- Email: [email protected]
Baseline LVAD Flow is an Important Risk for Hemoresponse to Blood Stream Infection in LVAD Patients with Fixed Cardiac Output
S234
The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019 567 Incidence and Predictors of Long-Term Renal Function Deterioration after Implantation of a Centrifugal, Continuous-Flow Device for Bridge to Transplant N. Kikuchi, A. Yoshimura, H. Hattori, A. Suzuki, T. Shiga, H. Niinami, N. Hagiwara and S. Nunoda. Tokyo Women's Medical University, Tokyo, Japan.
566 Metabolic Vasoreactivity in the Middle Cerebral Artery of Heart Failure Patients with and without Continuous-Flow Left Ventricular Support R. Ji,1 K. Akiyama,2 F. Castagna,1 A. Pinsino,1 J.R. Cockcroft,3 M. Yuzefpolskaya,1 A. Garan,1 V.K. Topkara,1 M.T. Pineda,4 H. Takayama,4 K. Takeda,4 Y. Naka,4 P.C. Colombo,1 B. McDonnell,3 E.J. Stöhr,3 and J.Z. Willey.5 1Medicine, Columbia University Medical Center, New York, NY; 2Surgery, Columbia University Medical Center, New York, NY; 3Physiology & Health, Cardiff Metropolitan University, Cardiff, CF5 2YB, United Kingdom; 4Cardiothoracic Surgery, Columbia University Medical Center, New York, NY; and the 5Neurology Stroke, Columbia University Medical Center, New York, NY. Purpose: In advanced heart failure (HF) patients, a normal cardiac output is restored after continuous-flow left ventricular assist device (CF-LVAD) implantation. Previous studies have suggested that cerebral autoregulation is preserved. However, it is not known whether CF-LVAD therapy affects the cerebrovascular reactivity to a metabolic challenge. Hypothesis: CF-LVAD patients will have a similar cerebrovascular response to a CO2-retention challenge compared with HF patients and healthy controls. Methods: Angle-corrected Doppler ultrasound images of the middle cerebral artery (MCA) were recorded immediately before and at the end of a 30s breathhold in 10 healthy controls, 4 HF and 7 CF-LVAD (HM II) patients. Time-averaged maximum blood velocity (TAMAX), peak flow velocity (Vmax), Pulsatility Index (PI) and Resistance Index (RI) were determined by tracing of the blood velocity envelope. Statistical differences were determined with 2-way ANOVA (% change is illustrated graphically). Results: In the MCA, significant baseline differences in TAMAX, Vmax, PI and RI existed between groups (all P < 0.05). Breathhold increased TAMAX and Vmax, although the difference was significantly greater in healthy controls (P = 0.04). Conversely, the CO2-retention challenge did not affect PI or RI in any group (Fig. 1 & 2). Conclusion: A metabolic challenge has a differential impact on cerebrovascular hemodynamics of HF and CF-LVAD patients compared with healthy controls. The pilot data suggest that cerebrovascular reserve may be altered already in HF and not further modulated after CF-LVAD implantation.
Purpose: Severe heart failure patients often have renal dysfunction (RD) due to low cardiac output. Especially in Japan, left ventricular assist device (LVAD) patients as bridge to transplantation need to wait for cardiac transplant for a long time due to limited donors. The aim of this study was to identify the long-term changes of renal function after implantation of an EVAHEARTÒ which is a centrifugal-type, continuous-flow LVAD, and factors predictive of renal function deterioration. Methods: This study was a retrospective observational cohort study. EVAHEARTÒ (LVAD) implantation was performed in 44 patients as a BTT at our institute between May 2005 and 2018. We investigated changes in renal function over 2 years among 41 patients supported by EVAHEARTÒ over 6 months. Furthermore, we also investigated the predictive factors of worsening renal failure. Results: The patients’ mean age at LVAD implantation was 40 § 12 years; 35 were male. Mean ejection fraction was 20 § 6 %. Mean estimated glomerular filtration rate (eGFR) at LVAD implantation was 66 § 31 ml/min/1.73m2; 20 (49 %) patients had renal impairment (eGFR < 60 ml/min/1.73m2). Changes in eGFR and BNP after LVAD implantation are shown in the Figure. Among patients with RD at implantation, higher right atrial (RA) pressure (13 § 5 vs 8 § 2 mmHg, p = 0.030) before LVAD implantation was associated with renal impairment at 2 years after implantation. Medication before and after LVAD implantation is not associated with renal deterioration. There is no relationship the incidence of re-admission due to some adverse events and RD at 2 years after LVAD implantation. Conclusion: Renal function improved early after EVAHEARTÒ implantation, but, gradually declined in most patients over 2 years. Among patients with renal impairment, high RA pressure, suggested “congestion”, at LVAD implantation had greater deterioration of renal function during a 2year follow-up period.
