title: Dynamic Changes in Aortic Vascular Stiffness in Patients Bridged to Transplant With Continuous-Flow Left Ventricular Assist Devices.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.affiliation: Division of Cardiology, University of Colorado, Aurora, Colorado.
authors.forename: Amit C
authors.initials: AC
authors.lastname: Patel
authors.affiliation: Department of Bioengineering, University of Colorado, Aurora, Colorado; Division of Pediatric Surgery, University of Colorado, Aurora, Colorado.
authors.forename: R Blair
authors.initials: RB
authors.lastname: Dodson
authors.affiliation: Division of Cardiology, University of Colorado, Aurora, Colorado.
authors.forename: William K
authors.initials: WK
authors.lastname: Cornwell
authors.affiliation: Department of Bioengineering, University of Colorado, Aurora, Colorado; Department of Pediatrics, Division of Cardiology, University of Colorado, Aurora, Colorado.
authors.forename: Kendall S
authors.initials: KS
authors.lastname: Hunter
authors.affiliation: Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colorado.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cleveland
authors.affiliation: Division of Cardiology, University of Colorado, Aurora, Colorado.
authors.forename: Andreas
authors.initials: A
authors.lastname: Brieke
authors.affiliation: Vanderbilt Heart and Vascular Institute, Nashville, Tennessee.
authors.forename: JoAnn
authors.initials: J
authors.lastname: Lindenfeld
authors.affiliation: Division of Cardiology, University of Colorado, Aurora, Colorado. Electronic address: Amrut.Ambardekar@ucdenver.edu.
authors.forename: Amrut V
authors.initials: AV
authors.lastname: Ambardekar
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000503:physiopathology / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery; D011182:Postoperative Care; D059289:Vascular Stiffness / Q000502:physiology*
keywords: aortic stiffness; heart failure; left ventricular assist device