Twenty-four-hour blood pressure and heart rate variability are reduced in patients on left ventricular assist device support

verfasst von

Francesco Castagna , Barry J. McDonnell, Giulio M. Mondellini , Antonia Gaudig , Alberto Pinsino , Carmel McEniery , Eric Jean Stöhr, Koji Takeda, Yoshifumi Naka, Nir Uriel, Melana Yuzefpolskaya, John R. Cockcroft, Gianfranco Parati, Paolo C. Colombo

Abstract

Background: Limited data exist on the circadian blood pressure (BP) and heart rate (HR) variations that occur in heart failure (HF) patients on left ventricular assist device (LVAD) support. Methods: We prospectively recorded clinic and 24-hour ambulatory BP and HR data in patients on HeartMate II LVAD support. Results were compared to HF patients with ejection fraction ≤30% and controls with no history of cardiovascular disease. Physiologic nocturnal BP and HR dipping was defined as a ≥10% decline compared to daytime values. Result: Twenty-nine LVAD patients (age 59 ± 15 years, 76% male, 38% ischemic etiology), 25 HF patients (age 64 ± 13 years, 84% male, 32% ischemic etiology) and 26 controls (age 56 ± 9 years, 62% male) were studied. Normal nocturnal BP dipping was less frequent in LVAD patients (10%) than in HF patients (28%) and controls (62%) and reversed BP dipping (BP increase at night) was more common in LVAD patients (24%), compared to HF (16%) and controls (8%), (p < 0.001, for all comparisons). Physiologic HR reduction was less frequent in LVAD patients (14%), compared to HF (16%) and controls (59%) (p < 0.001, for all comparisons). Among LVAD patients, 36% exhibited sustained hypertension over the 24-hours and 25% had white-coat hypertension. Conclusions: Treatment of advanced HF with an LVAD does not restore physiologic circadian variability of BP and HR; additionally, BP was not adequately controlled in more than a third of LVAD patients, and a quarter of them exhibited white-coat hypertension. Future studies are warranted to confirm these findings and investigate prognostic and management implications in this population.

Externe Organisation(en)

Columbia University
Montefiore Medical Center
University of Cambridge
Cardiff Metropolitan University
University of Milano-Bicocca
Istituto Auxologico Italiano

Typ

Artikel

Journal

Journal of Heart and Lung Transplantation

Band

41

Seiten

802-809

Anzahl der Seiten

8

ISSN

1053-2498

Publikationsdatum

06.2022

Publikationsstatus

Veröffentlicht

Peer-reviewed

Ja

ASJC Scopus Sachgebiete

Kardiologie und kardiovaskuläre Medizin, Transplantationsmedizin, Lungen- und Bronchialmedizin, Chirurgie

Ziele für nachhaltige Entwicklung

SDG 3 – Gute Gesundheit und Wohlergehen

Elektronische Version(en)

https://doi.org/10.1016/j.healun.2022.02.016 (Zugang: Geschlossen)