Sympathetic Markers are Different between Clinical Responders and Nonresponders after Left Ventricular Assist Device Implantation

Quin E. Denfeld, Christopher S. Lee, William R. Woodward, Shirin O. Hiatt, James O. Mudd, Beth A. Habecker

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)E1-E10
JournalJournal of Cardiovascular Nursing
Volume34
Issue number4
DOIs
StatePublished - Jul 1 2019

Keywords

  • Adrenergic receptor kinase-1
  • Health-related quality of life
  • Left ventricular assist device
  • Norepinephrine
  • Sympathetic nervous system

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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