Variability in Blood Pressure Assessment in Patients Supported with the HeartMate 3TM.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
pubmed:
27
6
2021
medline:
22
3
2022
entrez:
26
6
2021
Statut:
ppublish
Résumé
Targeted blood pressure (BP) control is a goal of left ventricular assist device medical management, but the interpretation of values obtained from noninvasive instruments is challenging. In the MOMENTUM 3 Continued Access Protocol, paired BP values in HeartMate 3 (HM3) patients were compared from arterial (A)-line and Doppler opening pressure (DOP) (319 readings in 261 patients) and A-line and automated cuff (281 readings in 247 patients). Pearson (R) correlations between A-line mean arterial (MAP) and systolic blood pressures (SBP) were compared with DOP and cuff measures according to the presence (>1 pulse in 5 seconds) or absence of a palpable radial pulse. There were only moderate correlations between A-line and noninvasive measurements of SBP (DOP R = 0.58; cuff R = 0.47) and MAP (DOP R = 0.48; cuff R = 0.37). DOP accuracy for MAP estimation, defined as the % of readings within ± 10 mmHg of A-line MAP, decreased from 80% to 33% for DOP ≤ 90 vs. >90 mmHg, and precision also diminished (mean absolute difference [MAD] increased from 6.3 ± 5.6 to 16.1 ± 11.4 mmHg). Across pulse pressures, cuff MAPs were within ±10 mmHg of A-line 62.9%-68.8% of measures and MADs were negligible. The presence of a palpable pulse reduced the accuracy and precision of the DOP-MAP estimation but did not impact cuff-MAP accuracy or precision. In summary, DOP may overestimate MAP in some patients on HM3 support. Simultaneous use of DOP and automated cuff and radial pulse may be needed to guide antihypertensive medication titration in outpatients on HM3 support.
Identifiants
pubmed: 34172641
doi: 10.1097/MAT.0000000000001497
pii: 00002480-202203000-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
374-383Informations de copyright
Copyright © ASAIO 2021.
Références
Nassif ME, Tibrewala A, Raymer DS, et al.: Systolic blood pressure on discharge after left ventricular assist device insertion is associated with subsequent stroke. J Heart Lung Transplant. 34: 503–508, 2015.
Patil NP, Sabashnikov A, Mohite PN, et al.: De novo aortic regurgitation after continuous-flow left ventricular assist device implantation. Ann Thorac Surg. 98: 850–857, 2014.
Saeed O, Jermyn R, Kargoli F, et al.: Blood pressure and adverse events during continuous flow left ventricular assist device support. Circ Heart Fail. 8: 551–556, 2015.
Cowger JA, Shah P, Pagani FD, et al.: Outcomes based on blood pressure in patients on continuous flow left ventricular assist device support: An Interagency Registry for Mechanically Assisted Circulatory Support analysis. J Heart Lung Transplant. 39: 441–453, 2020.
Berger A: Oscillatory blood pressure monitoring devices. BMJ (clinical research ed) 323: 919, 2001.
Lanier GM, Orlanes K, Hayashi Y, et al.: Validity and reliability of a novel slow cuff-deflation system for noninvasive blood pressure monitoring in patients with continuous-flow left ventricular assist device. Circ Heart Fail. 6: 1005–1012, 2013.
Tang PC, Pagani FD: Continuous-flow device engineering and pump technology. Cardiol Clin. 36: 451–463, 2018.
Mehra MR, Goldstein DJ, Uriel N, et al.; MOMENTUM 3 Investigators: Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N Engl J Med. 378: 1386–1395, 2018.
Mehra MR, Naka Y, Uriel N, et al.; MOMENTUM 3 Investigators: A fully magnetically levitated circulatory pump for advanced heart failure. N Engl J Med. 376: 440–450, 2017.
Mehra MR, Uriel N, Naka Y, et al.; MOMENTUM 3 Investigators: A fully magnetically levitated left ventricular assist device - final report. N Engl J Med. 380: 1618–1627, 2019.
Armstrong RA: Should Pearson’s correlation coefficient be avoided? Ophthalmic Physiol Opt. 39: 316–327, 2019.
Bennett MK, Roberts CA, Dordunoo D, Shah A, Russell SD: Ideal methodology to assess systemic blood pressure in patients with continuous-flow left ventricular assist devices. J Heart Lung Transplant. 29: 593–594, 2010.
Bennett MK, Adatya S: Blood pressure management in mechanical circulatory support. J Thorac Dis. 7: 2125–2128, 2015.
Li S, Beckman JA, Welch NG, et al.: Accuracy of Doppler blood pressure measurement in continuous-flow left ventricular assist device patients. ESC Heart Fail. 6: 793–798, 2019.
Myers TJ, Bolmers M, Gregoric ID, Kar B, Frazier OH: Assessment of arterial blood pressure during support with an axial flow left ventricular assist device. J Heart Lung Transplant. 28: 423–427, 2009.
Purohit SN, Cornwell WK 3rd, Pal JD, Lindenfeld J, Ambardekar AV: Living without a pulse: The vascular implications of continuous-flow left ventricular assist devices. Circ Heart Fail. 11: e004670, 2018.
Marcos-Abdala HG, Cruz-Solbes AS, Hussain I, et al.: Pulse assessment is important with blood pressure measurement in individuals with continuous flow left ventricular assist devices. Int J Artif Organs. 44: 124–129, 2021.
Magunia H, Schibilsky D, Hilberath JN, Schlensak C, Rosenberger P, Nowak-Machen M: Echocardiographic features of the fully magnetically levitated LVAD. JACC Cardiovasc Imaging. 10: 819–822, 2017.