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J Heart Lung Transplant. 2014 May;33(5):470-7. doi: 10.1016/j.healun.2014.01.004. Epub 2014 Jan 19.

Association between cell-derived microparticles and adverse events in patients with nonpulsatile left ventricular assist devices.

Author information

  • 1Departments of Cardiology, Texas Heart Institute, Houston, Texas.
  • 2Departments of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
  • 3Division of Thrombosis Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
  • 4Puget Sound Blood Center, Seattle, Washington.
  • 5Division of Biostatistics and Epidemiology, Texas Heart Institute, Houston, Texas.
  • 6Puget Sound Blood Center, Seattle, Washington; Hematology Division, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington.
  • 7Departments of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. Electronic address: lschwenke@texasheart.org.

Abstract

BACKGROUND:

Continuous-flow left ventricular assist devices (LVADs) expose blood cells to high shear stress, potentially resulting in the production of microparticles that express phosphatidylserine (PS+) and promote coagulation and inflammation. In this prospective study, we attempted to determine whether PS+ microparticle levels correlate with clinical outcomes in LVAD-supported patients.

METHODS:

We enrolled 20 patients undergoing implantation of the HeartMate II LVAD (Thoratec Corp, Pleasanton, CA) and 10 healthy controls who provided reference values for the microparticle assays. Plasma was collected before LVAD implantation, at discharge, at the 3-month follow-up, and when an adverse clinical event occurred. We quantified PS+ microparticles in the plasma using flow cytometry.

RESULTS:

During the study period, 8 patients developed adverse clinical events: ventricular tachycardia storm in 1, non-ST-elevation myocardial infarction in 2, arterial thrombosis in 2, gastrointestinal bleeding in 2, and stroke in 3. Levels of PS+ microparticles were higher in patients at baseline than in healthy controls (2.11% ± 1.26% vs 0.69% ± 0.46%, p = 0.007). After LVAD implantation, patient PS+ microparticle levels increased to 2.39% ± 1.22% at discharge and then leveled to 1.97% ± 1.25% at the 3-month follow-up. Importantly, levels of PS+ microparticles were significantly higher in patients who developed an adverse event than in patients with no events (3.82% ± 1.17% vs 1.57% ± 0.59%, p < 0.001), even though the 2 patient groups did not markedly differ in other clinical and hematologic parameters.

CONCLUSIONS:

Our results suggest that an elevation of PS+ microparticle levels may be associated with adverse clinical events. Thus, measuring PS+ microparticle levels in LVAD-supported patients may help identify patients at increased risk for adverse events.

Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

cell-derived microparticles; phosphatidylserine; ventricular assist device

PMID:
24656391
[PubMed - indexed for MEDLINE]
PMCID:
PMC3992167
Free PMC Article
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