Gastrointestinal Angiodysplasia is Part of the Vascular Pathophysiology of Advanced Heart Failure

Abstract

Purpose We have previously reported a high prevalence of gastrointestinal angiodysplasia (GIAD) in advanced HF patients undergoing LVAD evaluation. We now hypothesize that GIAD develop in relation to advancing heart failure and are associated with angiogenic dysregulation. Methods After informed consent, patients being evaluated for LVAD underwent video capsule endoscopy (VCE) for assessment of GIAD. Two control groups were formed: (1) NYHA Class 1 HF patients with LVEF angiogenesis was measured in both HF groups and a subset of paired pre and post LVAD patients. Results Median age and percent female of the advanced HF (n=17), NYHA 1 (n=4), non-HF controls (n=36) were as follows: (61, 61, 56; p = .789) and (18%, 0%, and 56%; p =0.020). Prevalence of GIAD was much higher in the advanced HF group as compared to the NYHA 1 and non-HF controls: 71% vs 25% vs 33% (p=0.009). Median Ang2 levels were numerically higher in the advanced HF as compared to the NYHA 1 group (5.4 vs 3.3ng/mL; p=0.138) although this did not reach statistical significance in this small sample. In 9 subjects with paired measurements, Ang2 increased from a mean of 6.7±3.5 to 11.3±7.6ng/mL (p=0.047) after LVAD implantation. Conclusion GIADs are already present in the majority of patients undergoing LVAD implantation and appear to be part of the pathophysiology of advanced heart failure. Angiogenic dysregulation predates LVAD implantation but is augmented in the setting of continuous flow LVAD support. Enrollment in this study is ongoing and at the time of abstract presentation, we anticipate a larger sample size.