Gastrointestinal bleeding and pro-angiogenic shift in the angiopoietin axis with continuous flow left ventricular assist device implantation

Adam L Edwards; C Mel Wilcox; Mark Beasley; Salpy V Pamboukian; Peter Mannon; Shajan Peter

doi:10.1016/j.amjms.2023.07.003

Gastrointestinal bleeding and pro-angiogenic shift in the angiopoietin axis with continuous flow left ventricular assist device implantation

Am J Med Sci. 2023 Oct;366(4):278-285. doi: 10.1016/j.amjms.2023.07.003. Epub 2023 Jul 27.

Authors

Adam L Edwards¹, C Mel Wilcox², Mark Beasley³, Salpy V Pamboukian⁴, Peter Mannon⁵, Shajan Peter⁶

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: aledwards@uabmc.edu.
² Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: cmwilcox@uabmc.edu.
³ School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: mbeasley@uab.edu.
⁴ Division of Cardiovascular Disease, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: spamboukian@uabmc.edu.
⁵ Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: peter.mannon@unmc.edu.
⁶ Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: ssugandha@uabmc.edu.

PMID: 37506847
DOI: 10.1016/j.amjms.2023.07.003

Abstract

Background: Gastrointestinal bleeding (GIB) affects up to 40% of continuous-flow left ventricular assist device (CF-LVAD) recipients. A higher risk of GIB is seen in CF-LVAD recipients with lower device pulsatility without a known mechanism. One hypothesis is that the novel hemodynamics in CF-LVAD recipients affect angiogenesis signaling. We aimed to (1) measure serum levels of angiopoietin (Ang)-1, Ang-2, and VEGF-A in CF-LVAD recipients with and without GIB and in healthy controls and (2) evaluate correlations of those levels with hemodynamics.

Methods: We recruited 12 patients with CF-LVADs (six who developed GIB after device implantation) along with 12 age-matched controls without heart failure or GIB and measured Ang-1, Ang-2, and VEGF-A levels in serum samples from each patient.

Results: CF-LVAD recipients had significantly higher Ang-2 and lower Ang-1 levels compared to controls with no difference in VEGF-A levels. CF-LVAD recipients with GIB had lower Ang-1 levels than those without GIB. There were trends for pulse pressure to be positively correlated with Ang-1 levels and negatively correlated with Ang-2 levels in CF-LVAD recipients with no correlation observed in healthy controls.

Conclusion: CF-LVAD recipients demonstrated a shift toward a pro-angiogenic phenotype in the angiopoietin axis that is significantly associated with GIB and may be linked to low pulse pressure.

Keywords: Angiopoietin; Gastrointestinal bleeding; Left ventricular assist device.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Angiopoietins
Gastrointestinal Hemorrhage / etiology
Heart Failure*
Heart-Assist Devices* / adverse effects
Humans
Retrospective Studies
Vascular Endothelial Growth Factor A

Substances

Vascular Endothelial Growth Factor A
Angiopoietins