Carotid artery structure and hemodynamics and their association with adverse vascular events in left ventricular assist device patients

Abstract

Left ventricular assist devices (LVADs) are associated with major vascular complications including stroke and gastrointestinal bleeding (GIB). These adverse vascular events may be the result of widespread vascular dysfunction resulting from pre-LVAD abnormalities or continuous flow during LVAD therapy. We hypothesized that pre-existing large artery atherosclerosis and/or abnormal blood flow as measured in carotid arteries using ultrasonography are associated with a post-implantation composite adverse outcome including stroke, GIB, or death. We retrospectively studied 141 adult HeartMate II patients who had carotid ultrasound duplex exams performed before and/or after LVAD surgery. Structural parameters examined included plaque burden and stenosis. Hemodynamic parameters included peak-systolic, end-diastolic, and mean velocity as well as pulsatility index. We examined the association of these measures with the composite outcome as well as individual subcomponents such as stroke. After adjusting for established risk factors, the composite adverse outcome was associated with pre-operative moderate-to-severe carotid plaque (OR 5.08, 95% CI 1.67–15.52) as well as pre-operative internal carotid artery stenosis (OR 9.02, 95% CI 1.06–76.56). In contrast, altered hemodynamics during LVAD support were not associated with the composite outcome. Our findings suggest that pre-existing atherosclerosis possibly in combination with LVAD hemodynamics may be an important contributor to adverse vascular events during mechanical support. This encourages greater awareness of carotid morphology pre-operatively and further study of the interaction between hemodynamics, pulsatility, and structural arterial disease during LVAD support.

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Acknowledgements

E. J. Stöhr and Barry J. McDonnell have received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie Grant agreement No 705219.

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Contributions

All of the listed authors contributed to the design, implementation, and preparation of this study. Specifically, MK, AG, MM, and ER contributed to data collection. MK, AZ, and AJ performed data analysis. MK, BM, and ES as well as MY, PC, and JW all contributed to study design and data interpretation. Final manuscript preparation was performed by MK and all authors read and approved the final manuscript. A portion of this manuscript has been presented in abstract format at a scientific meeting, namely the International Society for Heart & Lung Transplantation.

Corresponding author

Correspondence to Michael E. Kiyatkin.

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Conflict of interest

Paolo Colombo has previously received grant funding from Abbott for unrelated work that in no way affected any aspect of this particular study. The remaining authors had no conflicts of interest whatsoever.

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Kiyatkin, M.E., Zuver, A.M., Gaudig, A. et al. Carotid artery structure and hemodynamics and their association with adverse vascular events in left ventricular assist device patients. J Artif Organs (2021). https://doi.org/10.1007/s10047-020-01229-1

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Keywords

  • Left ventricular assist device (LVAD)
  • Heart mate II
  • Stroke
  • Atherosclerosis
  • Ultrasound