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Sci Rep. 2019 Apr 11;9(1):5909. doi: 10.1038/s41598-019-42334-3.

Functional capillary impairment in patients with ventricular assist devices.

Author information

1
Division of Cardiothoracic and Vascular Anesthesia, Medical University of Vienna, Vienna, Austria.
2
Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
3
Department of Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
4
Ludwig-Boltzmann-Cluster for Cardiovascular Research, Vienna, Austria.
5
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
6
Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria.
7
Intitute of Medical Statistics, Medical University of Vienna, Vienna, Austria.
8
Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria. bernd.jilma@meduniwien.ac.at.

Abstract

The implantation of continuous - flow ventricular assist devices (VAD) is suggested to evoke angiodysplasia contributing to adverse events such as gastrointestinal bleeding. We evaluated in vivo capillary density and glycocalyx dimensions to investigate possible systemic microvascular changes in patients with chronic heart failure and VAD support vs. standard medical treatment. Forty-two patients with VAD support were compared to forty-one patients with ischemic and non-ischemic chronic heart failure (CHF) on standard pharmacotherapy and to a group of forty-two healthy subjects in a prospective cross-sectional study. Sublingual microcirculation was visualized using Sidestream Darkfield videomicroscopy and functional and perfused total capillary densities were quantified. Patients with VAD implantation were followed for one year and bleeding events were recorded. Median time after VAD implantation was 18 months. Patients were treated with centrifugal-flow devices (n = 31) or axial-flow devices (n = 11). Median functional capillary density was significantly lower in patients with VAD therapy as compared to CHF patients (196 vs. 255/mm2, p = 0.042, adjusted p-value). Functional and total capillary densities were 44% and 53% lower (both p < 0.001) in patients with VAD therapy when compared to healthy subjects. Cox regression analysis revealed loss of capillary density as a significant predictor of bleeding events during one -year follow-up of VAD patients (HR: 0.987, CI (95%): 0.977-0.998, p = 0.021 for functional and 0.992, CI (95%): 0.985-0.999, p = 0.03 for total capillary density). In conclusion, patients with VAD support exhibit capillary density rarefaction, which was associated with bleeding events. If confirmed independently, capillary impairment may be evaluated as novel marker of bleeding risk.

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