Characteristics of strokes associated with centrifugal flow left ventricular assist devices

Abstract Stroke is a devastating complication of left ventricular assist device (LVAD) therapy. Understanding the characteristics, risk factors and outcomes of strokes associated with the centrifugal flow LVADs is important to devise better strategies for management and prevention. This is a retrosp...

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Autores principales:	Ovais Inamullah, Yuting P. Chiang, Muath Bishawi, Martin Weiss, Michael W. Lutz, Laura J. Blue, Wayne Feng, Carmelo A. Milano, Matthew Luedke, Nada El Husseini
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f8c7a1fb6bdb4e1bb6f6fe210ef9fbbf
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spelling	oai:doaj.org-article:f8c7a1fb6bdb4e1bb6f6fe210ef9fbbf2021-12-02T13:56:47ZCharacteristics of strokes associated with centrifugal flow left ventricular assist devices10.1038/s41598-021-81445-82045-2322https://doaj.org/article/f8c7a1fb6bdb4e1bb6f6fe210ef9fbbf2021-01-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-81445-8https://doaj.org/toc/2045-2322Abstract Stroke is a devastating complication of left ventricular assist device (LVAD) therapy. Understanding the characteristics, risk factors and outcomes of strokes associated with the centrifugal flow LVADs is important to devise better strategies for management and prevention. This is a retrospective cohort study at a single US academic medical center. The cohort includes patients who received a first time Heartmate 3 (HM3) or Heartware (HVAD) LVAD between September 2009 through February 2018 and had a stroke while the LVAD was in place. Descriptive statistics were used when appropriate. A logistic regression analysis was used to determine predictors of poor outcome. Out of a total of 247 patients, 12.1% (N = 30, 24 HVAD and 6 HM3) had a stroke (63% ischemic) and 3 of these patients had pump thrombosis. Events per patient year (EPPY) were similar for HVAD and HM3 patients (0.3 ± 0.1). INR was subtherapeutic in 47.4% of ischemic stroke patients and supratherapeutic in 18.2% of hemorrhagic stroke patients. Concurrent infections were more common in the setting of hemorrhagic stroke than ischemic stroke (45.4% vs 5.3%, p = 0.008). Strokes were severe in most cases, with initial NIH stroke scale (NIHSS) higher in HM3 patients compared to HVAD patients (mean 24.6 vs 16) and associated with high in-patient mortality (21.1% of ischemic stroke vs. 88.8% of hemorrhagic stroke). Predictors of death within 30 days and disability at 90 days included creatinine at stroke onset, concurrent infection, hemorrhaghic stroke, and initial stroke severity (NIHSS). A score derived from these variables predicted with 100% certainty mortality at 30 days and mRS ≥ 4 at 90 days. For patients with centrifugal flow LVADs, ischemic strokes were more common but hemorrhagic strokes were associated with higher in-patient mortality and more frequently seen in the setting of concurrent infections. Infections, sub or supratherapeutic INR range, and comorbid cardiovascular risk factors may all be contributing to the stroke burden. These findings may inform future strategies for stroke prevention in this population.Ovais InamullahYuting P. ChiangMuath BishawiMartin WeissMichael W. LutzLaura J. BlueWayne FengCarmelo A. MilanoMatthew LuedkeNada El HusseiniNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ovais Inamullah Yuting P. Chiang Muath Bishawi Martin Weiss Michael W. Lutz Laura J. Blue Wayne Feng Carmelo A. Milano Matthew Luedke Nada El Husseini Characteristics of strokes associated with centrifugal flow left ventricular assist devices
description	Abstract Stroke is a devastating complication of left ventricular assist device (LVAD) therapy. Understanding the characteristics, risk factors and outcomes of strokes associated with the centrifugal flow LVADs is important to devise better strategies for management and prevention. This is a retrospective cohort study at a single US academic medical center. The cohort includes patients who received a first time Heartmate 3 (HM3) or Heartware (HVAD) LVAD between September 2009 through February 2018 and had a stroke while the LVAD was in place. Descriptive statistics were used when appropriate. A logistic regression analysis was used to determine predictors of poor outcome. Out of a total of 247 patients, 12.1% (N = 30, 24 HVAD and 6 HM3) had a stroke (63% ischemic) and 3 of these patients had pump thrombosis. Events per patient year (EPPY) were similar for HVAD and HM3 patients (0.3 ± 0.1). INR was subtherapeutic in 47.4% of ischemic stroke patients and supratherapeutic in 18.2% of hemorrhagic stroke patients. Concurrent infections were more common in the setting of hemorrhagic stroke than ischemic stroke (45.4% vs 5.3%, p = 0.008). Strokes were severe in most cases, with initial NIH stroke scale (NIHSS) higher in HM3 patients compared to HVAD patients (mean 24.6 vs 16) and associated with high in-patient mortality (21.1% of ischemic stroke vs. 88.8% of hemorrhagic stroke). Predictors of death within 30 days and disability at 90 days included creatinine at stroke onset, concurrent infection, hemorrhaghic stroke, and initial stroke severity (NIHSS). A score derived from these variables predicted with 100% certainty mortality at 30 days and mRS ≥ 4 at 90 days. For patients with centrifugal flow LVADs, ischemic strokes were more common but hemorrhagic strokes were associated with higher in-patient mortality and more frequently seen in the setting of concurrent infections. Infections, sub or supratherapeutic INR range, and comorbid cardiovascular risk factors may all be contributing to the stroke burden. These findings may inform future strategies for stroke prevention in this population.
format	article
author	Ovais Inamullah Yuting P. Chiang Muath Bishawi Martin Weiss Michael W. Lutz Laura J. Blue Wayne Feng Carmelo A. Milano Matthew Luedke Nada El Husseini
author_facet	Ovais Inamullah Yuting P. Chiang Muath Bishawi Martin Weiss Michael W. Lutz Laura J. Blue Wayne Feng Carmelo A. Milano Matthew Luedke Nada El Husseini
author_sort	Ovais Inamullah
title	Characteristics of strokes associated with centrifugal flow left ventricular assist devices
title_short	Characteristics of strokes associated with centrifugal flow left ventricular assist devices
title_full	Characteristics of strokes associated with centrifugal flow left ventricular assist devices
title_fullStr	Characteristics of strokes associated with centrifugal flow left ventricular assist devices
title_full_unstemmed	Characteristics of strokes associated with centrifugal flow left ventricular assist devices
title_sort	characteristics of strokes associated with centrifugal flow left ventricular assist devices
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/f8c7a1fb6bdb4e1bb6f6fe210ef9fbbf
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Characteristics of strokes associated with centrifugal flow left ventricular assist devices

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