Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Current Hypertension Reports
Erschienen in: Current Hypertension Reports 2/2016

01.02.2016 | Blood Pressure Monitoring and Management (J Cockcroft, Section Editor)

Hypertension and Stroke in Patients with Left Ventricular Assist Devices (LVADs)

verfasst von: Joshua Z. Willey, Amelia K. Boehme, Francesco Castagna, Melana Yuzefpolskaya, A. Reshad Garan, Veli Topkara, Paolo C. Colombo

Erschienen in: Current Hypertension Reports | Ausgabe 2/2016

Einloggen, um Zugang zu erhalten

Abstract

Stroke is one of the most dreaded complications of left ventricular assist device therapy in patients with end-stage congestive heart failure. There is strong evidence linking anticoagulation and infection with ischemic and hemorrhagic strokes, though recent data has emerged regarding the importance of elevated blood pressure. In the recently completed Heartware Ventricular Assist Device studies, a mean arterial pressure greater than 90 mmHg was associated with greater stroke risk, particularly the hemorrhagic subtype. In this review, we discuss recent evidence regarding deleterious effects of uncontrolled hypertension in patients with left ventricular devices, and propose measurement and management strategies.
Literatur
1.•
Kirklin JK, Naftel DC, Pagani FD, et al. Sixth INTERMACS annual report: a 10,000-patient database. J Heart Lung Transplant. 2014;33(6):555–64. This manuscript reviews recent trends in implantation and complications after placement of LVAD.CrossRefPubMed
2.••
Estep JD, Starling RC, Horstmanshof DA, et al. Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: results from the ROADMAP study. J Am Coll Cardiol. 2015;66(16):1747–61. This up to date manuscript provides a description of improved survival and quality of life with LVAD despite a greater risk of complications.CrossRefPubMed
3.••
Teuteberg JJ, Slaughter MS, Rogers JG, et al. The HVAD left ventricular assist device: risk factors for neurological events and risk mitigation strategies. JACC Heart Fail. 2015;3(10):818–28. The comprehensive overview of hypertension as a complicating factor in HVAD associated strokes is included in this manuscript.CrossRefPubMed
4.
Harvey L, Holley C, Roy SS, et al. Stroke after left ventricular assist device implantation: outcomes in the continuous-flow era. Ann Thorac Surg. 2015;100(2):535–41.CrossRefPubMed
5.
Boehme AK, Pamboukian SV, George JF, et al. Predictors of thromboembolic events in patients with ventricular assist device. ASAIO J. 2015;61(6):640–7.CrossRefPubMed
6.
Willey JZ, Demmer RT, Takayama H, Colombo PC, Lazar RM. Cerebrovascular disease in the era of left ventricular assist devices with continuous flow: risk factors, diagnosis, and treatment. J Heart Lung Transplant. 2014;33(9):878–87.CrossRefPubMed
7.
Morgan JA, Brewer RJ, Nemeh HW, et al. Stroke while on long-term left ventricular assist device support: incidence, outcome, and predictors. ASAIO J. 2014;60(3):284–9.CrossRefPubMed
8.
Starling RC, Moazami N, Silvestry SC, et al. Unexpected abrupt increase in left ventricular assist device thrombosis. N Engl J Med. 2014;370(1):33–40.CrossRefPubMed
9.
Whitson BA, Eckman P, Kamdar F, et al. Hemolysis, pump thrombus, and neurologic events in continuous-flow left ventricular assist device recipients. Ann Thorac Surg. 2014;97(6):2097–103.CrossRefPubMed
10.
Stulak JM, Lee D, Haft JW, et al. Gastrointestinal bleeding and subsequent risk of thromboembolic events during support with a left ventricular assist device. J Heart Lung Transplant. 2013;33(1):60–4.CrossRefPubMed
11.
Stulak JM, Deo S, Schirger J, et al. Preoperative atrial fibrillation increases risk of thromboembolic events after left ventricular assist device implantation. Ann Thorac Surg. 2013;96(6):2161–7.CrossRefPubMed
12.
Kato TS, Schulze PC, Yang J, et al. Pre-operative and post-operative risk factors associated with neurologic complications in patients with advanced heart failure supported by a left ventricular assist device. J Heart Lung Transplant. 2012;31(1):1–8.CrossRefPubMed
13.
Pagani F, Milano CA, Tatooles A, et al. HeartWare HVAD for the treatment of pateints with advanced heart failure ineligible for cardiac transplantation: results from the ENDURANCE destination therapy trial. J Heart Lung Transplant. 2015;34:S9.CrossRef
14.
Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754–832.CrossRefPubMed
15.
Go AS, Mozaffarian D, Roger VL, et al. Executive summary: heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129(3):399–410.CrossRefPubMed
16.
Park TH, Ko Y, Lee SJ, et al. Identifying target risk factors using population attributable risks of ischemic stroke by age and sex. J Stroke. 2015;17(3):302–11.PubMedCentralCrossRefPubMed
17.
Hemphill 3rd JC, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032–60.CrossRefPubMed
18.
January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):2071–104.CrossRefPubMed
19.