568 Baseline LVAD Flow is an Important Risk for Hemoresponse to Blood Stream Infection in LVAD Patients with Fixed Cardiac Output N. Bart,1 S. Emmanuel,2 D. Andresen,3 K. Muthiah,1 and C.S. Hayward.1 1Heart Transplant and Failure, St Vincents Hospital, Sydney, Australia; 2Cardiothoracic Surgery, St Vincents Hospital, Sydney, Australia; and the 3Infectious Disease, St Vincents Hospital, Sydney, Australia. Purpose: Patients with left ventricular assist devices (LVAD) are at particular risk during sepsis due to an inability to augment cardiac output due to impaired ventricular function and fixed pump speed. Aims: To profile the flow, power and pulsatility index of patients who develop a blood stream infection (BSI) using LVAD log files as a marker of hemodynamic response, and to compare the response of those patients that require ICU admission with those that stay on the ward.
Abstracts Methods: Patients with HeartWare HVAD devices implanted between November 2007 and June 2016 with available log file data were studied for flow, power and speed. A subset of 13 patients who had pulsatility data available was also analysed. All patients included had BSIs during their time on pump, and patients were used as their own controls. Baseline data was defined as the 24-hour period 7 days after LVAD implant, and BSI data was the 48-hour period around a positive blood culture. Results: A total of 48 patients (male=39, female=9) were studied. Average patient age at implant was 49.2 § 13.4 and average INTERMACS score of 2 § 0.6. With constant LVAD speed, there was an expected increase in flow from a baseline median of 4795 (IQR 4399.9- 5531.3) to 5251 (IQR (4522.3-5806.9) (p<0.01) at the time of BSI. There was also an increase in power from 3760 (IQR 3233.6-4517.1)-3977 (IQR 3478.0-4660.9) (p<0.01). There was a non-significant decrease in pulsatility index from 1.06 at baseline to 0.94 at BSI time. A total of 29/48 (60%) patients were managed in the intensive care unit (ICU), with 13/29 (14/29) sent to ICU due to the BSI, and the remainder already in ICU. Flow was significantly lower at baseline in the group in ICU 4765.4 § 809 (baseline flow of 4471.4 § 785.9 in the subset sent to ICU with BSI), compared with ward patients 5260.0 § 830 (p<0.05) potentially indicating less cardiovascular reserve. Flow increased in both the ward and ICU groups at the time of BSI, with the delta flow being significant for those in ICU (p<0.05) but not those on the ward. Conclusion: To our knowledge, this is the first study using LVAD log files for flow, power and pulsatility index as hemodynamic makers of sepsis. This study shows that LVAD flow in the 48 hours of a positive blood culture is an important physiological marker and may also be a marker of patients more susceptible to ICU admission when confronted with a hemodynamic insult.
