Low Blood Pressure Threshold for Adverse Outcomes During Left Ventricular Assist Device Support.
Low Blood Pressure Threshold for Adverse Outcomes During Left Ventricular Assist Device Support.
复制标题
左心室辅助装置支持期间不良结果的低血压阈值。
DOI：
10.1016/j.amjcard.2021.12.045
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Goldenberg,Ilan
中科院分区：
文献类型：
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作者：
Vidula,Himabindu;Altintas,Onur;McNitt,Scott;DeVore,AdamD;Birati,EdoY;Genuardi,MichaelV;Sheikh,FarooqH;Polonsky,Bronislava;Alexis,JeffreyD;Gosev,Igor;Bisognano,JohnD;Kutyifa,Valentina;Seidmann,Abraham;Goldenberg,Ilan
已有研究表明，接受左心室辅助装置(LVAD)的患者维持低平均动脉压(MAP)与降低中风/死亡风险有关。然而，最优MAP范围的下限尚未确定。我们的目标是在一组经常进行纵向MAP测量的同时代的LVAD接受者中确定这一下限。在平均1.7±1.1年的随访期间，我们分析了三级医学中心309名LVAD患者(32%的LVAD叶轮完全磁悬浮)的86651个MAP测量结果。用COX比例风险回归模型研究指标出院后3年内连续MAP测量与卒中/死亡的关系。多变量分析发现，与MAP>；75 mm≤相比，MAP阈值较低，与死亡风险(危险比4.74，95%可信区间2.85至7.87，P<0.001)、中风(HR 2.72；，95%CI 1.39至5.33，P<0.001)以及中风/死亡(HR 4.45，95%CI 2.83至6.99，P<0.01)相关。在按年龄、性别、种族、设备类型、肾功能、右侧心力衰竭和血压药物分类的亚组中，与MAP≤75 mm/hgHg相关的风险是一致的。综上所述，我们的研究结果表明，无论危险因素或医疗管理如何，在长期随访期间，左心衰患者维持MAP≤75毫米汞柱与中风/死亡风险增加有关。
It has been suggested that maintaining low mean arterial pressure (MAP) in left ventricular assist device (LVAD) recipients is associated with a reduced risk of stroke/death. However, the lower limit of the optimal MAP range has not been established. We aimed to identify this lower limit in a contemporary cohort of LVAD recipients with frequent longitudinal MAP measurements. We analyzed 86,651 MAP measurements in 309 patients with an LVAD (32% LVADs with full magnetic levitation of the impeller) at a tertiary medical center during a mean follow-up of 1.7 ± 1.1 years. Cox proportional hazards regression modeling was used to study the association of serial MAP measurements with stroke/death within 3 years after index discharge. Multivariate analysis identified MAP ≤75 mm Hg, compared with MAP >75 mm Hg, as the low MAP threshold associated with increased risk of death (hazard ratio [HR] 4.74, 95% confidence interval [CI] 2.85 to 7.87, p <0.001), stroke (HR 2.72;, 95% CI 1.39 to 5.33, p = 0.01), and stroke/death (HR 4.45, 95% CI 2.83 to 6.99, p <0.001). The risk associated with MAP ≤75 mm Hg was consistent in subgroups categorized by age, gender, race, device type, renal function, right-sided heart failure, and blood pressure medications. In conclusion, our findings suggest that maintaining MAP ≤75 mm Hg during long-term follow-up in LVAD recipients is associated with increased risk of stroke/death regardless of risk factors or medical management.