Key result
Baseline elevation of both TNF-α and Ang-2 before LVAD implantation was associated with an increased risk of significant bleeding events within 180 days (HR 2.3; 95% CI 1.2-4.6; p=0.02).
Why the study?
Angiopoietin-2 and TNF-alpha may be linked to bleeding in LVAD patients, but changes in these biomarkers and their correlation with nonsurgical bleeding required description.
Do elevated baseline levels of Ang-2 and TNF-α predict bleeding events in patients receiving a HeartMate II LVAD?
Cohort (n=140)
Yes
Do elevated baseline levels of Ang-2 and TNF-α predict bleeding events in patients receiving a HeartMate II LVAD?
Hazard Ratio: 2.3 (95% CI 1.2–4.6)
Absolute Event Rate: 60% vs 38%
p-value: p=0.02
Elevated baseline levels of Ang-2 and TNF-α are associated with a more than twofold increased risk of bleeding events following LVAD implantation.
May refine bleeding risk prediction in LVAD patients; hypothesis-generating and requires prospective validation before clinical use.
The purpose of this study was to describe the changes in plasma levels of angiogenic and inflammatory biomarkers, specifically Ang-2 and TNF-α, in patients receiving HeartMate II (HMII) left ventricular assist device (LVAD) and correlate them with nonsurgical bleeding. It has been shown that angiopoietin-2 (Ang-2) and tissue necrosis factor-α (TNF-α) may be linked to bleeding in LVAD patients. This study utilized biobanked samples prospectively collected from the PREVENT study, a prospective, multicenter, single-arm, nonrandomized study of patients implanted with HMII. Paired serum samples were obtained in 140 patients before implantation and at 90 days postimplantation. Baseline demographics were as follows: age 57 ± 13 years, 41% had ischemic etiology, 82% male, and 75% destination therapy indication. In the 17 patients with baseline elevation of both TNF-α and Ang-2, 10 (60%) experienced a significant bleeding event within 180 days postimplant compared with 37 of 98 (38%) patients with Ang-2 and TNF-α below the mean ( p = 0.02). The hazard ratio for a bleeding event was 2.3 (95% CI: 1.2-4.6) in patients with elevated levels of both TNF-α and Ang-2. In the PREVENT multicenter study, patients with elevations in serum Angiopoietin-2 and TNF-α at baseline before LVAD implantation demonstrated increased bleeding events after LVAD implantation.
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Kim et al. (2023) conducted a cohort in Left ventricular assist device (LVAD) support (n=140). Baseline elevation of both TNF-α and Ang-2 vs. Ang-2 and TNF-α below the mean was evaluated on Significant bleeding event within 180 days postimplant (HR 2.3, 95% CI 1.2-4.6, p=0.02). Baseline elevation of both TNF-α and Ang-2 before LVAD implantation was associated with an increased risk of significant bleeding events within 180 days (HR 2.3; 95% CI 1.2-4.6; p=0.02).
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