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Published on: August 16, 2021
Sympathetic Markers are Different Between Clinical Responders and Nonresponders After Left Ventricular Assist Device
Quin E Denfeld1, Christopher S Lee, William R Woodward
1Quin E. Denfeld, PhD, RN Knight Cardiovascular Institute and Department of Physiology & Pharmacology, Oregon Health & Science University, Portland. Christopher S. Lee, PhD, RN, FAAN, FAHA, FHFSA William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts. William R. Woodward, PhD Department of Physiology & Pharmacology and Department of Neurology, Oregon Health & Science University, Portland. Shirin O. Hiatt, MS, RN, MPH School of Nursing, Oregon Health & Science University, Portland. James O. Mudd, MD Knight Cardiovascular Institute, Oregon Health & Science University, Portland. Beth A. Habecker, PhD Knight Cardiovascular Institute and Department of Physiology & Pharmacology, Oregon Health & Science University, Portland.
Background:
Clinical response to left ventricular assist devices (LVADs), as measured by health-related quality of life, varies among patients after implantation; however, it is unknown which pathophysiological mechanisms underlie differences in clinical response by health-related quality of life.
Objective:
The purpose of this study was to compare changes in sympathetic markers (β-adrenergic receptor kinase-1 [βARK1], norepinephrine [NE], and 3,4-dihydroxyphenylglycol [DHPG]) between health-related quality of life clinical responders and nonresponders from pre- to post-LVAD implantation.
Methods:
We performed a secondary analysis on a subset of data from a cohort study of patients from pre- to 1, 3, and 6 months after LVAD implantation. Clinical response was defined as an increase of 5 points or higher on the Kansas City Cardiomyopathy Questionnaire Clinical Summary score from pre- to 6 months post-LVAD implantation. We measured plasma βARK1 level with an enzyme-linked immunosorbent assay and plasma NE and DHPG levels with high-performance liquid chromatography with electrochemical detection. Latent growth curve modeling was used to compare the trajectories of markers between groups.
Results:
The mean (SD) age of the sample (n = 39) was 52.9 (13.2) years, and most were male (74.4%) and received LVADs as bridge to transplantation (69.2%). Preimplantation plasma βARK1 levels were significantly higher in clinical responders (n = 19) than in nonresponders (n = 20) (P = .001), but change was similar after LVAD (P = .235). Preimplantation plasma DHPG levels were significantly lower in clinical responders than in nonresponders (P = .002), but the change was similar after LVAD (P = .881). There were no significant differences in plasma NE levels.
Conclusions:
Preimplantation βARK1 and DHPG levels are differentiating factors between health-related quality of life clinical responders and nonresponders to LVAD, potentially signaling differing levels of sympathetic stimulation underlying clinical response.
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