Evidence map›Paper›PMID 31181953›Full record

ArticleCirculation. Heart failure2019

Preimplant Phosphodiesterase-5 Inhibitor Use Is Associated With Higher Rates of Severe Early Right Heart Failure After Left Ventricular Assist Device Implantation.

Gaurav Gulati, E Wilson Grandin, Kevin Kennedy, Fausto Cabezas, David D DeNofrio, Robb Kociol, J Eduardo Rame, Francis D Pagani, James K Kirklin, Robert L Kormos and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation. Heart failure, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
  4. Review
  5. Article
  6. Article
  7. Tetralogy of Fallot Across the Lifespan: A Focus on the Right Ventricle.CJC pediatric and congenital heart disease · 2023
    Review
  8. Review
  9. Article
  10. Review
  11. Review
  12. Review
  13. Review
  14. Article
  15. Review
  16. Article
  17. Review
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Gaurav GulatiCardiovascular Center, Tufts Medical Center, Boston, MA (G.G., D.D.D., M.K.).
E Wilson GrandinCardiovascular Institute (E.W.G., F.C.).
Kevin KennedySmith Center for Outcomes Research in Cardiology (E.W.G., K.K.).
Fausto CabezasCardiovascular Institute (E.W.G., F.C.).
David D DeNofrioCardiovascular Center, Tufts Medical Center, Boston, MA (G.G., D.D.D., M.K.).
Robb KociolDivision of Cardiology (R.K.), Beth Israel Deaconess Medical Center, Boston, MA.
J Eduardo RameDivision of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (J.E.R.).
Francis D PaganiDivision of Cardiothoracic Surgery, University of Michigan School of Medicine, Ann Arbor (F.D.P.).
James K KirklinDivision of Cardiothoracic Surgery, University of Alabama Birmingham School of Medicine (J.K.K.).
Robert L KormosHeart and Vascular Institute, University of Pittsburgh Medical Center, PA (R.L.K.).
Jeffrey TeutebergCardiovascular Medicine, Stanford University Medical Center, CA (J.T.).
Michael KiernanCardiovascular Center, Tufts Medical Center, Boston, MA (G.G., D.D.D., M.K.).

Funding

CTSA Graduate ProgramTL1TR002546 · NCATS · TUFTS UNIVERSITY BOSTON · PI KENT, DAVID M · 2018 to 2022
$4.2M
NCATS NIH HHS TL1 TR002546
6 · The paper itself

Abstract

Background Early right heart failure (RHF) occurs commonly in left ventricular assist device (LVAD) recipients, and increased right ventricular (RV) afterload may contribute. Selective pulmonary vasodilators, like phosphodiesterase-5 inhibitors (PDE5i), are used off-label to reduce RV afterload before LVAD implantation, but the association between preoperative PDE5i use and early RHF after LVAD is unknown. Methods and Results We analyzed adult patients from the INTERMACS registry (Interagency Registry for Mechanically Assisted Circulatory Support) who received a continuous flow LVAD after 2012. Patients on PDE5i were propensity-matched 1:1 to controls. The primary outcome was the incidence of severe early RHF, defined as the composite of death from RHF within 30 days, need for RV assist device support within 30 days, or use of inotropes beyond 14 days. Of 11 544 continuous flow LVAD recipients, 1199 (10.4%) received preoperative PDE5i. Compared to controls, patients on PDE5i had higher pulmonary artery systolic pressure (53.4 mm Hg versus 49.5 mm Hg) and pulmonary vascular resistance (2.6 WU versus 2.3 WU; P<0.001 for both). Before propensity matching, the incidence of severe early RHF was higher among patients on PDE5i than in controls (29.4% versus 23.1%; unadjusted odds ratio (OR), 1.32; 95% CI, 1.17-1.50). This association persisted after propensity matching (PDE5i, 28.9% versus control 23.7%; OR, 1.31; 95% CI, 1.09-1.57), driven by a higher incidence of prolonged inotropic support. Similar results were observed across a wide range of subgroups stratified by markers of pulmonary vascular disease and RV dysfunction. Conclusions Patients treated with preoperative PDE5i had markers of increased RV afterload and HF severity compared to unmatched controls. Even after propensity matching, patients receiving preimplant PDE5i therapy had higher rates of post-LVAD RHF.

Indexed as

AdultAgedCyclic Nucleotide Phosphodiesterases, Type 5FemaleHeart-Assist DevicesHeart FailureHeart VentriclesHumansIncidenceMaleMiddle AgedPhosphodiesterase 5 InhibitorsRegistriesRetrospective StudiesRisk FactorsVentricular Dysfunction, RightCyclic Nucleotide Phosphodiesterases, Type 5Phosphodiesterase 5 Inhibitorsheart failureincidencepulmonary arteryrisk factorsvascular resistance

Identifiers

PMID31181953
PMCPMC6624075

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.