Key result
Continuous-flow mechanical circulatory support was associated with higher angiopoietin-2/log10 BNP levels than advanced heart failure (2.80 vs 1.88, p<0.001), which predicted gastrointestinal bleeding.
Why the study?
Gastrointestinal bleeding during mechanical circulatory support is a major unsolved comorbidity linked to inadequate angiopoietin-2 activation, but angiopoietin-2 regulation remains unknown.
Does continuous-flow mechanical circulatory support therapy alter angiopoietin-2 levels and predict gastrointestinal bleeding in patients with advanced heart failure?
Cohort (n=32)
Does continuous-flow mechanical circulatory support therapy alter angiopoietin-2 levels and predict gastrointestinal bleeding in patients with advanced heart failure?
Absolute Event Rate: 2.8% vs 1.88%
p-value: p=< 0.001
Angiopoietin-2 levels are elevated following mechanical circulatory support initiation and are associated with a higher incidence of gastrointestinal bleeding, particularly in patients with systemic congestion and inflammation.
Angiopoietin-2 elevation after continuous-flow MCS may flag higher GI bleeding risk; hypothesis-generating and requires prospective validation before clinical use.
Gastrointestinal bleeding (GIB) during mechanical circulatory support (MCS) is a major unsolved comorbidity. Inadequate activation of angiopoietin-2-related systems is considered as a major cause of GIB. However, the regulation of angiopoietin-2 remains unknown. Consecutive 20 patients who received continuous-flow MCS therapy (MCS group) and 12 with advanced heart failure (HF; HF group) were prospectively enrolled and their angiopoetin-2 levels were compared. Angiopoietin-2 level had a moderate correlation with log10 B-type natriuretic peptide (BNP; r = 0.39, p < 0.001). The MCS group had significantly higher angiopoietin-2 level divided by log10 BNP compared with the HF group (2.80 ± 0.20 vs. 1.88 ± 0.17, p < 0.001). Angiopoetin-2 had a moderate correlation with central venous pressure and C-reactive protein during the MCS support (r = 0.51 and r = 0.45, respectively). Higher angiopoietin-2 level divided by log10 BNP (> 4.3) was significantly associated with the occurrence of GIB with a hazard ratio of 296 (95% confidence interval 2.24-38620, p = 0.0224). Angiopoietin-2 was already elevated in the HF cohort and more elevated following MCS initiation. Among the MCS cohort, angiopoietin-2 was particularly elevated in patients with systemic congestion and inflammation and was associated with higher incidence of GIB.
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Nakamura et al. (2020) conducted a cohort in Mechanical circulatory support and advanced heart failure (n=32). Continuous-flow mechanical circulatory support vs. Advanced heart failure was evaluated on Angiopoietin-2 level divided by log10 BNP (p=< 0.001). Continuous-flow mechanical circulatory support was associated with higher angiopoietin-2/log10 BNP levels than advanced heart failure (2.80 vs 1.88, p<0.001), which predicted gastrointestinal bleeding.
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