Higher soluble thrombomodulin and angiogenic markers in continuous flow left ventricular assist device–supported patients associated with arteriovenous malformation and nonsurgical bleeding
Bleeding complications are a bane of continuous flow left ventricular assist devices (cfLVAD); gastrointestinal bleeding (GIB) from arteriovenous malformation (AVM) predominating. We hypothesized that shear stress disrupts vascular endothelium altering angiogenesis and contributing to bleeding. We p...
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Elsevier
2024-11-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S295013342400082X |
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| author | Kavitha Muthiah, MBChB, PhD, FRACP, FCSANZ Louise L. Dunn, BSc(Hons), PhD Hunter Eckford, BMedSci David Connor, BMedSci(Hons), PhD Desiree Robson, RN Peter S. Macdonald, MBBS, FRACP, MD, PhD Christopher S. Hayward, MD, FRACP |
| author_facet | Kavitha Muthiah, MBChB, PhD, FRACP, FCSANZ Louise L. Dunn, BSc(Hons), PhD Hunter Eckford, BMedSci David Connor, BMedSci(Hons), PhD Desiree Robson, RN Peter S. Macdonald, MBBS, FRACP, MD, PhD Christopher S. Hayward, MD, FRACP |
| author_sort | Kavitha Muthiah, MBChB, PhD, FRACP, FCSANZ |
| collection | DOAJ |
| description | Bleeding complications are a bane of continuous flow left ventricular assist devices (cfLVAD); gastrointestinal bleeding (GIB) from arteriovenous malformation (AVM) predominating. We hypothesized that shear stress disrupts vascular endothelium altering angiogenesis and contributing to bleeding. We profiled markers of endothelial dysfunction (soluble thrombomodulin [sTM]) and angiogenesis (angiopoietin-1 [Ang-1], angiopoietin-2 [Ang-2]) in 21 patients implanted with a centrifugal cfLVAD. Bleeding episodes were documented in 11 patients, 8 had GIB, 4 of whom had AVMs. We observed a dynamic change in sTM and Ang-2/Ang-1 ratio following cfLVAD support (p = 0.030 and p = 0.025, respectively). Bleeding patients had higher sTM and Ang-2/Ang-1 ratios than patients with no bleeding (p = 0.04 and p = 0.06, respectively). At D180, patients with AVMs had significantly higher Ang-2/Ang-1 ratios vs patients without proven AVMs (p = 0.006). We conclude that bleeding in cfLVAD-supported patients is associated with alteration in endothelial/vascular homeostasis, possibly contributing to AVM formation. |
| format | Article |
| id | doaj-art-ccfcaaed3a6e4364b1119944b6badeb3 |
| institution | OA Journals |
| issn | 2950-1334 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-ccfcaaed3a6e4364b1119944b6badeb32025-08-20T02:12:46ZengElsevierJHLT Open2950-13342024-11-01610013310.1016/j.jhlto.2024.100133Higher soluble thrombomodulin and angiogenic markers in continuous flow left ventricular assist device–supported patients associated with arteriovenous malformation and nonsurgical bleedingKavitha Muthiah, MBChB, PhD, FRACP, FCSANZ0Louise L. Dunn, BSc(Hons), PhD1Hunter Eckford, BMedSci2David Connor, BMedSci(Hons), PhD3Desiree Robson, RN4Peter S. Macdonald, MBBS, FRACP, MD, PhD5Christopher S. Hayward, MD, FRACP6Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia; Corresponding author: Kavitha Muthiah, MBChB, PhD, FRACP, FCSANZ, Heart and Lung Transplant Unit, St Vincent’s Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia.Victor Chang Cardiac Research Institute, Sydney, AustraliaHeart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, AustraliaSt. Vincent's Centre For Applied Medical Research, Sydney, Australia; Department of Hematology, St. Vincent's Hospital, Sydney, Sydney, AustraliaHeart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, AustraliaHeart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, AustraliaHeart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, AustraliaBleeding complications are a bane of continuous flow left ventricular assist devices (cfLVAD); gastrointestinal bleeding (GIB) from arteriovenous malformation (AVM) predominating. We hypothesized that shear stress disrupts vascular endothelium altering angiogenesis and contributing to bleeding. We profiled markers of endothelial dysfunction (soluble thrombomodulin [sTM]) and angiogenesis (angiopoietin-1 [Ang-1], angiopoietin-2 [Ang-2]) in 21 patients implanted with a centrifugal cfLVAD. Bleeding episodes were documented in 11 patients, 8 had GIB, 4 of whom had AVMs. We observed a dynamic change in sTM and Ang-2/Ang-1 ratio following cfLVAD support (p = 0.030 and p = 0.025, respectively). Bleeding patients had higher sTM and Ang-2/Ang-1 ratios than patients with no bleeding (p = 0.04 and p = 0.06, respectively). At D180, patients with AVMs had significantly higher Ang-2/Ang-1 ratios vs patients without proven AVMs (p = 0.006). We conclude that bleeding in cfLVAD-supported patients is associated with alteration in endothelial/vascular homeostasis, possibly contributing to AVM formation.http://www.sciencedirect.com/science/article/pii/S295013342400082Xleft ventricular assist devicemechanical circulatory supportgastrointestinal bleedingarteriovenous malformationangiogenesis |
| spellingShingle | Kavitha Muthiah, MBChB, PhD, FRACP, FCSANZ Louise L. Dunn, BSc(Hons), PhD Hunter Eckford, BMedSci David Connor, BMedSci(Hons), PhD Desiree Robson, RN Peter S. Macdonald, MBBS, FRACP, MD, PhD Christopher S. Hayward, MD, FRACP Higher soluble thrombomodulin and angiogenic markers in continuous flow left ventricular assist device–supported patients associated with arteriovenous malformation and nonsurgical bleeding JHLT Open left ventricular assist device mechanical circulatory support gastrointestinal bleeding arteriovenous malformation angiogenesis |
| title | Higher soluble thrombomodulin and angiogenic markers in continuous flow left ventricular assist device–supported patients associated with arteriovenous malformation and nonsurgical bleeding |
| title_full | Higher soluble thrombomodulin and angiogenic markers in continuous flow left ventricular assist device–supported patients associated with arteriovenous malformation and nonsurgical bleeding |
| title_fullStr | Higher soluble thrombomodulin and angiogenic markers in continuous flow left ventricular assist device–supported patients associated with arteriovenous malformation and nonsurgical bleeding |
| title_full_unstemmed | Higher soluble thrombomodulin and angiogenic markers in continuous flow left ventricular assist device–supported patients associated with arteriovenous malformation and nonsurgical bleeding |
| title_short | Higher soluble thrombomodulin and angiogenic markers in continuous flow left ventricular assist device–supported patients associated with arteriovenous malformation and nonsurgical bleeding |
| title_sort | higher soluble thrombomodulin and angiogenic markers in continuous flow left ventricular assist device supported patients associated with arteriovenous malformation and nonsurgical bleeding |
| topic | left ventricular assist device mechanical circulatory support gastrointestinal bleeding arteriovenous malformation angiogenesis |
| url | http://www.sciencedirect.com/science/article/pii/S295013342400082X |
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