Mean Arterial Pressure is Not Associated with Hemocompatibility-Related Outcomes in LVAD Patients

2021 
Purpose Elevated mean arterial pressure (MAP) is associated with stroke in patients with HeartMate II and Heartware HVAD left ventricular assist devices (LVADs). We assessed the relationship between mean arterial pressure (MAP) and hemocompatibility-related clinical adverse events (HRAE) in patients with LVADs. Methods Prospectively collected hemodynamic data from LVAD patients who had undergone invasive hemodynamic ramp study at our institution between 4/2014-7/2018 were analyzed. ROC analysis was performed to determine optimal cutoff value for MAP, and patients were divided into two groups: high MAP (≥90mmHg) and low MAP ( Results 91 patients (average age 61 ± 11 years, 34% women, 40% Black, 38% ischemic cardiomyopathy) were included in the analysis. Of all patients, 29% had HeartWare HVADs, 57% HeartMate II, and 14% HeartMate 3 LVADs. MAP was not significantly associated with HRAE, HR 1.53 (95% CI 0.88-2.64, p=0.13), even when adjusted for LVAD type, HR 1.65 (95% CI 0.95-2.87, p=0.076). Similarly, MAP was not significantly associated with HCS. Low MAP was, however, significantly associated with higher mortality, HR 2.47 (95% CI 1.13-5.39, p=0.024, Figure 1A), and higher rates of heart failure readmission, HR 2.05 (95% CI 1.06-3.99, p=0.034) (figure 1B). Conclusion MAP was not significantly associated with HRAE in this population of LVAD patients. However, low MAP was significantly associated with mortality and heart failure readmission.
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