Are elevated serum haemolysis markers a harbinger of adverse events in HeartMate II patients?

Zayat, Rashad; Shoaib, Mohamed Ibrahim; Khattab, Mohammad Amen; Ahmad, U.; Goetzenich, Andreas; Stoppe, Christian; Foldenauer, Ann Christina; Moza, Ajay; Schnoering, Heike; Autschbach, Rüdiger; Tewarie, Lachmandath

doi:10.1093/icvts/ivy027

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…Even after the treatment, the percentages of echinocytes and spherocytes are still higher than the normal level in the first week, before they gradually return to normal level in the second week. At the same time, the free hemoglobin level is much higher than the normal level of 40 mg/L ( 16 ), and it further increases as the treatment time increases, as shown in Fig. 1 E .…”

Section: Hemolysis In Ecmo and Morphology Of Rbcsmentioning

confidence: 84%

Fatigue of red blood cells under periodic squeezes in ECMO

Pan

et al. 2022

Proc. Natl. Acad. Sci. U.S.A.

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Hemolysis usually happens instantly when red blood cells (RBCs) rupture under a high shear stress. However, it is also found to happen gradually in the extracorporeal membrane oxygenation (ECMO) under low but periodic squeezes. In particular, the gradual hemolysis is accompanied by a progressive change in morphology of RBCs. In this work, the gradual hemolysis is studied in a microfluidic device with arrays of narrow gaps the same as the constructions in ECMO. RBCs are seen to deform periodically when they flow through the narrow gaps, which causes the release of adenosine-triphosphate (ATP) from RBCs. The reduced ATP level in the cells leads to the fatigue of RBCs with the progressive changes in morphology and the gradual loss of deformability. An empirical model for the fatigue of RBCs is established under the periodic squeezes with controlled deformation, and it reveals a different way of the hemolysis that is dominated by the squeeze frequency. This finding brings a new insight into the mechanism of hemolysis, and it helps to improve the design of circulatory support devices.

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Section: Hemolysis In Ecmo and Morphology Of Rbcsmentioning

confidence: 84%

Fatigue of red blood cells under periodic squeezes in ECMO

Pan

et al. 2022

Proc. Natl. Acad. Sci. U.S.A.

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“…LVAD implantation can lead to chronic subclinical hemolysis, which is frequently the consequence of pump thrombosis and is statistically associated with higher mortality [32]. LDH is therefore commonly monitored and an increase over 700 IU/L (2.5 fold normal) is predictive of pump thrombosis and cerebrovascular accident [33].…”

Section: Plos Onementioning

confidence: 99%

Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy

et al. 2020

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Background Chronic subclinical hemolysis is frequent in patients implanted with Left Ventricular Assist Device (LVAD) and is associated with adverse outcomes. Consequences of LVADs-induced subclinical hemolysis on kidney structure and function is currently unknown. Methods Thirty-three patients implanted with a Heartmate II LVAD (Abbott, Inc, Chicago IL) were retrospectively studied. Hemolysis, Acute Kidney Injury (AKI) and the evolution of estimated Glomerular Filtration Rate were analyzed. Proximal Tubulopathy (PT) groups were defined according to proteinuria, normoglycemic glycosuria, and electrolytic disorders. The Receiver Operating Characteristic (ROC) curve was used to analyze threshold of LDH values associated with PT. Results Median LDH between PT groups were statistically different, 688 IU/L [642–703] and 356 IU/L [320–494] in the “PT” and “no PT” groups, respectively p = 0.006. To determine PT group, LDH threshold > 600 IU/L was associated with a sensitivity of 85.7% (95% CI, 42.1–99.6) and a specificity of 84.6% (95% CI, 65.1–95.6). The ROC's Area Under Curve was 0.83 (95% CI, 0.68–0.98). In the “PT” group, patients had 4.2 [2.5–5.0] AKI episodes per year of exposure, versus 1.6 [0.4–3.7] in the “no PT” group, p = 0.03. A higher occurrence of AKI was associated with subsequent development of Chronic Kidney Disease (CKD) (p = 0.02) and death (p = 0.05). Conclusions LVADs-induced subclinical hemolysis is associated with proximal tubular functional alterations, which in turn contribute to the occurrence of AKI and subsequent CKD. Owing to renal toxicity of hemolysis, measures to reduce subclinical hemolysis intensity as canula position or pump parameters should be systematically considered, as well as specific nephroprotective therapies.

