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Article Dans Une Revue ESC Heart Failure Année : 2024

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

Ali Akamkam
  • Fonction : Auteur
Vincent Galand
  • Fonction : Auteur
Marie Jungling
  • Fonction : Auteur
Clément Delmas
  • Fonction : Auteur
Camille Dambrin
  • Fonction : Auteur
Mathieu Pernot
  • Fonction : Auteur
Michel Kindo
  • Fonction : Auteur
Philippe Rouviere
  • Fonction : Auteur
Thomas Senage
  • Fonction : Auteur
Olivier Chavanon
  • Fonction : Auteur
Marylou Para
  • Fonction : Auteur
Vlad Gariboldi
  • Fonction : Auteur
Matteo Pozzi
  • Fonction : Auteur
Pierre‐yves Litzler
  • Fonction : Auteur
Gerard Babatasi
  • Fonction : Auteur
Olivier Bouchot
  • Fonction : Auteur
Costin Radu
  • Fonction : Auteur
Thierry Bourguignon
  • Fonction : Auteur
Nicolas d'Ostrevy
  • Fonction : Auteur
Ramzi Abi Akar
  • Fonction : Auteur
Fabrice Vanhuyse
  • Fonction : Auteur
Maïra Gaillard
  • Fonction : Auteur
Gilles Chatelier
  • Fonction : Auteur
Audrey Fels
  • Fonction : Auteur
Erwan Flecher
  • Fonction : Auteur
Julien Guihaire
  • Fonction : Auteur

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.

Dates et versions

hal-04536212 , version 1 (08-04-2024)

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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, ⟨10.1002/ehf2.14716⟩. ⟨hal-04536212⟩
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