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Updated: Apr 19, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Systolic blood pressure on discharge after left ventricular assist device insertion is associated with subsequent
Michael E Nassif1, Anjan Tibrewala2, David S Raymer1
1Division of Cardiology.
Insights
Elevated systolic blood pressure (SBP) in patients with continuous-flow left ventricular assist devices (CF-LVAD) significantly increases stroke risk. Managing hypertension may reduce stroke incidence in these patients.
Area of Science:
- Cardiovascular Medicine
- Neurosurgery
- Medical Devices
Background:
- Stroke is a major complication for patients with continuous-flow left ventricular assist devices (CF-LVAD).
- Hypertension is a known risk factor for stroke, but its specific association with stroke in LVAD patients is not well understood.
Purpose of the Study:
- To investigate the relationship between blood pressure levels and stroke risk in patients supported by CF-LVAD.
- To determine if elevated systolic blood pressure (SBP) is an independent predictor of stroke in this patient population.
Main Methods:
- A cohort of 275 CF-LVAD patients surviving implant hospitalization was analyzed.
- Patients were stratified into two groups based on averaged SBP within 48 hours before discharge (above or below a median of 100 mm Hg).
- Time to stroke was compared between groups using Cox proportional hazard models.
Main Results:
- Patients with above-median SBP (mean 110 mm Hg) had a significantly higher incidence of stroke (16%) compared to those with below-median SBP (mean 95 mm Hg, 7%).
- The association between elevated SBP and stroke risk remained significant after adjusting for factors like age, diabetes, and prior stroke.
- Receiver operating characteristic analysis indicated SBP as a continuous predictor of stroke (AUC=0.64).
Conclusions:
- Elevated systolic blood pressure is independently associated with an increased risk of stroke in patients with CF-LVAD.
- Managing hypertension presents a potential modifiable strategy to decrease stroke incidence in CF-LVAD patients.
Background:
Stroke is a significant complication in patients supported with continuous-flow left ventricular assist devices (CF-LVAD) and hypertension is a significant risk factor for stroke, but the association between blood pressure and stroke in LVAD patients is not well characterized.
Methods:
We identified 275 consecutive patients who survived implant hospitalization between January 2005 and April 2013. Patients were grouped according to systolic blood pressure (SBP) as above a median and below a median of 100 mm Hg by their averaged systolic blood pressure during the 48 hours before discharge from implantation hospitalization. The groups were compared for the primary outcome of time to stroke.
Results:
The above-median SBP group had mean SBP of 110 mm Hg and the below-median SBP group had mean SBP of 95 mm Hg. There were no significant between-group differences in body mass index, smoking, vascular disease, hypertension, atrial fibrillation, or prior stroke. During a mean follow-up of 16 months, stroke occurred in 16% of the above-median SBP group vs in 7% of the below-median SBP group (hazard ratio, 2.38; 95% confidence interval, 1.11-5.11), with a similar proportion of hemorrhagic and ischemic strokes in each group. In Cox proportional hazard models adjusting for age, diabetes, or prior stroke, the hazard ratio remained statistically significant. SBP as a continuous variable predictor of stroke had an area under the curve of 0.64 in a receiver operating characteristic curve analysis.
Conclusions:
In this large, CF-LVAD cohort, elevated SBP was independently associated with a greater risk of subsequent stroke. These results identify management of hypertension as a potential modifiable risk factor for reducing the incidence of stroke in patients supported by CF-LVAD.
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