Dataset Information

Relationship between spleen size and exercise tolerance in advanced heart failure patients with a left ventricular assist device.

ABSTRACT:

Objective

Spleen volume increases in patients with advanced heart failure (HF) after left ventricular assist device (LVAD) implantation. However, the relationship between spleen volume and exercise tolerance (peak oxygen consumption [VO₂]) in these patients remains unknown. In this exploratory study, we enrolled 27 patients with HF using a LVAD (median age: 46 years). Patients underwent blood testing, echocardiography, right heart catheterization, computed tomography (CT), and cardiopulmonary exercise testing. Spleen size was measured using CT volumetry, and the correlations/causal relationships of factors affecting peak VO₂ were identified using structural equation modeling.

Results

The median spleen volume was 190.0 mL, and peak VO₂ was 13.2 mL/kg/min. The factors affecting peak VO₂ were peak heart rate (HR; β = 0.402, P = .015), pulmonary capillary wedge pressure (PCWP; β = - 0.698, P = .014), right ventricular stroke work index (β = 0.533, P = .001), blood hemoglobin concentration (β = 0.359, P = .007), and spleen volume (β = 0.215, P = .041). Spleen volume correlated with peak HR, PCWP, and hemoglobin concentration, reflecting sympathetic activity, cardiac preload, and oxygen-carrying capacity, respectively, and was thus related to peak VO₂. These results suggest an association between spleen volume and exercise tolerance in advanced HF.

SUBMITTER: Hiraiwa H

PROVIDER: S-EPMC8832641 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Publications

Relationship between spleen size and exercise tolerance in advanced heart failure patients with a left ventricular assist device.

Hiraiwa Hiroaki H Okumura Takahiro T Sawamura Akinori A Araki Takashi T Mizutani Takashi T Kazama Shingo S Kimura Yuki Y Shibata Naoki N Oishi Hideo H Kuwayama Tasuku T Kondo Toru T Furusawa Kenji K Morimoto Ryota R Adachi Takuji T Yamada Sumio S Mutsuga Masato M Usui Akihiko A Murohara Toyoaki T

BMC research notes 20220210 1

<h4>Objective</h4>Spleen volume increases in patients with advanced heart failure (HF) after left ventricular assist device (LVAD) implantation. However, the relationship between spleen volume and exercise tolerance (peak oxygen consumption [VO<sub>2</sub>]) in these patients remains unknown. In this exploratory study, we enrolled 27 patients with HF using a LVAD (median age: 46 years). Patients underwent blood testing, echocardiography, right heart catheterization, computed tomography (CT), and ...[more]

PMID: 35144676

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Project description:ObjectivesThis study investigates the use of a Bayesian statistical model to address the limited predictive capacity of existing risk scores derived from multivariate analyses. This is based on the hypothesis that it is necessary to consider the interrelationships and conditional probabilities among independent variables to achieve sufficient statistical accuracy.BackgroundRight ventricular failure (RVF) continues to be a major adverse event following left ventricular assist device (LVAD) implantation.MethodsData used for this study were derived from 10,909 adult patients from the Inter-Agency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who had a primary LVAD implanted between December 2006 and March 2014. An initial set of 176 pre-implantation variables were considered. RVF post-implant was categorized as acute (<48 h), early (48 h to 14 daysays), and late (>14 days) in onset. For each of these endpoints, a separate tree-augmented naïve Bayes model was constructed using the most predictive variables employing an open source Bayesian inference engine.ResultsThe acute RVF model consisted of 33 variables including systolic pulmonary artery pressure (PAP), white blood cell count, left ventricular ejection fraction, cardiac index, sodium levels, and lymphocyte percentage. The early RVF model consisted of 34 variables, including systolic PAP, pre-albumin, lactate dehydrogenase level, INTERMACS profile, right ventricular ejection fraction, pro-B-type natriuretic peptide, age, heart rate, tricuspid regurgitation, and body mass index. The late RVF model included 33 variables and was predicted mostly by peripheral vascular resistance, model for end-stage liver disease score, albumin level, lymphocyte percentage, and mean and diastolic PAP. The accuracy of all Bayesian models was between 91% and 97%, with an area under the receiver operator characteristics curve between 0.83 and 0.90, sensitivity of 90%, and specificity between 98% and 99%, significantly outperforming previously published risk scores.ConclusionsA Bayesian prognostic model of RVF based on the large, multicenter INTERMACS registry provided highly accurate predictions of acute, early, and late RVF on the basis of pre-operative variables. These models may facilitate clinical decision making while screening candidates for LVAD therapy.

Dataset Information

Relationship between spleen size and exercise tolerance in advanced heart failure patients with a left ventricular assist device.

Objective

Results

Publications

Relationship between spleen size and exercise tolerance in advanced heart failure patients with a left ventricular assist device.

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