Elevated Levels of Inflammation in Patients on Long-Term Continuous Flow Left Ventricular Assist Device (CF-LVAD) Support

Abstract

Purpose Elevated levels of inflammatory markers shortly after implantation predict mortality in patients supported with left ventricular assist devices (LVADs). However, no study has investigated the long-term effects of continuous-flow LVAD (CF-LVAD) support on inflammation. CF-LVAD support may expose heart failure patients to high levels of inflammation either as a result of the non-physiological continuous-flow or as a result of the blood contact with an artificial surface. We hypothesize that in CF-LVAD recipients the levels of inflammatory markers are higher than those of healthy controls and these levels increase over time with long-term CF-LVAD support. Methods and Materials We examined the levels of inflammatory markers longitudinally at the heart failure baseline prior to CF-LVAD implantation and at 3, 6, and 9 months post-implantation and compared them to the levels of inflammation in healthy controls. Results The levels of MDC, MCP-1, TNF-alpha were significantly higher in the CF-LVAD recipients compared to the healthy controls at 3, 6, and 9 months post-implantation. Compared to healthy controls, IP-10 levels were higher at 3 and 9 months, while CRP levels were significantly higher only at 9 months post-implantation. [ figure 1 ] Conclusions Our study is the first to find that inflammation is high in patients on long term CF-LVAD support. Elevated levels of inflammation may be the results of both the heart failure condition prior to the implantation and the long term device support. Monitoring inflammatory markers and treatment to reduce inflammation may have clinical importance in these patients and should be further investigated.