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

Quin Denfeld, Christopher Lee, William Woodward, Shirin O. Hiatt, James Mudd, Beth Habecker

Research output: Contribution to journalArticle

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

Fingerprint

Heart-Assist Devices
Adrenergic Receptors
Phosphotransferases
Quality of Life
Norepinephrine
Cardiomyopathies
Cohort Studies
Transplantation
Enzyme-Linked Immunosorbent Assay
High Pressure Liquid Chromatography
Growth

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

Cite this

@article{ec6122bb5ef3420e9578248040f1bace,
title = "Sympathetic Markers are Different between Clinical Responders and Nonresponders after Left Ventricular Assist Device Implantation",
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.",
keywords = "Adrenergic receptor kinase-1, Health-related quality of life, Left ventricular assist device, Norepinephrine, Sympathetic nervous system",
author = "Quin Denfeld and Christopher Lee and William Woodward and Hiatt, {Shirin O.} and James Mudd and Beth Habecker",
year = "2019",
month = "7",
day = "1",
doi = "10.1097/JCN.0000000000000580",
language = "English (US)",
volume = "34",
pages = "E1--E10",
journal = "Journal of Cardiovascular Nursing",
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T1 - Sympathetic Markers are Different between Clinical Responders and Nonresponders after Left Ventricular Assist Device Implantation

AU - Denfeld, Quin

AU - Lee, Christopher

AU - Woodward, William

AU - Hiatt, Shirin O.

AU - Mudd, James

AU - Habecker, Beth

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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