Blood Pressure Profiles of Patients with Left Ventricular Assist Devices

Abstracts S217 demonstrate that DOP overestimates both MAP and TMP 12±10 mmHg and 7.9±9.2 mmHg, whereas MAP underestimates TMP -5.36±9.1 mmHg. TEOS was able to find pulse in 80% patients with absent radial pulse and in 96% patients with palpable radial pulse. Presence or absence of radial pulse did not alter the differences between the different BP measurement readings. Conclusion: BP measurements obtained by DOP, SAP and TSP are closely related to each other. MAP and TMP are also within close BP measurement. These results suggest routine utilization of TSP for assessment of BP. DOP can also be cautiously used in case of unavailability of equipment necessary for TSP measurement, as results indicate that DOP significantly overestimates MAP and TMP. 5( 83) Blood Pressure Profiles of Patients with Left Ventricular Assist Devices P.T. Campbell ,1 S. Krim,1 S. Desai,1 S. Mandras,1 H. Patel,1 M.R. Mehra,2 H. Ventura.1  1John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; 2Cardiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA. Purpose: Blood pressure (BP) and its management in patients with Left Ventricular Assist Devices (LVAD) remains enigmatic. Accordingly we sought to describe blood pressure profiles and factors determining BP variability in stable LVAD patients. Methods: Ambulatory LVAD patients were evaluated by oscillometric cuff and arterial Doppler to measure BP. Based on guideline recommendations, controlled (C) BP was defined as Mean Arterial Pressure (MAP) ≤ 80mmHg and uncontrolled (UC) as > 80mmHg. Orthostatic hypotension was defined as ≥ -5mmHg (equal to a 15mmHg decline in SBP). In patients with oscillometric BP a MAP was calculated, so that correlation between oscillometric and Doppler MAP could be performed. Results: 50 consecutive patients were included of which 26% (n= 13) were controlled. No significant differences in baseline demographics, including history of hypertension, diabetes or impaired renal function, were found between the 2 groups. There was no significant difference in the number of BP medications prescribed (2.4 C vs. 2.9 UC, p= 0.13) between the 2 groups. UC patients had significantly higher Pulsatility Index (PI) (5.7 vs. 4.7, p= 0.02) and more likely to have preserved RV function post-implant (57% vs 38%, p= 0.05). The MAP was higher in all positions (92 vs. 74mmHg supine, 90 vs. 72mmHg seated and 90 vs. 71mmHg standing, respectively, all p< 0.0001) in the UC population and there was a trend towards greater decline in MAP (supine to standing) in the C group (-3 vs. -1.4mmHg, p= 0.30). Cuff pressure (p= 0.008) and calculated MAP (p= 0.006) were higher in the UC group and there was a trend to higher prevalence of a palpable pulse in the UC group (p= 0.07). In the UC group, but not the C group, the calculated MAP was significantly lower than the measured Doppler MAP (82 vs 90mmHg, p= 0.002). In univariate analysis amlodipine use and reduced renal function (GFR < 60) were the only factors associated with greater decline in MAP upon standing (p= 0.02, both). Of the 6 patients that had symptoms of orthostatic hypotension and a decline in MAP upon standing, the mean change was -7mmHg (range =  -2 to -10.5mmHg). Conclusion: BP control was suboptimal in this cohort by current guidelines. Furthermore, orthostatic hypotension should be defined as symptoms plus a decline in MAP of ≥ -5mmHg. However 83% of the symptomatic orthostasis patients experienced a decline of ≥ 7mmHg, suggesting a new threshold for defining this enity.

8Cardiovascular

Sciences, University Hospitals Leuven, Leuvan, Belgium; Medicine, University Hospital Münster, Münster, Germany; 10XDX, Brisbane, CA; 11Medicine, Duke University, Durham, NC; 12Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; 13Medicine, Abbott Northwestern Hospital, Minneapolis, MN. 9Cardiovascular

Purpose: A GEP test has been established as a non-invasive surveillance method to rule out acute cellular rejection. The GEP score is computed from the expression levels of 11 informative genes which are associated with immune activation. We hypothesize that prior mechanical circulatory support (MCS) of heart transplant recipient is associated with carry-over effects on the recipient’s immune system that may be detected by changes in GEP. Methods: GEP scores (AlloMap) and associated clinical information about prior MCS from heart transplant recipients from the IMAGE and CARGO II studies were analyzed. For each patient in the MCS or no prior MCS groups, the patient’s average AlloMap score and 11 gene subcomponents were computed, overall and within time periods: 2 - 6 m, 7 - 12 m, 13 - 24 m, 25 - 36 m, and ≥  37 m post transplant. The mean GEP score and gene subcomponent levels for MCS and no prior MCS groups were compared by t test. Results: The clinical outcomes (hemodynamic compromise or death) in patients with and without prior MCS were not different in these studies. Although no overall effect of prior MCS was observed on the total AlloMap score in the IMAGE or CARGO II studies; three genes (WDR40A, G6b, PF4) were significantly decreased in MCS vs no prior MCS patients in both CARGO II and IMAGE (only in the 2 -6 or 7-12 m time frames, respectively (Table 1) with a mean reduction of up to 40% in the absolute value. Conclusion: Compared to controls, prior MCS may be associated with early decreased expression of 3 gene subcomponents associated with hematopoesis or platelet activation in the AlloMap GEP signature (in the first 12 months). The clinical relevance of these differences requires further investigation and may add to our understanding of the effects of MCS on the hematological system.

5( 84) Gene Expression Profiling Test (GEP) Scores and Outcomes of Heart Transplant with Prior Mechanical Circulatory Support: Results from IMAGE and CARGO II N. Uriel ,1 J. Teuteberg,2 S. Pinney,3 M. Crespo-Leiro,4 S. Hall,5 A. Crumbley,6 M. Deng,7 J. Vanhaecke,8 J. Stypmann,9 D. Hiller,10 P.J. Arnold,10 J. Yee,10 C. Patel,11 R. Starling,12 D. Feldman.13  1Medicine, Columbia University, New York, NY; 2Medicine, University of Pittsburgh, Pittsburgh, PA; 3Medicine, Mount Sinai, New York, NY; 4Medicine, Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Universitario A Coruña, La Coruña, Spain; 5Medicine, Baylor Heart Hospital, Dallas, TX; 6Medicine, Medical University of South Carolina, Charleston, SC; 7Medicine, UCLA Medical Center, Los Angeles, CA;

5( 85) Transplanting Patients with VADs Using the Organ Care System Shows Significantly Improved Outcomes: A New Standard of Care? D. García Sáez , B. Zych, P. Mohite, A. Sabashnikov, C. Bowles, R. Hards, M. Hedger, G. Edwards, F. de Robertis, T. Bahrami, M. Amrani, N. Banner, A.R. Simon.  Harefield Hospital NHS Trust, Harefield, London, United Kingdom.