TY - JOUR
T1 - Sympathetic Markers are Different between Clinical Responders and Nonresponders after Left Ventricular Assist Device Implantation
AU - Denfeld, Quin E.
AU - Lee, Christopher S.
AU - Woodward, William R.
AU - Hiatt, Shirin O.
AU - Mudd, James O.
AU - Habecker, Beth A.
N1 - Funding Information:
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. The work reported in this article was supported by the National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) through a postdoctoral fellowship (Denfeld) at Oregon Health & Science
Funding Information:
University Knight Cardiovascular Institute (T32HL094294). Dr Denfeld is currently supported as a scholar of the Oregon Building Interdisciplinary Research Careers in Women's Health K12 Program funded by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the NIH under Award Number K12HD043488. Plasma samples and data for this project were collected as part of a parent study funded by the National Institutes of Health/ National Institute of Nursing Research (1R01NR013492; Lee) and supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR000128). Drs Habecker and Woodward are funded by the NIH/NHLBI (R01HL093056; Habecker). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - 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.
AB - 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.
KW - Adrenergic receptor kinase-1
KW - Health-related quality of life
KW - Left ventricular assist device
KW - Norepinephrine
KW - Sympathetic nervous system
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U2 - 10.1097/JCN.0000000000000580
DO - 10.1097/JCN.0000000000000580
M3 - Article
C2 - 31094762
AN - SCOPUS:85067907265
VL - 34
SP - E1-E10
JO - Journal of Cardiovascular Nursing
JF - Journal of Cardiovascular Nursing
SN - 0889-4655
IS - 4
ER -