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Carotid Artery Blood Flow and Its Association with Stroke during Left Ventricular Assist Device Support
Abstracts 400 Current Smoking and Increased Risk of Stroke in Patients with Left Ventricular Assist Device S. Sherazi,1 I. Goldenberg,1 S. McNitt,1 V. Kutyifa,1 I. Gosev,2 K. Wood,2 L. Chen,1 S. Polonsky,1 H. Vidula,1 and J. Alexis.1 1Cardiology, University of Rochester Medical Center, Rochester, NY; and the 2 Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, NY. Purpose: The purpose of this study was to analyze the impact of smoking status at the time of left ventricular assist device (LVAD) implantation on clinical outcomes including all-cause mortality, readmission and stroke. Methods: Retrospective data collection and analyses were performed on 350 patients implanted with LVAD at the University of Rochester Medical Rochester, NY from May 5, 2008, to June 26, 2018. Patients were stratified as current smoker (smoking within 30 days prior to LVAD implantation), former smoker and never smoker. Stroke was defined as a transient ischemic attack or cerebrovascular accident (hemorrhagic or ischemic). Results: There were 43 current smokers, 190 former and 117 never smokers. Current smokers were younger (mean age 49.6 § 11.1 years), as compared with former (58.5 § 11.2 years) and never smokers (56.8 § 12.2 years) p <0.001. Figure 1 shows the Kaplan-Meier curve for cumulative probability of stroke by smoking status. At 2 years, the cumulative probability of stroke was 40% among current smokers, compared with 16% among former smokers and 14% among never smokers (p 0.016). In a multivariate model adjusted for significant clinical variables, current smoking was associated with 79% higher risk of stroke when compared with all non-current smokers (hazard ratio 1.79, 95% confidence interval 1.02-3.13, p 0.039). There was no difference in all-cause mortality and readmission rates among current smokers and former and never smokers. Conclusion: In this single center study of patients with an LVAD, current smokers were younger and at significantly higher risk of stroke when compared with former smokers and never smokers. LVAD patients with current smoking status should be educated early on to prevent deleterious effects of smoking post LVAD implantation.
S171 Purpose: Left ventricular assist device (LVAD) surgery is a life-prolonging therapy for advanced heart failure (HF). Despite many improvements over the years, LVADs continue to be associated with a high incidence of stroke and other vascular complications such as gastrointestinal bleeding (GIB). At present, the pathogenesis of these complications during LVAD support remains unclear. Abnormal structure and hemodynamics in large arteries are a potential contributor. We hypothesized that structural abnormalities and flow alterations will be significantly associated with stroke and a composite outcome of stroke, GIB, and death in HF patients before and during LVAD support. Methods: We conducted a retrospective analysis of 141 carotid duplex studies in adult patients who received the HeartMate II LVAD. Clinical Doppler exams were evaluated before and after LVAD implantation. Parameters evaluated included peak-systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV), pulsatility index (PI), ICA/CCA PSV ratio, plaque burden, and ICA stenosis. In addition, we noted demographics, outcomes, and LVAD speed parameters. Results: Compared with HF patients, LVAD patients had decreased PSV (CCA: 80 vs. 50 cm/s, ICA: 72 vs. 56 cm/s; both P<0.05) and PI (CCA: 1.5 vs. 0.6, ICA: 1.2 vs. 0.5; both P<0.01) as well as increased EDV (CCA: 19 vs. 30 cm/s, ICA: 24 vs. 35 cm/s; both P<0.01) and total plaque burden (65% vs. 82%; P<0.05). Presence of ICA stenosis before LVAD implantation was significantly associated with both stroke (50% with stenosis vs. 12% without; P<0.05) and the combined outcome after implantation (88% with stenosis vs. 44% without; P<0.05), while presence of plaque was associated only with the combined outcome (58% with plaque vs. 28% without; P<0.01). Conversely, arterial flow parameters during LVAD support were not associated with either outcome. Conclusion: We conclude that structural arterial disease in HF patients, namely carotid artery stenosis and plaque as evidenced by Doppler evaluation, was associated with stroke, GIB, and death during LVAD support while arterial flow parameters were not. Flow parameters during LVAD support were likewise unrelated to adverse events. Our findings support routine carotid duplex evaluation for clinical outcome prediction and encourage further study of the unique vascular physiology resulting from LVAD support. 402 Different Risk Factors for Ischemic and Hemorrhagic Stroke on Continuous Flow Left Ventricular Assist Device Support H.K. Lamba,1 M. Kim,1 L. Hart,1 B. Chou,1 C. Rao,1 S. Chatterjee,1 S. Sattee,2 F. Cheema,1 A. Civitello,1 R. Delgado,1 A. Nair,1 A. Shafii,1 G. Loor,1 T. Rosengart,1 O. Frazier,1 and J. Morgan.3 1Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Texas Heart Institute at Baylor College of Medicine, Houston, TX; 2Baylor College of Medicine, Houston, TX; and the 3Texas Heart Institute at Baylor College of Medicine, Houston, TX.
