology, Department of Medicine (S.F., S.H., M.B.) and Division of Cardiothoracic Surgery, Department of Surgery (A.M.), Stony Brook University, Long Island, NY. snepatel@montefiore.org.
authors: Snehal R
authors: SR
authors: Patel
mesh_terms: D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000503:physiopathology; D001794:Blood Pressure; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D020300:Intracranial Hemorrhages / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013923:Thromboembolism / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: aortic valve insufficiency; blood pressure; cerebral hemorrhage; thrombosis