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

authored by: 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.
External Organisation(s): Columbia University
Montefiore Medical Center
Cardiff Metropolitan University
University of Cambridge
University of Milan - Bicocca (UNIMIB)
Istituto Auxologico Italiano
Type: Article
Journal: Journal of Heart and Lung Transplantation
Volume: 41
Pages: 802-809
No. of pages: 8
ISSN: 1053-2498
Publication date: 06.2022
Publication status: Published
Peer reviewed: Yes
ASJC Scopus subject areas: Cardiology and Cardiovascular Medicine, Transplantation, Pulmonary and Respiratory Medicine, Surgery
Sustainable Development Goals: SDG 3 - Good Health and Well-being
Electronic version(s): https://doi.org/10.1016/j.healun.2022.02.016 (Access: Closed)