401 Carotid Artery Blood Flow and Its Association with Stroke during Left Ventricular Assist Device Support M.E. Kiyatkin,1 A.M. Zuver,1 A. Gaudig,2 M. Tiburcio,1 B.J. McDonnell,3 M. Yuzefpolskaya,1 P.C. Colombo,1 E.J. Stöhr,4 and J.Z. Willey.1 1Columbia University Irving Medical Center, New York, NY; 2 University of M€ unster, M€ unster, Germany; 3Cardiff Metropolitan University, Cardif, United Kingdom; and the 4Cardiff Metropolitan University, Cardiff, United Kingdom.
Purpose: Patients with end-stage heart failure on left ventricular assist devices are predisposed to stroke. Preoperative factors associated with increased stroke risk are poorly understood. Methods: Single-center retrospective review of 725 patients from 2000 to 2017 who received a continuous flow left ventricular assist device (CF-LVAD) at our institution. Logistic regression analysis was performed to determine independent predictors of ischemic and hemorrhagic stroke. Results: Mean age was 54.0§13.7 years, most patients were male 573 (79.0%), and most were implanted as a bridge to transplant 421 (58.1%) (Table 1). Of these, 118 (16.3%) patients had an ischemic stroke at a median follow-up of 128 (Range:1-4042, IQR 36-456) days. A history of diabetes was independently associated with an ischemic stroke (HR 1.7 95% CI 1.1 to 2.6, p=0.01). Hemorrhagic stroke, excluding ischemic conversions (N=16, 2.2%), occurred in 86 (11.9%) patients at a median follow up of 281 (Range:5-2436, IQR 92-698) days. Female gender (HR 1.9 95% CI 1.1 to 3.4, p=0.02) and INTERMACS class I (HR 2.2 95% CI 1.3 to 3.7, p=0.04) were independently associated with development of hemorrhagic stroke while on CF-LVAD support. Patients with ischemic and hemorrhagic stroke
S171 Purpose: Left ventricular assist device (LVAD) surgery is a life-prolonging therapy for advanced heart failure (HF). Despite many improvements over the years, LVADs continue to be associated with a high incidence of stroke and other vascular complications such as gastrointestinal bleeding (GIB). At present, the pathogenesis of these complications during LVAD support remains unclear. Abnormal structure and hemodynamics in large arteries are a potential contributor. We hypothesized that structural abnormalities and flow alterations will be significantly associated with stroke and a composite outcome of stroke, GIB, and death in HF patients before and during LVAD support. Methods: We conducted a retrospective analysis of 141 carotid duplex studies in adult patients who received the HeartMate II LVAD. Clinical Doppler exams were evaluated before and after LVAD implantation. Parameters evaluated included peak-systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV), pulsatility index (PI), ICA/CCA PSV ratio, plaque burden, and ICA stenosis. In addition, we noted demographics, outcomes, and LVAD speed parameters. Results: Compared with HF patients, LVAD patients had decreased PSV (CCA: 80 vs. 50 cm/s, ICA: 72 vs. 56 cm/s; both P<0.05) and PI (CCA: 1.5 vs. 0.6, ICA: 1.2 vs. 0.5; both P<0.01) as well as increased EDV (CCA: 19 vs. 30 cm/s, ICA: 24 vs. 35 cm/s; both P<0.01) and total plaque burden (65% vs. 82%; P<0.05). Presence of ICA stenosis before