Increased Aortic Stiffness is Associated with Higher Rates of Stroke, GI-bleeding and Pump Thrombosis in CF-LVAD Patients

Abstract Background In the general population, increased aortic stiffness is associated with an increased risk of cardiovascular events. Previous studies have demonstrated an increase in aortic stiffness in continuous-flow left ventricular assist device (CF-LVAD) patients. However, the association between aortic stiffness and common adverse events is unknown. Methods 40 HeartMate II (HMII) pts (51±8 years, 32% female, 25% ischemic) implanted between January 2011 and September 2017 were included. Two-dimensional transthoracic echocardiograms of the ascending aorta, obtained prior to HMII placement and early after heart transplant, were analyzed to calculate Aortic-Stiffness Index (AO-SI). The study cohort was divided into patients who had an increased vs. reduced AO-SI following LVAD support. A composite outcome of gastrointestinal bleeding, stroke, and pump thrombosis was defined as the primary endpoint and compared between the groups. Results While median AO-SI increased significantly following HMII support (AO-SI: 4.4 to 6.5, p=0.012), 16 patients had reduced AO-SI. Patients with increased (n=24) AO-SI had a significantly higher rate of the composite end-point (58% vs 12%, OR 9.8, p Conclusions Increased aortic stiffness in HMII patients is associated with significantly higher rates of adverse events. Further studies are warranted to determine the causality between aortic stiffness and adverse events, as well as the effect of neurohormonal modulation on the conduit vasculature in CF-LVAD patients. Subject terms Heart Failure; Vascular Disease