Johansson BB. Hypertension mechanisms causing stroke. Clin Exp Pharmacol Physiol. 1999;26(7):563–5.CrossRefPubMed
20.
Yaghi S, Eisenberger A, Willey JZ. Symptomatic intracerebral hemorrhage in acute ischemic stroke after thrombolysis with intravenous recombinant tissue plasminogen activator: a review of natural history and treatment. JAMA Neurol. 2014;71(9):1181–5.PubMedCentralCrossRefPubMed
21.
Menon BK, Saver JL, Prabhakaran S, et al. Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator. Stroke. 2012;43(9):2293–9.CrossRefPubMed
22.
Weigel R, Hohenstein A, Schlickum L, Weiss C, Schilling L. Angiotensin converting enzyme inhibition for arterial hypertension reduces the risk of recurrence in patients with chronic subdural hematoma possibly by an antiangiogenic mechanism. Neurosurgery. 2007;61(4):788–92. discussion 792–783.CrossRefPubMed
23.
Laviv Y, Rappaport ZH. Risk factors for development of significant chronic subdural hematoma following conservative treatment of acute subdural hemorrhage. Br J Neurosurg. 2014;28(6):733–8.CrossRefPubMed
24.•
Wasson LT, Yuzefpolskaya M, Wakabayashi M, et al. Hypertension: an unstudied potential risk factor for adverse outcomes during continuous flow ventricular assist device support. Heart Fail Rev. 2014;20(3):317–22. This is an important review article highlighting the potential mechanisms by which hypertension may lead to complications with LVAD.CrossRef
25.••
Nassif ME, Tibrewala A, Raymer DS, et al. Systolic blood pressure on discharge after left ventricular assist device insertion is associated with subsequent stroke. J Heart Lung Transplant. 2015;34(4):503–8. This study of the effects of elevated blood pressure even before hospital discharge has a deleterious effect on stroke risk and provides additional data that the risk from hypertension may not be due to only an acute reaction at time of stroke.CrossRefPubMed
26.
Uzarski JS, Scott EW, McFetridge PS. Adaptation of endothelial cells to physiologically-modeled, variable shear stress. PLoS One. 2013;8(2):e57004.PubMedCentralCrossRefPubMed
27.•
Cornwell 3rd WK, Tarumi T, Aengevaeren VL, et al. Effect of pulsatile and nonpulsatile flow on cerebral perfusion in patients with left ventricular assist devices. J Heart Lung Transplant. 2014;33(12):1295–303. This physiologic study highlights that patients with continuous flow VAD's still have preserved cerebral autoregulation.CrossRefPubMed
28.
Ortega-Gutierrez S, Petersen N, Masurkar A, et al. Reliability, asymmetry, and age influence on dynamic cerebral autoregulation measured by spontaneous fluctuations of blood pressure and cerebral blood flow velocities in healthy individuals. J Neuroimaging. 2013;24(4):379–86.CrossRefPubMed
29.
30.•
Colombo PC, Lanier GM, Orlanes K, Yuzefpolskaya M, Demmer RT. Usefulness of a standard automated blood pressure monitor in patients with continuous-flow left ventricular assist devices. J Heart Lung Transplant. 2015. The appropriate strategies for measuring hypertension in patients with LVAD is reviewed in this manuscript.
31.
Lanier GM, Orlanes K, Hayashi Y, et al. Validity and reliability of a novel slow cuff-deflation system for noninvasive blood pressure monitoring in patients with continuous-flow left ventricular assist device. Circ Heart Fail. 2013;6(5):1005–12.CrossRefPubMed
32.
Jauch EC, Saver JL, Adams Jr HP, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.CrossRefPubMed
33.
Powers WJ, Derdeyn CP, Biller J, et al. American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020–35.CrossRefPubMed
Metadaten
Titel
Hypertension and Stroke in Patients with Left Ventricular Assist Devices (LVADs)
verfasst von
Joshua Z. Willey
Amelia K. Boehme
Francesco Castagna
Melana Yuzefpolskaya
A. Reshad Garan
Veli Topkara
Paolo C. Colombo
Publikationsdatum
01.02.2016
Verlag
Springer US
Erschienen in
Current Hypertension Reports / Ausgabe 2/2016
Print ISSN: 1522-6417
Elektronische ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-015-0618-1

Weitere Artikel der Ausgabe 2/2016

Current Hypertension Reports 2/2016 Zur Ausgabe

Hypertension and Metabolic Syndrome (J Sperati, Section Editor)

Ghrelin and Blood Pressure Regulation

Therapeutic Trials (M Weir, Section Editor)

GLP-1 Agonists and Blood Pressure: A Review of the Evidence

Antihypertensive Agents: Mechanisms of Drug Action (ME Ernst, Section Editor)

Usefulness of the Polypill for the Prevention of Cardiovascular Disease and Hypertension

Secondary Hypertension: Nervous System Mechanisms (M Wyss, Section Editor)

The Role of CNS in the Effects of Salt on Blood Pressure

Pathogenesis of Hypertension (W Elliott, Section Editor)

Dietary Nitrate Lowers Blood Pressure: Epidemiological, Pre-clinical Experimental and Clinical Trial Evidence

Pathogenesis of Hypertension (W Elliott, Section Editor)

Bisphenol A, Hypertension, and Cardiovascular Diseases: Epidemiological, Laboratory, and Clinical Trial Evidence

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise