{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T21:54:16Z","timestamp":1793138056318,"version":"4.5.0"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>\n              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\u2009544 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\u2009Hg versus 49.5 mm\u2009Hg) and pulmonary vascular resistance (2.6 WU versus 2.3 WU;\n              <jats:italic>P<\/jats:italic>\n              &lt;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\u20131.50). This association persisted after propensity matching (PDE5i, 28.9% versus control 23.7%; OR, 1.31; 95% CI, 1.09\u20131.57), 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.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.118.005537","type":"journal-article","created":{"date-parts":[[2019,6,11]],"date-time":"2019-06-11T09:00:34Z","timestamp":1560243634000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":48,"title":["Preimplant Phosphodiesterase-5 Inhibitor Use Is Associated With Higher Rates of Severe Early Right Heart Failure After Left Ventricular Assist Device Implantation"],"prefix":"10.1161","volume":"12","author":[{"given":"Gaurav","family":"Gulati","sequence":"first","affiliation":[{"name":"Cardiovascular Center, Tufts Medical Center, Boston, MA (G.G., D.D.D., M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Wilson","family":"Grandin","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute (E.W.G., F.C.)"},{"name":"Smith Center for Outcomes Research in Cardiology (E.W.G., K.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Smith Center for Outcomes Research in Cardiology (E.W.G., K.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fausto","family":"Cabezas","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute (E.W.G., F.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David D.","family":"DeNofrio","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Tufts Medical Center, Boston, MA (G.G., D.D.D., M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robb","family":"Kociol","sequence":"additional","affiliation":[{"name":"Division of Cardiology (R.K.), Beth Israel Deaconess Medical Center, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Eduardo","family":"Rame","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (J.E.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis D.","family":"Pagani","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, University of Michigan School of Medicine, Ann Arbor (F.D.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K.","family":"Kirklin","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, University of Alabama Birmingham School of Medicine (J.K.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Kormos","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, University of Pittsburgh Medical Center, PA 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