Decoupling 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

Authors

Teruhiko Imamura, The University of Chicago
Nikhil Narang, Advocate Aurora HealthFollow
Gene Kim, The University of Chicago
Jayant Raikhelkar, Columbia University Irving Medical Center
Ben Chung, The University of ChicagoFollow
Ann Nguyen, The University of Chicago
Luise Holzhauser, The University of Chicago
Daniel Rodgers, The University of Chicago
Sara Kalantari, The University of Chicago
Bryan Smith, The University of Chicago
Takeyoshi Ota, The University of Chicago Medicine
Tae Song, The University of Chicago Medicine
Colleen Juricek, The University of Chicago Medicine
Daniel Burkhoff, Columbia University Irving Medical CenterFollow
Valluvan Jeevanandam, The University of Chicago Medicine
Gabriel Sayer, Columbia University Irving Medical Center
Nir Uriel, Columbia University Irving Medical Center

Recommended Citation

Imamura T, Narang N, Kim G, et al. Decoupling 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. J Am Heart Assoc. 2020;9(7):e014801. doi:10.1161/JAHA.119.014801

Affiliations

Advocate Heart Institute Advocate Christ Medical Center

Abstract

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.

Document Type

Article

PubMed ID

32223394