Article Dans Une Revue ESC Heart Failure Année : 2024

Association between pulmonary artery pulsatility and mortality after implantation of left ventricular assist device

1 Hôpital Marie-Lannelongue
2 Centre hospitalier Saint-Joseph [Paris]
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
4 UR - Université de Rennes
5 Institut Coeur Poumon [CHU Lille]
6 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
7 Hôpital Haut-Lévêque [CHU Bordeaux]
8 UB - Université de Bordeaux
9 HUS - Hôpitaux Universitaires de Strasbourg
10 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
11 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
12 UM - Université de Montpellier
13 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
14 Hôpital Michallon
15 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
16 TIMONE - Hôpital de la Timone [CHU - APHM]
17 Hôpital Louis Pradel [CHU - HCL]
18 Hôpital Charles Nicolle [Rouen]
19 UNICAEN - Université de Caen Normandie
20 CHU Caen Normandie - CHU Caen Normandie – Centre Hospitalier Universitaire de Caen Normandie
21 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
22 CHU Henri Mondor [Créteil]
23 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
24 CHU Clermont-Ferrand
25 HEGP - Hôpital Européen Georges Pompidou [APHP]
26 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
27 hpsj - Groupe Hospitalier Paris Saint-Joseph
28 HPPIT - Hypertension pulmonaire : physiopathologie et innovation thérapeutique

Résumé

Abstract Aims Right ventricular failure after left ventricular assist device (LVAD) implantation is a major concern that remains challenging to predict. We sought to investigate the relationship between preoperative pulmonary artery pulsatility index (PAPi) and mortality after LVAD implantation. Methods and results A retrospective analysis of the ASSIST‐ICD multicentre registry allowed the assessment of PAPi before LVAD according to the formula [(systolic pulmonary artery pressure − diastolic pulmonary artery pressure)/central venous pressure]. The primary endpoint was survival at 3 months, according to the threshold value of PAPi determined by the receiver operating characteristic (ROC) curve. A multivariate analysis including demographic, echographic, haemodynamic, and biological variables was performed to identify predictive factors for 2 year mortality. One hundred seventeen patients were included from 2007 to 2021. The mean age was 58.45 years (±13.16), with 15.4% of women (sex ratio 5.5). A total of 53.4% were implanted as bridge to transplant and 43.1% as destination therapy. Post‐operative right ventricular failure was observed in 57 patients (48.7%), with no significant difference between survivors and non‐survivors at 1 month (odds ratio 1.59, P = 0.30). The median PAPi for the whole study population was 2.83 [interquartile range 1.63–4.69]. The threshold value of PAPi determined by the ROC curve was 2.84. Patients with PAPi ≥ 2.84 had a higher survival rate at 3 months [PAPi < 2.84: 58.1% [46.3–72.8%] vs. PAPi ≥ 2.84: 89.1% [81.1–97.7%], hazard ratio (HR) 0.08 [0.02–0.28], P < 0.01], with no significant difference after 3 months (HR 0.67 [0.17–2.67], P = 0.57). Other predictors of 2 year mortality were systemic hypertension (HR 4.22 [1.49–11.97], P < 0.01) and diabetes mellitus (HR 4.90 [1.83–13.14], P < 0.01). LVAD implantation as bridge to transplant (HR 0.18 [0.04–0.74], P = 0.02) and heart transplantation (HR 0.02 [0.00–0.18], P < 0.01) were associated with a higher survival rate at 2 years. Conclusions Preoperative PAPi < 2.84 was associated with a higher risk of early mortality after LVAD implantation without impacting 2 year outcomes among survivors.

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hal-04536212 , version 1 (15-07-2024)

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Ali Akamkam, Vincent Galand, Marie Jungling, Clément Delmas, Camille Dambrin, et al.. Association between pulmonary artery pulsatility and mortality after implantation of left ventricular assist device. ESC Heart Failure, 2024, Online ahead of print. ⟨10.1002/ehf2.14716⟩. ⟨hal-04536212⟩
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