Author + information
- Received May 23, 2016
- Revision received August 22, 2016
- Accepted August 26, 2016
- Published online December 1, 2016.
- Snehal R. Patel, MDa,∗ (, )
- Shivank Madan, MDa,
- Omar Saeed, MDa,
- Mohammed Algodi, MDa,
- Anne Luke, NPb,
- Marc Gibber, MDc,
- Daniel J. Goldstein, MDb and
- Ulrich P. Jorde, MDa
- aDivision of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- bDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- cDepartment of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- ↵∗Reprint requests and correspondence:
Dr. Snehal R. Patel, Division of Cardiology, Heart Failure, Cardiac Transplantation, and Mechanical Circulatory Support, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Medical Arts Pavilion–7th Floor, Bronx, New York 10467.
Objectives This study sought to determine whether the nasal mucosa can serve as a surrogate for evaluating arteriovenous malformations (AVMs) related gastrointestinal (GI) bleeding in patients supported by continuous-flow left ventricular assist devices (CF LVADs).
Background Bleeding from the mucosal surfaces of GI tract, particularly AVMs, is the most common complication of CF LVAD support. The pathophysiology of AVM formation during CF LVAD support is of critical interest yet poorly understood; in large part because of the length and accessibility of the GI tract. Nasal endoscopy is a minimally invasive, bedside test giving access to a mucosal surface possibly representative of the GI tract.
Methods Eighty subjects (35 with CF LVAD, 30 with heart failure reduced ejection fraction [HFrEF], and 15 controls without heart failure) underwent nasal endoscopy for systematic evaluation of the intranasal mucosa for the presence of hypervascularity (HV). Patient records were reviewed for episodes and etiology of GI bleeding.
Results Nasal HV was present in 63%, 57%, and 20% of the LVAD, HFrEF, and control groups, respectively (p = 0.018). Although the prevalence was similar, the severity of nasal HV was significantly higher in the CF LVAD group compared with the HFrEF group. Of the baseline characteristics in the entire cohort, only a history of heart failure was associated with HV (odds ratio: 4.8; 95% confidence interval: 1.02 to 22.31; p = 0.040) in adjusted logistic regression modeling. HV was strongly associated with GI bleeding in the CF LVAD cohort: the incidence was 32% in subjects with HV compared with 0% in subjects with normal mucosa (p = 0.023).
Conclusions In this pilot study, HV of the nasal mucosa was associated with GI bleeding in subjects with CF LVADs. Nasal endoscopy has significant potential to further investigation into mechanisms of bleeding and risk stratification during CF LVAD support.
This study was supported by intramural research funds. Dr. Jorde has served as an unpaid consultant for St. Jude Medical. Dr. Goldstein has has served as a consultant for St. Jude Medical and HeartWare, Inc.; is a national principal investigator for the St. Jude Medical–sponsored MOMENTUM 3 trial; and has received travel support from St. Jude Medical to attend meetings related to the MOMENTUM 3 trial. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 23, 2016.
- Revision received August 22, 2016.
- Accepted August 26, 2016.
- American College of Cardiology Foundation