LVAD implantation was significantly associated with both stroke (50% with stenosis vs. 12% without; P<0.05) and the combined outcome after implantation (88% with stenosis vs. 44% without; P<0.05), while presence of plaque was associated only with the combined outcome (58% with plaque vs. 28% without; P<0.01). Conversely, arterial flow parameters during LVAD support were not associated with either outcome. Conclusion: We conclude that structural arterial disease in HF patients, namely carotid artery stenosis and plaque as evidenced by Doppler evaluation, was associated with stroke, GIB, and death during LVAD support while arterial flow parameters were not. Flow parameters during LVAD support were likewise unrelated to adverse events. Our findings support routine carotid duplex evaluation for clinical outcome prediction and encourage further study of the unique vascular physiology resulting from LVAD support. 402 Different Risk Factors for Ischemic and Hemorrhagic Stroke on Continuous Flow Left Ventricular Assist Device Support H.K. Lamba,1 M. Kim,1 L. Hart,1 B. Chou,1 C. Rao,1 S. Chatterjee,1 S. Sattee,2 F. Cheema,1 A. Civitello,1 R. Delgado,1 A. Nair,1 A. Shafii,1 G. Loor,1 T. Rosengart,1 O. Frazier,1 and J. Morgan.3 1Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Texas Heart Institute at Baylor College of Medicine, Houston, TX; 2Baylor College of Medicine, Houston, TX; and the 3Texas Heart Institute at Baylor College of Medicine, Houston, TX.
401 Carotid Artery Blood Flow and Its Association with Stroke during Left Ventricular Assist Device Support M.E. Kiyatkin,1 A.M. Zuver,1 A. Gaudig,2 M. Tiburcio,1 B.J. McDonnell,3 M. Yuzefpolskaya,1 P.C. Colombo,1 E.J. Stöhr,4 and J.Z. Willey.1 1Columbia University Irving Medical Center, New York, NY; 2 University of M€ unster, M€ unster, Germany; 3Cardiff Metropolitan University, Cardif, United Kingdom; and the 4Cardiff Metropolitan University, Cardiff, United Kingdom.
Purpose: Patients with end-stage heart failure on left ventricular assist devices are predisposed to stroke. Preoperative factors associated with increased stroke risk are poorly understood. Methods: Single-center retrospective review of 725 patients from 2000 to 2017 who received a continuous flow left ventricular assist device (CF-LVAD) at our institution. Logistic regression analysis was performed to determine independent predictors of ischemic and hemorrhagic stroke. Results: Mean age was 54.0§13.7 years, most patients were male 573 (79.0%), and most were implanted as a bridge to transplant 421 (58.1%) (Table 1). Of these, 118 (16.3%) patients had an ischemic stroke at a median follow-up of 128 (Range:1-4042, IQR 36-456) days. A history of diabetes was independently associated with an ischemic stroke (HR 1.7 95% CI 1.1 to 2.6, p=0.01). Hemorrhagic stroke, excluding ischemic conversions (N=16, 2.2%), occurred in 86 (11.9%) patients at a median follow up of 281 (Range:5-2436, IQR 92-698) days. Female gender (HR 1.9 95% CI 1.1 to 3.4, p=0.02) and INTERMACS class I (HR 2.2 95% CI 1.3 to 3.7, p=0.04) were independently associated with development of hemorrhagic stroke while on CF-LVAD support. Patients with ischemic and hemorrhagic stroke