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“…While signs of hemolysis are present during acute pump thrombosis episodes, patients with CF‐LVADs have been shown to have evidence of subclinical hemolysis at baseline . Early elevation of LDH post CF‐LVAD implantation, as well as an elevated baseline level of hemolysis, has a proven track‐record of being predictive of future thrombotic events …”

Section: Lactate Dehydrogenase Isoenzymes and Hemolysis In Pump Thrommentioning

confidence: 99%

“…26,43 While signs of hemolysis are present during acute pump thrombosis episodes, patients with CF-LVADs have been shown to have evidence of subclinical hemolysis at baseline. [43][44][45] Early elevation of LDH post CF-LVAD implantation, as well as an elevated baseline level of hemolysis, has a proven track-record of being predictive of future thrombotic events. [43][44][45][46] Total serum LDH level elevation has long been used to indicate pump thrombosis but is a nonspecific finding and can be found in several inflammatory and pathologic states.…”

Section: Isoenzymes and Hemolysis In Pump Thrombosismentioning

confidence: 99%

“…[43][44][45] Early elevation of LDH post CF-LVAD implantation, as well as an elevated baseline level of hemolysis, has a proven track-record of being predictive of future thrombotic events. [43][44][45][46] Total serum LDH level elevation has long been used to indicate pump thrombosis but is a nonspecific finding and can be found in several inflammatory and pathologic states. 26 Differential LDH isoenzyme elevations may be used in patients with CF-LVADs to differentiate pump thrombosis from other pathological disease states.…”

Section: Isoenzymes and Hemolysis In Pump Thrombosismentioning

confidence: 99%

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Clinical implications of LDH isoenzymes in hemolysis and continuous‐flow left ventricular assist device‐induced thrombosis

et al. 2019

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Pump‐induced thrombosis continues to be a major complication of continuous‐flow left ventricular assist devices (CF‐LVADs), which increases the risks of thromboembolic stroke, peripheral thromboembolism, reduced pump flow, pump failure, cardiogenic shock, and death. This is confounded by the fact that there is currently no direct measure for a proper diagnosis during pump support. Given the severity of this complication and its required treatment, the ability to accurately differentiate CF‐LVAD pump thrombosis from other complications is vital. Hemolysis measured by elevated lactate dehydrogenase (LDH) enzyme levels, when there is clinical suspicion of pump‐induced thrombosis, is currently accepted as an important metric used by clinicians for diagnosis; however, LDH is a relatively nonspecific finding. LDH exists as five isoenzymes in the body, each with a unique tissue distribution. CF‐LVAD pump thrombosis has been associated with elevated serum LDH‐1 and LDH‐2, as well as decreased LDH‐4 and LDH‐5. Herein, we review the various isoenzymes of LDH and their utility in differentiating hemolysis seen in CF‐LVAD pump thrombosis from other physiologic and pathologic conditions as reported in the literature.

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Are elevated serum haemolysis markers a harbinger of adverse events in HeartMate II patients?

Abstract: LLH as assessed by elevated fHb and LDH values at discharge during HeartMate II support is associated with thromboembolic events.

Cited by 5 publications

References 25 publications

Fatigue of red blood cells under periodic squeezes in ECMO

Fatigue of red blood cells under periodic squeezes in ECMO

Hemolysis induced by Left Ventricular Assist Device is associated with proximal tubulopathy

Clinical implications of LDH isoenzymes in hemolysis and continuous‐flow left ventricular assist device‐induced thrombosis

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