Long-term Device Support Research Articles

Longitudinal Assessment of Inflammation in Recipients of Continuous-Flow Left Ventricular Assist Devices

BackgroundThe long-term effects of continuous-flow left ventricular assist device (CF-LVAD) support on trends of inflammatory markers over time are unknown. We examined the hypothesis that the levels of inflammatory markers in CF-LVAD recipients are higher than in healthy controls and that these levels increase over time with long-term CF-LVAD support. MethodsWe examined the levels of inflammatory markers longitudinally at baseline before CF-LVAD implantation and at 3, 6, and 9 months after implantation. We then compared the levels of inflammatory markers to those in a healthy control group. ResultsCompared with baseline values before CF-LVAD implantation, left ventricular end-diastolic diameter (LVEDd) and left ventricular end-systolic diameter (LVESd) decreased significantly at 3, 6, and 9 months after CF-LVAD implantation. Brain natriuretic peptide (BNP) levels dropped significantly after CF-LVAD implantation but did not normalize. Improvements in ejection fraction at 3, 6, and 9 months after CF-LVAD implantation did not reach significance. Monocyte chemoattractant protein-1, interferon γ-induced protein, and C-reactive protein levels were higher in the CF-LVAD recipients at each of the time points (baseline before CF-LVAD implantation and 3, 6, and 9 months after implantation) compared with levels in healthy controls. In CF-LVAD recipients, serum interleukin-8, tumour necrosis factor-α, and macrophage inflammatory protein-β increased significantly at 9 months, and macrophage-derived chemokine increased at 6 months after CF-LVAD implantation compared with baseline. ConclusionsDespite improvements in LV dimensions and BNP levels, markers of inflammation remained higher in CF-LVAD recipients. High levels of inflammation in CF-LVAD recipients may result from heart failure preconditioning or the long-term device support, or both. Because inflammation may be detrimental to CF-LVAD recipients, future studies should determine whether inflammatory pathways are reversible.

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

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.