Cowger JA, Chamogeorgakis T, Borgi J, Grafton G, Selektor Y, Nemeh H, Williams C, Tita C, Lanfear D. Systolic blood pressure and outcomes in patients on continuous flow LVAD support: An INTERMACS analysis. J Heart Lung Transplant. 2018;37(4):S30-S31.
J Heart Lung Transplant
Purpose: High mean arterial pressures in continuous flow(cf) LVAD patients are associated with increased stroke and pump thrombosis risks. Optimal thresholds for systolic blood pressure are unknown.
Methods: Systolic blood pressure (SBP) measurements in operative survivors of cfLVAD implant were obtained from the INTERMACS registry at 3, 6, and 12 months after implant. Survival was estimated with Kaplan-Meier methods and Cox Hazard Ratios [95% CI] for 1 year mortality were calculated.
Results: SBPs were available in 7738 operative survivors at 3 and 6 months. The mean±std SBPs at discharge, 3, 6, and 12 months were 91.8±14.9, 98.9±16.1, 100.3±16.4, and 101.0±16.3 mmHg. Patients with an SBP < 80 at 3 months were more likely to be INTERMACS 1 or 2, Bridge to transplant, and less likely to be African American. Survival was worse in those with low systolic blood pressure (table, p< 0.001). Compared with having an SBP > 100 at 3 months, SBPs < 80 (HR 2.0 [1.6-2.4]) and 81-100 (HR 1.2 [1.1-1.4]) were associated with increased 1-year mortality. Controlling for age, race, sex, axial-flow configuration, preoperative albumin, preoperative creatinine, INTERMACS profile, 1Y mortality was still higher with SBP < 80 (HR 2.0 [1.6-2.5]) and SBP 81-100 (HR 1.2 [1.02-1.4], p= 0.03) vs. an SBP > 100 mmHg.
Conclusion: Lower SBP after cfLVAD is independently associated with worse survival. This raises concern that excessive SBP control may be harmful in these patients. Dedicated trials to determine optimal BP targets are warranted.