Abstract 10979: ACE-inhibitor or ARB Therapy Reduces the Risk for GI Bleeding in LVAD Patients
Introduction: Gastrointestinal bleeding (GIB) due to arteriovenous malformations (AVMs) is a major source of morbidity for patients supported with left ventricular assist devices (LVADs). Recent studies implicate angiogenesis mediated by vascular endothelial growth factor (VEGF) in AVM formation. Transforming growth factor-β is biochemically upstream of VEGF and is up-regulated after LVAD implantation. Angiotensin converting enzyme inhibitors (ACE-inhibitors) and angiotensin receptor blockers (ARBs) inhibit TGF-β.
Hypothesis: ACE-inhibitor/ARB therapy will be independently associated with a reduced risk of GIB overall and GIB due to AVMs in LVAD patients.
Methods: We reviewed the records of all patients aged 18 years or older receiving a continuous flow LVAD (HeartMate II or Heartware) at Johns Hopkins Hospital from 1/2004 to 9/2013 (n=186). We excluded patients for whom follow-up records were not available (n=3), those supported with a LVAD for less than 100 contiguous days (n=51), and those missing covariates included in statistical models (n=8), leaving 124 patients included for analyses. Cox proportional hazards models adjusted for demographic, cardiovascular, and laboratory variables were used to assess the association of ACE-inhibitor/ARB therapy with GIB.
Results: Mean age of patients was 52 years and 75% were male. Ninety-seven patients received ACE-inhibitor and/or ARB therapy during LVAD support. Thirty-six patients (29%) had at least one GIB after discharge from their LVAD implantation; 15 of these 36 episodes (42%) were due to confirmed AVMs. Among ACE/ARB patients, 24% had a post-discharge GIB (23/97) versus 48% (13/27) of non-ACE/ARB patients. Fully adjusted Cox proportional hazards model demonstrated that ACE-inhibitor/ARB therapy was independently associated with a reduced risk of GIB after hospital discharge (HR 0.37, 95% CI 0.17-0.81, p=0.012) with suggestion of reduced risk of GIB due to AVMs (HR 0.32, 95% CI 0.10-1.06, p=0.06).
Conclusions: ACE-inhibitor and ARBs are independently associated with a reduced risk of GIB in LVAD patients and should be considered for all LVAD patients without contraindications. Possible biologic mechanisms of this observation remain unexplored and warrant further investigation.
Author Disclosures: B.A. Houston: None. J. Vaishnav: None. A.L. Schneider: None. P.E. Miller: None. K. Faridi: None. A. Shah: None. C. Sciortino: None. G.R. Stevens: None. R.J. Tedford: None. D. Judge: None. R. Rouf: None. S.D. Russell: None.
- © 2015 by American Heart Association, Inc.