BACKGROUND An optimal blood pressure (BP) range to mitigate morbidity and mortality on left ventricular assist device (LVAD) support has not been clearly defined. METHODS Average Doppler opening pressure, mean arterial pressure (MAP), and/or systolic blood pressure (SBP) were calculated in operative survivors (n = 16,155) of LVAD support in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). BP distributions were used to group patients into low (BP <25th percentile), normal (25-75th percentile), high (75th-95th percentile), and very high (>95th percentile). Associations between BP and adverse events were evaluated using Cox regression (hazard ratio[HR], 95% confidence interval). RESULTS The median (25th, 75th) MAP, Doppler, and SBP (mm Hg) during continuous flow LVAD support were 84 (77, 90), 85 (80, 92), and 99 (90, 107) mm Hg, respectively. BP had a bimodal risk association with survival. At 3 years, survival was 58% ± 1.8% in those with low MAP (≤75 mm Hg) vs 70% ± 0.9%, 71% ± 1.5%, and 63% ± 3.0% in the those with normal, high, or very high average MAP, respectively. Patients with chronically low MAP (≤75 mm Hg), Doppler (≤80 mm Hg), and SBP (<90 mm Hg) had 35%-42% higher adjusted hazards of death than patients with normal or high BP (p ≤ 0.0001). Patients with MAP >100 mm Hg, Doppler ≥105 mm Hg, and SBP ≥120 mm Hg had 17%-20% higher adjusted hazards of death than those with normal pressures (p < 0.05). In patients on axial flow LVADs, elevated SBP (HR 1.08 [95% confidence interval, 1.04-1.13] per 10 mm Hg increase) but not MAP correlated with increased incident of stroke. CONCLUSIONS In INTERMACS, BP extremes during LVAD support increase the risk for adverse events, supporting a MAP goal >75 mm Hg and <90 mm Hg. Hypotension conferred the highest risk for mortality. Excessive BP control should be avoided, and Doppler opening pressure should not be assumed to represent MAP in all patients.

中文翻译：

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基于连续流左心室辅助装置支持的患者血压的结果：机械辅助循环支持分析的机构间登记处。


背景技术尚未明确定义左心室辅助装置（LVAD）支持下减轻发病率和死亡率的最佳血压（BP）范围。方法 在机械辅助循环支持机构间登记处 (INTERMACS) 中计算 LVAD 支持的手术幸存者 (n = 16,155) 的平均多普勒开放压、平均动脉压 (MAP) 和/或收缩压 (SBP)。血压分布用于将患者分为低血压（血压<25th id=0>95th 百分位数）。使用 Cox 回归（风险比 [HR]，95% 置信区间）评估血压和不良事件之间的关联。结果 连续流 LVAD 支持期间的中位 (25、75) MAP、多普勒和 SBP (mm Hg) 分别为 84 (77、90)、85 (80、92) 和 99 (90、107) mm Hg。 BP 与生存存在双峰风险关联。 3 年时，MAP 低（≤75 mm Hg）患者的生存率为 58% ± 1.8%，而 MAP 正常、高或较高的患者的生存率为 70% ± 0.9%、71% ± 1.5% 和 63% ± 3.0%。分别非常高的平均 MAP。长期低 MAP (≤75 mm Hg)、多普勒 (≤80 mm Hg) 和 SBP (<90 id=1>100 mm Hg、多普勒 ≥105 mm Hg、SBP ≥120 mm Hg) 的患者有 17%-20在使用轴流 LVAD 的患者中，SBP 升高（每增加 10 mm Hg，HR 1.08 [95% 置信区间，1.04-1.13]）但与 MAP 无关，调整后的死亡风险百分比较高（p < 0.05）。结论 在 INTERMACS 中，LVAD 支持期间的血压极值会增加不良事件的风险，支持 MAP 目标 >75 mm Hg 和 <90 mm Hg 会带来最高的死亡风险。不应假定多普勒开放压代表所有患者的 MAP。