Taylor Mendenhall
Myocardial Functional Improvement is Associated with Improved HF-related Outcomes in Patients While on Durable LVAD: an STS INTERMACS Analysis
Mentor: Stavros Drakos, MD, PHD, FACC
Department: CVRTI
Background
Chronic HFrEF patients can experience cardiac structural and functional improvement in response to guideline-directed medical therapy (GDMT) and leading to better outcomes. A subset of advanced HF patients on LVAD support and GDMT can also experience cardiac structural and functional improvement. Using a multi-center dataset we sought to investigate how the improved cardiac function affected HF-related outcomes while on durable LVAD.
Methods
The study group included STS INTERMACS database patients with durable continuous flow LVAD. We excluded patients with pulsatile flow LVADs, right VAD only, total artificial heart, congenital heart disease, hypertrophic or restrictive cardiomyopathy and baseline LVEF ≥40%. Based on the maximum LVEF achieved after 6 or more months on LVAD support, patients were divided into two groups, LVEF <40% and ≥40%. The annualized rates of cardiac arrhythmia, right HF, hepatic dysfunction and the mean KCCQ12 score were compared between the two groups.
Results
Our study included 9,518 patients. Baseline characteristics are presented in the Table. Post-LVAD LVEF of ≥40% occurred in 12% of patients (n=1,131). Patients with post-LVAD LVEF ≥40% were at lower risk of sustained arrhythmia, right HF, hepatic dysfunction, and more likely to have a better KCCQ12 score compared to patients with post-LVAD LVEF <40%.
Conclusions
Consistent with prior reports, 12% of patients achieved a post-LVAD LVEF ≥40%. These patients with an improved LV function experienced a lower risk of cardiac arrhythmia, right HF, and hepatic dysfunction during LVAD support. Approaches to maximize improvement of LV function while on LVAD should be pursued.
