American Heart Association

Old drug… new trick? Treatment with sildenafil may prevent device thrombosis and ischemic stroke in LVAD patients.

Contributor: Chris Sobowale

Bleeding and thrombosis account for almost half of adverse events in patients with CF-LVADs.

Saeed et al analyzed 144 HeartMate II (HMII) CF-LVAD patients in a single center, retrospective study. Patients in the sildenafil groups were on sildenafil for pulmonary hypertension or right ventricular dysfunction for at least 30 days after discharge from CF-LVAD implant. Patients were divided into four groups:

  1. Low level hemolysis not on sildenafil (n=31)
  2. Low level hemolysis on sildenafil (n= 16)
  3. No low level hemolysis not on sildenafil n= (76)
  4. No low level hemolysis on sildenafil (n=21)

Peripheral venous pressure, a surrogate for central venous pressure

Contributor: Steven Stroud

Bedside assessment of volume status is an age-old practice for clinicians. Spoiler alert: we are not very good at it. So, is there an alternate, accurate, less invasive way to assess volume status in decompensated heart failure patients other than measurement of central hemodynamics? Well, every hospitalized patient gets (at least) one peripheral intravenous (IV) line. What if we transduced the peripheral venous pressure (PVP) to estimate central venous pressure (CVP)? Sperry and colleagues demonstrated that PVP was highly correlated with CVP (r=0.947). OK, but does that help me estimate  pulmonary catheter wedge pressure (PCWP)? PVP was mildly correlated (r=0.57) with PCWP, but patients with PVP >10mmHG did have a 100% positive predictive value of PCWP >20mmHg (n=13). Big news— worry less about keeping batteries in that little flashlight for the neck exam.