Angiodysplasias (AGD) are common sites of bleeding in the gastrointestinal (GI) tract
after Continuous Flow Left Ventricular Assist Device (CF-LVAD) implantation. We sought
to investigate whether AGDs are formed as a result of LVAD physiology or preexist
as a consequence of heart failure. Thirty-six subjects with HF reduced EF (HFrEF)
underwent video capsule endoscopy (VCE) to assess for the presence of AGD. Fifty-three
subjects without HF who underwent VCE for a nonbleeding indication formed a control
group. The prevalence of AGD was significantly higher in the HFrEF compared to the
non-HF controls (50% vs 13%, p = 0.0002). This association persisted after controlling for age and comorbidities.
Within the HFrEF cohort, higher Ang2, NT-proBNP and BUN were associated with the presence
of AGD. AGD in the GI tract are associated with HFrEF. This is the first description
of a new pathology associated with HFrEF and adds to our understanding of CF LVAD
associated GI bleeding.
Abbreviations:
CF LVAD (Continuous Flow Left Ventricular Assist Device), GI (Gastrointestinal), AGD (Angiodysplasia), HFrEF (Heart Failure reduced Ejection Fraction), VCE (Video Capsule Endoscopy)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Heart and Lung TransplantationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Continuous-flow LVAD support causes a distinct form of intestinal angiodysplasia.Circ Res. 2017; 121: 963-969
- Association of nasal mucosal vascular alterations, gastrointestinal arteriovenous malformations, and bleeding in patients with continuous-flow left ventricular assist devices.JACC Heart Fail. 2016; 4: 962-970
- Wireless capsule endoscopy in the investigation of patients with chronic renal failure and obscure gastrointestinal bleeding (preliminary data).World J Gastroenterol. 2006; 12: 5182-5185
- Gastrointestinal bleeding due to angiodysplasia in patients on hemodialysis: a single-center study.Saudi J Kidney Dis Transpl. 2016; 27: 748-751
- Role of angiopoietin-2 in vascular physiology and pathophysiology.Cells. 2019; 8: 471-490
- HIF-1alpha and HIF-2alpha induced angiogenesis in gastrointestinal vascular malformation and reversed by thalidomide.Sci Rep. 2016; 6: 27280
- Thalidomide-induced angiopoietin 2, Notch1 and Dll4 downregulation under hypoxic condition in tissues with gastrointestinal vascular malformation and human umbilical vein endothelial cells.J Dig Dis. 2014; 15: 85-95
- Plasma angiopoietin-1, angiopoietin-2, and angiopoietin receptor tie-2 levels in congestive heart failure.J Am Coll Cardiol. 2004; 43: 423-428
- Stepwise increase of angiopoietin-2 serum levels is related to haemodynamic and functional impairment in stable chronic heart failure.Eur J Cardiovasc Prev Rehabil. 2011; 18: 607-614
- Patients with heart failure and preserved ejection fraction are at risk of gastrointestinal bleeding.J Clin Med. 2019; 8: 1240-1252
- Experimental venous congestion causes peripheral release of angiopoietin-2 and tissue necrosis factor-α - A new insight into the pathophysiology of gastrointestinal bleeding in CF-LVAD patients.J Heart Lung Transplant. 2019; 38: S136
Article info
Publication history
Published online: November 14, 2021
Identification
Copyright
© 2021 International Society for Heart and Lung Transplantation. All rights reserved.
