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Published on: June 12, 2021
Gastrointestinal bleeding and pro-angiogenic shift in the angiopoietin axis with continuous flow left ventricular
Adam L Edwards1, C Mel Wilcox1, Mark Beasley2
1Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Insights
Continuous-flow left ventricular assist device (CF-LVAD) recipients with gastrointestinal bleeding (GIB) show altered angiopoietin levels. Lower angiopoietin-1 and higher angiopoietin-2 are linked to GIB and may be associated with low pulse pressure.
Area of Science:
- Cardiovascular Science
- Vascular Biology
- Gastroenterology
Background:
- Gastrointestinal bleeding (GIB) affects up to 40% of continuous-flow left ventricular assist device (CF-LVAD) recipients.
- Low device pulsatility is a risk factor for GIB in CF-LVAD patients, but the underlying mechanism is unknown.
- Altered hemodynamics in CF-LVAD recipients may impact angiogenesis signaling.
Purpose of the Study:
- To measure serum levels of angiopoietin (Ang)-1, Ang-2, and VEGF-A in CF-LVAD recipients with and without GIB, and in healthy controls.
- To evaluate correlations between these angiopoietin levels and hemodynamic parameters in CF-LVAD recipients.
Main Methods:
- Recruited 12 CF-LVAD recipients (6 with GIB) and 12 age-matched controls.
- Measured serum Ang-1, Ang-2, and VEGF-A levels.
- Correlated angiopoietin levels with device hemodynamics, including pulse pressure.
Main Results:
- CF-LVAD recipients had higher Ang-2 and lower Ang-1 levels than controls; VEGF-A levels were similar.
- CF-LVAD recipients with GIB had lower Ang-1 levels compared to those without GIB.
- Trends suggested pulse pressure positively correlated with Ang-1 and negatively with Ang-2 in CF-LVAD recipients.
Conclusions:
- CF-LVAD recipients exhibit a pro-angiogenic shift in the angiopoietin axis.
- This shift is significantly associated with GIB and potentially linked to low pulse pressure.
- Understanding these vascular changes may inform strategies to reduce GIB in CF-LVAD patients.
Background:
Gastrointestinal bleeding (GIB) affects up to 40% of continuous-flow left ventricular assist device (CF-LVAD) recipients. A higher risk of GIB is seen in CF-LVAD recipients with lower device pulsatility without a known mechanism. One hypothesis is that the novel hemodynamics in CF-LVAD recipients affect angiogenesis signaling. We aimed to (1) measure serum levels of angiopoietin (Ang)-1, Ang-2, and VEGF-A in CF-LVAD recipients with and without GIB and in healthy controls and (2) evaluate correlations of those levels with hemodynamics.
Methods:
We recruited 12 patients with CF-LVADs (six who developed GIB after device implantation) along with 12 age-matched controls without heart failure or GIB and measured Ang-1, Ang-2, and VEGF-A levels in serum samples from each patient.
Results:
CF-LVAD recipients had significantly higher Ang-2 and lower Ang-1 levels compared to controls with no difference in VEGF-A levels. CF-LVAD recipients with GIB had lower Ang-1 levels than those without GIB. There were trends for pulse pressure to be positively correlated with Ang-1 levels and negatively correlated with Ang-2 levels in CF-LVAD recipients with no correlation observed in healthy controls.
Conclusion:
CF-LVAD recipients demonstrated a shift toward a pro-angiogenic phenotype in the angiopoietin axis that is significantly associated with GIB and may be linked to low pulse pressure.
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