Decoupling between Pulmonary Artery and Wedge Pressure is Associated with Hemocompatibility-Related Adverse Events Following LVAD Implantation

Purpose Hemocompatibility-related adverse events (HRAEs) are major causes of readmission in LVAD patients. Decoupling between diastolic pulmonary artery pressure (dPAP) and pulmonary capillary wedge pressure (PCWP) is an index of pulmonary vascular damage. This study assessed the implication of decoupling on HRAEs in LVAD patients. Methods In this prospective study LVAD patients underwent invasive hemodynamic tests and were followed for 1 year. Decoupling was defined as a difference >5 mmHg between dPAP and PCWP. One-year freedom from any HRAEs and the net burden of HRAEs, which was calculated by using a hemocompatibility score (using 4 escalating tiers of hierarchal severity to derive a total score for events), were compared between those with and without decoupling. Results Among 92 LVAD patients (median age 61 years, 57% male), 44 patients (48%) had decoupling. One-year freedom from any HRAEs was 49% in the decoupling group compared with 79% in the decoupling-free group (p = 0.005; Figure 1A). The average hemocompatibility score in the decoupling group was significantly higher compared with the control group (2.14 vs. 0.67; p = 0.004; Figure 1B), due to reduced Tier I (1-2 gastrointestinal bleedings or medically managed pump thrombosis; p = 0.027) and Tier IIIB scores (HRAEs-related death; p = 0.041). Conclusion The presence of decoupling between dPAP and PCWP was associated with HRAEs in LVAD patients. Studies evaluating if a reduction in decoupling will also reduce HRAE's is warranted. Hemocompatibility-related adverse events (HRAEs) are major causes of readmission in LVAD patients. Decoupling between diastolic pulmonary artery pressure (dPAP) and pulmonary capillary wedge pressure (PCWP) is an index of pulmonary vascular damage. This study assessed the implication of decoupling on HRAEs in LVAD patients. In this prospective study LVAD patients underwent invasive hemodynamic tests and were followed for 1 year. Decoupling was defined as a difference >5 mmHg between dPAP and PCWP. One-year freedom from any HRAEs and the net burden of HRAEs, which was calculated by using a hemocompatibility score (using 4 escalating tiers of hierarchal severity to derive a total score for events), were compared between those with and without decoupling. Among 92 LVAD patients (median age 61 years, 57% male), 44 patients (48%) had decoupling. One-year freedom from any HRAEs was 49% in the decoupling group compared with 79% in the decoupling-free group (p = 0.005; Figure 1A). The average hemocompatibility score in the decoupling group was significantly higher compared with the control group (2.14 vs. 0.67; p = 0.004; Figure 1B), due to reduced Tier I (1-2 gastrointestinal bleedings or medically managed pump thrombosis; p = 0.027) and Tier IIIB scores (HRAEs-related death; p = 0.041). The presence of decoupling between dPAP and PCWP was associated with HRAEs in LVAD patients. Studies evaluating if a reduction in decoupling will also reduce HRAE's is warranted.