HEMODYNAMIC EFFECTS OF SILDENAFIL ON RIGHT HEART FUNCTION IN LEFT VENTRICULAR DEVICES
Solomon R, Obi C, Sharma S, Smith Z, Gheewala N, Cabrera R, Lanfear D, Jennings D, and Long T. HEMODYNAMIC EFFECTS OF SILDENAFIL ON RIGHT HEART FUNCTION IN LEFT VENTRICULAR DEVICES. J Am Coll Cardiol 2019; 73(9):831.
J Am Coll Cardiol
Background: Right ventricular failure (RVF) is the leading cause of morbidity and mortality for patients with a left ventricular assist device (LVAD). There is limited data to support lowering pulmonary pressure with a phosphodiesterase inhibitor to improve right ventricular function. This study aims to evaluate the hemodynamic effects of sildenafil on right heart function in LVAD patients. Methods: This was a single center, retrospective, cohort study comparing LVAD patients on sildenafil versus those who were not (control group). Patients who received a LVAD from January 2010 to December 2015 were included in the study. Primary endpoint was right heart function at 1, 6, and 12 months post-LVAD implantation. Secondary endpoints include changes in CVP, PCWP, PAPs/d/m, LVEDD, TAPSE, FAC and dosage of sildenafil. Right heart failure was defined as CVP > 20 and CVP:PCWP > 0.63. Hemodynamic parameters are collected by manual review of echocardiograms for each patient at baseline, 1 month, 6 months and 12 months post-LVAD placement. Results: 168 patients were included in the analysis, of which 62 received sildenafil and 106 did not. The mean age was 55 ± 13. Heartmate II was the most common LVAD (82%). There were no differences in RVF at baseline (6.7 vs 4.9%, p = 0.726) and at 1 month (3.8 vs 4.2%, p = 1.00). There were no occurrences of RVF at 6 and 12 months in either group. Baseline CVP (mmHg) and PCWP (mmHg) were higher in the sildenafil group compared to control group (CVP 11 [6,21.8] vs 9 [6,18], p = 0.036; PCWP 24 [19.25,31] vs 19[15,24], p = 0.001), respectively. No difference was noted in CVP or PCWP between groups up to 12 months postLVAD. PAPs/d were higher at baseline and at 1 month in the sildenafil group but no differences at 6 and 12-month. PAPm at baseline was higher in sildenafil (38.5 [35,43.75] vs 32 [25.75,36], p < 0.001) and at 1 month (26.5 [22.25,34.25] vs 18 [14.5,24.5], p = 0.002). No differences were noted between groups in FAC, TAPSE, and LVEDD. Conclusion: There were no differences observed in the incidence of RVF up to 12 months post-LVAD placement between patients who received sildenafil and those who did not. Sildenafil does not appear to have a significant effect on hemodynamic parameters in patients with LVAD.
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