title: The Incidence, Predictors and Outcomes of Gastrointestinal Bleeding in Patients with Left Ventricular Assist Device (LVAD).
abstract: OBJECTIVE
  To evaluate rate, recurrence, and predictors of gastrointestinal bleeding (GIB) and impact of endoscopy in left ventricular assist device (LVAD) patients.
  
  
  METHODS
  This is a cohort study of all patients who received the current-generation continuous-flow HeartMate II LVAD from 2005 to 2013 at our institution. Patients were followed up, and GIB events recorded until death, time of heart transplantation, or end of observation.
  
  
  RESULTS
  LVAD was implanted in 112 patients (median age 67 years, 88% male). A total of 44 patients (39%) had 74 GIB events occurring at a rate of 42.9 per 100 p-y. Endoscopy was performed in 77% of patients, and GIB source was identified in 57% with upper GIB found in almost two-third of cases. Right ventricular dysfunction and post-LVAD ejection fraction >30% were associated with higher GIB rates. Higher pulsatility index was associated with lower GIB rates. Re-bleeding occurred in 19 (43%) patients at a rate of 62.5 per 100 p-y and was not affected by endoscopic therapy at the index endoscopy.
  
  
  CONCLUSIONS
  GIB in LVAD patients is common, occurring primarily in the upper GI tract. Upper endoscopy is the preferred strategy though lower endoscopy is also recommended for a full workup. Endoscopy can identify GIB lesions in about 50% of patients, but re-bleeding is common. Right ventricular dysfunction and post-LVAD ejection fraction >30% are associated with higher GIB rates. Higher pulsatility index is associated with lower GIB rates. Reduction in pump speed is a potential strategy for managing and preventing GIB.
authors.affiliation: Department of Internal Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-3003, USA. Haseeb.Jabbar@medicine.ufl.edu.
authors.forename: Haseeb R
authors.initials: HR
authors.lastname: Jabbar
authors.affiliation: Department of Internal Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-3003, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Abbas
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL, USA.
authors.forename: Charles T
authors.initials: CT
authors.lastname: Klodell
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, FL, USA.
authors.forename: Myron
authors.initials: M
authors.lastname: Chang
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, FL, USA.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Dai
authors.affiliation: Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Draganov
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004724:Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000473:pathology*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000628:therapy*
keywords: Angioectasia; Endoscopy; Gastrointestinal bleeding; Incidence; Left ventricular assist device (LVAD); Outcomes; Predictors