Abstract 12907: Heart Transplantation and Not Left Ventricle Assist Device Therapy Restores Circadian Variability of Pulse Pressure Amplification in Heart Failure Patients

IntroductionPulse pressure (PP) amplification, defined as the peripheral-to-aortic PP ratio, is an independent risk factor for cardiovascular and all-cause mortality. In healthy populations, PP amplification is known to decrease at night due to the nocturnal reduction of heart rate (HR) associated with decreased sympathetic tone. Heart failure (HF) and left ventricle assist device (LVAD) support have been previously associated with increased sympathetic tone, but their effect on circadian variation of PP amplification has never been investigated. In the present study, we aimed at investigating whether1) HF and LVAD therapy reduce circadian variability of PP amplification; and 2) orthotopic heart transplantation (OHT) restores normal nocturnal reduction.Methods27 healthy controls, 25 outpts with HF, 29 outpts on LVAD, and 25 OHT recipients were prospectively studied using the Mobil-O-Graph, a validated ambulatory blood pressure monitor that records HR, peripheral blood pressure and estimates central aortic blood pressure. Data were collected every 30 minutes for 24 consecutive hours following an outpatient visit. Day and night intervals were defined for each patient based on his/her habits. PP amplification was calculated as peripheral PP/aortic PP.ResultsDemographics are summarized in table 1. Healthy controls and OHT recipients, but not HF and LVAD pts, maintain a significant physiological circadian reduction of PP amplification (table 2). Interestingly, LVAD pts showed an inverse though non significant trend towards an increase PP amplification at night. In accordance, HR decreased at night in healthy, HF and OHT pts, but not in LVAD recipients (table 2)ConclusionsHF pts have reduced circadian variability of PP amplification. OHT and not LVAD therapy restores normal physiological patterns. HR does not decline in LVAD pts at night. This result suggests persistent upregulation of the sympathetic tone in HF and LVAD pts that resolves after OHT.