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Functional capillary impairment in patients with ventricular assist devices

The implantation of continuous – flow ventricular assist devices (VAD) is suggested to evoke angiodysplasia contributing to adverse events such as gastrointestinal bleeding. We evaluated in vivo capillary density and glycocalyx dimensions to investigate possible systemic microvascular changes in pat...

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Autores principales: Wadowski, Patricia P., Steinlechner, Barbara, Zimpfer, Daniel, Schlöglhofer, Thomas, Schima, Heinrich, Hülsmann, Martin, Lang, Irene M., Gremmel, Thomas, Koppensteiner, Renate, Zehetmayer, Sonja, Weikert, Constantin, Pultar, Joseph, Jilma, Bernd
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459831/
https://www.ncbi.nlm.nih.gov/pubmed/30976042
http://dx.doi.org/10.1038/s41598-019-42334-3
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author Wadowski, Patricia P.
Steinlechner, Barbara
Zimpfer, Daniel
Schlöglhofer, Thomas
Schima, Heinrich
Hülsmann, Martin
Lang, Irene M.
Gremmel, Thomas
Koppensteiner, Renate
Zehetmayer, Sonja
Weikert, Constantin
Pultar, Joseph
Jilma, Bernd
author_facet Wadowski, Patricia P.
Steinlechner, Barbara
Zimpfer, Daniel
Schlöglhofer, Thomas
Schima, Heinrich
Hülsmann, Martin
Lang, Irene M.
Gremmel, Thomas
Koppensteiner, Renate
Zehetmayer, Sonja
Weikert, Constantin
Pultar, Joseph
Jilma, Bernd
author_sort Wadowski, Patricia P.
collection PubMed
description The implantation of continuous – flow ventricular assist devices (VAD) is suggested to evoke angiodysplasia contributing to adverse events such as gastrointestinal bleeding. We evaluated in vivo capillary density and glycocalyx dimensions to investigate possible systemic microvascular changes in patients with chronic heart failure and VAD support vs. standard medical treatment. Forty-two patients with VAD support were compared to forty-one patients with ischemic and non-ischemic chronic heart failure (CHF) on standard pharmacotherapy and to a group of forty-two healthy subjects in a prospective cross-sectional study. Sublingual microcirculation was visualized using Sidestream Darkfield videomicroscopy and functional and perfused total capillary densities were quantified. Patients with VAD implantation were followed for one year and bleeding events were recorded. Median time after VAD implantation was 18 months. Patients were treated with centrifugal-flow devices (n = 31) or axial-flow devices (n = 11). Median functional capillary density was significantly lower in patients with VAD therapy as compared to CHF patients (196 vs. 255/mm(2), p = 0.042, adjusted p-value). Functional and total capillary densities were 44% and 53% lower (both p < 0.001) in patients with VAD therapy when compared to healthy subjects. Cox regression analysis revealed loss of capillary density as a significant predictor of bleeding events during one -year follow-up of VAD patients (HR: 0.987, CI (95%): 0.977–0.998, p = 0.021 for functional and 0.992, CI (95%): 0.985–0.999, p = 0.03 for total capillary density). In conclusion, patients with VAD support exhibit capillary density rarefaction, which was associated with bleeding events. If confirmed independently, capillary impairment may be evaluated as novel marker of bleeding risk.
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spelling pubmed-64598312019-04-16 Functional capillary impairment in patients with ventricular assist devices Wadowski, Patricia P. Steinlechner, Barbara Zimpfer, Daniel Schlöglhofer, Thomas Schima, Heinrich Hülsmann, Martin Lang, Irene M. Gremmel, Thomas Koppensteiner, Renate Zehetmayer, Sonja Weikert, Constantin Pultar, Joseph Jilma, Bernd Sci Rep Article The implantation of continuous – flow ventricular assist devices (VAD) is suggested to evoke angiodysplasia contributing to adverse events such as gastrointestinal bleeding. We evaluated in vivo capillary density and glycocalyx dimensions to investigate possible systemic microvascular changes in patients with chronic heart failure and VAD support vs. standard medical treatment. Forty-two patients with VAD support were compared to forty-one patients with ischemic and non-ischemic chronic heart failure (CHF) on standard pharmacotherapy and to a group of forty-two healthy subjects in a prospective cross-sectional study. Sublingual microcirculation was visualized using Sidestream Darkfield videomicroscopy and functional and perfused total capillary densities were quantified. Patients with VAD implantation were followed for one year and bleeding events were recorded. Median time after VAD implantation was 18 months. Patients were treated with centrifugal-flow devices (n = 31) or axial-flow devices (n = 11). Median functional capillary density was significantly lower in patients with VAD therapy as compared to CHF patients (196 vs. 255/mm(2), p = 0.042, adjusted p-value). Functional and total capillary densities were 44% and 53% lower (both p < 0.001) in patients with VAD therapy when compared to healthy subjects. Cox regression analysis revealed loss of capillary density as a significant predictor of bleeding events during one -year follow-up of VAD patients (HR: 0.987, CI (95%): 0.977–0.998, p = 0.021 for functional and 0.992, CI (95%): 0.985–0.999, p = 0.03 for total capillary density). In conclusion, patients with VAD support exhibit capillary density rarefaction, which was associated with bleeding events. If confirmed independently, capillary impairment may be evaluated as novel marker of bleeding risk. Nature Publishing Group UK 2019-04-11 /pmc/articles/PMC6459831/ /pubmed/30976042 http://dx.doi.org/10.1038/s41598-019-42334-3 Text en © The Author(s) 2019 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Wadowski, Patricia P.
Steinlechner, Barbara
Zimpfer, Daniel
Schlöglhofer, Thomas
Schima, Heinrich
Hülsmann, Martin
Lang, Irene M.
Gremmel, Thomas
Koppensteiner, Renate
Zehetmayer, Sonja
Weikert, Constantin
Pultar, Joseph
Jilma, Bernd
Functional capillary impairment in patients with ventricular assist devices
title Functional capillary impairment in patients with ventricular assist devices
title_full Functional capillary impairment in patients with ventricular assist devices
title_fullStr Functional capillary impairment in patients with ventricular assist devices
title_full_unstemmed Functional capillary impairment in patients with ventricular assist devices
title_short Functional capillary impairment in patients with ventricular assist devices
title_sort functional capillary impairment in patients with ventricular assist devices
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459831/
https://www.ncbi.nlm.nih.gov/pubmed/30976042
http://dx.doi.org/10.1038/s41598-019-42334-3
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