Impairments in Blood Pressure Regulation and Cardiac Baroreceptor Sensitivity Among Patients With Heart Failure Supported With Continuous-Flow Left Ventricular Assist Devices.
Impairments in Blood Pressure Regulation and Cardiac Baroreceptor Sensitivity Among Patients With Heart Failure Supported With Continuous-Flow Left Ventricular Assist Devices.
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DOI：
10.1161/circheartfailure.120.007448
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发表时间：
2021-01
期刊：
影响因子：
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通讯作者：
Cornwell WK 3rd
中科院分区：
文献类型：
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作者：
Sailer C;Edelmann H;Buchanan C;Giro P;Babcock M;Swanson C;Spotts M;Schulte M;Pratt-Cordova A;Coe G;Beindorff M;Page RL 2nd;Ambardekar AV;Pal JD;Kohrt W;Wolfel E;Lawley JS;Tarumi T;Cornwell WK 3rd
连续流 (CF) 左心室辅助装置 (LVAD) 可改善晚期心力衰竭 (HF) 患者的预后。然而，缺乏生理脉搏容易产生副作用，包括血压 (BP) 失控，并且关于 CF-LVAD 对血压调节影响的数据很少。 12 名晚期心力衰竭患者（10 名男性，60±11 岁）在 CF-LVAD 植入前 2.7±4.1 个月和植入后 4.3±1.3 个月完成血流动力学评估。在 Valsalva 动作、自主呼吸和 0.05Hz 重复蹲站动作期间通过动脉导管监测心率 (HR) 和收缩压 (SBP)，以表征心脏压力感受器敏感性。在仰卧、30°和60°的抬头倾斜（HUT）期间评估血浆去甲肾上腺素水平。在心肺运动测试（CPET）期间监测心率和血压。心脏压力感受器敏感性（由 Valsalva 以及自主呼吸和蹲站动作期间 HR 和 SBP 的傅立叶变换和传递函数增益确定）在 LVAD 植入之前和之后受到损害。去甲肾上腺素 (NE) 水平在 LVAD 前显着升高并有所改善，但在 LVAD 后仍然升高（仰卧位 NE 与 LVAD 后相比：654±437 vs. 323±164pg/mL）。 LVAD 后 CPET 测试期间血压升高，但变化幅度不大，与 LVAD 前 CPET 期间观察到的变化相当。在晚期 HFrEF 患者中，CF-LVAD 植入与自主神经张力的适度改善相关，但心脏压力感受器敏感性持续降低。运动引起的血压升高被减弱。这些发现为 CF-LVAD 支持的患者中中风等不良事件和功能持续下降的机制提供了新的线索。
Continuous-flow (CF) left ventricular assist devices (LVADs) improve outcomes for patients with advanced heart failure (HF). However, the lack of a physiologic pulse predisposes to side-effects including uncontrolled blood pressure (BP) and there are little data regarding the impact of CF-LVADs on BP regulation. Twelve patients (10 males, 60±11years) with advanced HF completed hemodynamic assessment 2.7±4.1 months before, and 4.3±1.3 months following CF-LVAD implantation. Heart rate (HR) and systolic BP (SBP) via arterial catheterization were monitored during Valsalva maneuver, spontaneous breathing and a 0.05Hz repetitive squat-stand maneuver to characterize cardiac baroreceptor sensitivity. Plasma norepinephrine levels were assessed during head-up tilt (HUT) at supine, 30° and 60°. HR and BP were monitored during cardiopulmonary exercise testing (CPET). Cardiac baroreceptor sensitivity, determined by Valsalva as well as Fourier transformation and transfer function gain of HR and SBP during spontaneous breathing and squat-stand maneuver, was impaired prior to and following LVAD implantation. Norepinephrine (NE) levels were markedly elevated pre-LVAD and improved – but remained elevated post-LVAD (supine NE pre- v. post-LVAD: 654±437 v. 323±164pg/mL). BP increased during CPET testing post-LVAD, but the magnitude of change was modest and comparable to the changes observed during the pre-LVAD CPET. Among patients with advanced HFrEF, CF-LVAD implantation is associated with modest improvements in autonomic tone, but persistent reductions in cardiac baroreceptor sensitivity. Exercise-induced increases in BP are blunted. These findings shed new light on mechanisms for adverse events such as stroke, and persistent reductions in functional capacity, among patients supported by CF-LVADs.