Abstract
<h3>Purpose</h3> Stroke is one of the leading complications during CF-LVAD support. The purpose of this observational study was to investigate the temporal relationship of circulating homocysteine (Hcy) and oxidative stress as potential markers to identify CF-LVAD patients at risk for developing postoperative strokes. <h3>Methods</h3> We analyzed available blood samples from 24 selected subjects including non-heart failure control group(n=6) and heart-failure patients undergoing CF-LVAD implant(n=18). The CF-LVAD patients were selected in stroke group(n=6) those who developed stroke within a month after implant and were compared to selected matched patients who did not develop stroke(n=12). Baseline Hcy, malondialdehyde(MDA) and antioxidant were compared between groups. Weekly blood samples at 1,2,3 and 4 weeks were analyzed in selected stroke and no-stroke groups. <h3>Results</h3> At baseline, CF-LVAD patients had higher plasma Hcy and MDA and lower antioxidant than the control group(Fig1A-C). There was a significant 1.8-fold increase in baseline Hcy in stroke group compared to no-stroke group though there were no differences in the levels of MDA and antioxidant between them(Fig1A-C). In stroke group, post-implant levels of Hcy and MDA increased temporally and remained elevated while these trends were not seen in the no-stroke group(Fig1D-F). There was also a significant depletion in antioxidant in stroke group at week 4 compared to no-stroke group(Fig1F). <h3>Conclusion</h3> A near 2-fold rise in baseline Hcy was seen in stroke group patients compared to no-stroke patients, suggesting its utility as a potential biomarker to predict stroke risk after CF-LVAD implant. Elevated Hcy, oxidative stress and depleted antioxidant may be important indicators of systemic response of the body to CF-LVAD in patients who have stroke. These findings also suggest that vascular endothelial dysfunction may plan an important role in the development of stroke in CF-LVAD recipients.
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