569 What Happens to Right Ventricular Strain and Function Following Tricuspid Valve Repair in Patients Undergoing Implantation of a Left Ventricular Assist Device? O.N. Kislitsina,1 A.S. Anderson,1 J.D. Thomas,1 J.D. Rich,1 J.E. Wilcox,1 E.E. Vorovich,1 A. Zhou,2 A.C. Andrei,3 R. Harap,1 P.M. McCarthy,4 C.W. Yancy,1 and D.T. Pham.4 1Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL; 2CTU, Northwestern University Feinberg School of Medicine, Chicago, IL; 3Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; and the 4Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Purpose: Pre- and post-operative RV function were analyzed by echocardiography, including RV longitudinal strain in 80 patients with moderate or higher pre-implant TR to evaluate the impact of concomitant tricuspid valve repair during LVAD implantation on post-operative RV function. Methods: Between 2008 and 2017, 100 patients with moderate (Mod), moderate-severe (M/S), or severe (Sev) TR underwent LVAD implantation at our institution. Forty-four (44) patients had concomitant TV repair (TVR) and 56 did not have TV repair (No-TVR). Preoperative and postoperative clinical, echocardiographic and hemodynamic parameters were recorded in 80 of the patients and included right ventricular (RV) freewall longitudinal strain (FLS) and RV Fractional Area Change (FAC) calculated retrospectively using speckle-tracking echocardiography. Results: Preoperatively, 41% of patients in the TVR group and 77% in the No-TVR group had Mod TR (p<0.001), while 59% in the TVR group and 23% in the No-TVR group had M/S or Sev TR (p<0.001). Preoperative and postoperative invasive hemodynamic parameters were not significantly different between the two groups. Preoperative RV-FLS was -6.7% in the
S235 TVR group and -5.0% in the No-TVR group (p=0.35). RV-FAC was 19.6% in the TVR group and 15.9% in the No-TVR group (p=0.50). 51% of the TVR group versus 75% of the No-TVR group were discharged directly home, avoiding an inpatient rehab or nursing home (p=0.021). However, 44% of the TVR group and only 18% of the No-TVR group were readmitted within 30 days (p=0.021). 3 months postop, RV-FLS was -6.0% in the TVR group and -6.7% in the No-TVR group (p=0.15). RVFAC was 17.5% in the TVR group and 21.5% in the No-TVR group (p=0.08). RV size was stable or more dilated at 3 months in 44% of the TVR group and in 15% of the No-TVR group (p=0.005) with RV size improving in 5% of the TVR group and in 20% of the No-TVR group (p=0.005). Five-year survival was 28% for the TVR group and 57% for the No-TVR group. Conclusion: RV strain analysis tracks hemodynamic and echocardiographic parameters and does not add to the assessment of RV function in patients undergoing LVAD implantation with or without TVR. Repairing moderate TV regurgitation at the time of LVAD implantation is not associated with improved outcomes and emphasizes the need for a definitive prospective trial.
570 Cystatin C is Superior to Creatinine for Prediction of Adverse Events in Heart Failure Patients Undergoing LVAD Implant A. Pinsino,1 A. Gaudig,2 E.A. Royzman,2 M.B. Dominguez,2 J. Radhakrishnan,2 K. Toma,2 A.M. Zuver,2 M. Tiburcio,3 V. Topkara,2 A. Masoumi,2 A.R. Garan,2 H. Takayama,3 K. Takeda,3 Y. Naka,3 R.T. Faillace,1 R.T. Demmer,4 P.C. Colombo,2 and M. Yuzefpolskaya.2 1Medicine, Jacobi AECOM, Bronx, NY; 2Department of Medicine, Columbia University Medical Center, New York, NY; 3 Department of Surgery, Columbia University Medical Center, New York, NY; and the 4Epidemiology and Community Health, University of Minnesota, Minneapolis, MN. Purpose: Accurate estimation of renal function using glomerular filtration rate (eGFR) is key for prediction of adverse events among HF pts undergoing LVAD implant. Changes in muscle mass are frequent among HF pts and represent a known confounder of serum creatinine (sCr) based equations. Cystatin C (CysC) is independent of muscle mass and provides an alternative measure of eGFR. We aimed to prospectively compare the value of CysC vs. sCr based eGFR in the prediction of postoperative outcomes among pts undergoing LVAD implant. Methods: sCr and CysC were concurrently measured pre-LVAD in 73 pts (age 61§13, F 16%). CKD stages were defined by sCr-eGFR and CysCeGFR using MDRD4 and CysC-CKD-EPI equations, respectively. The primary endpoint was a composite of severe right ventricular failure (sRVF) or renal replacement therapy (RRT) on the index admission. Predictive values of sCr-eGFR and CysC-eGFR were compared. The independent effect of sCr and CysC on the primary endpoint was assessed using multivariable models. Results: Compared to pre-LVAD sCr-eGFR, CysC-eGFR reclassified 46 (63%) pts: 7 (16%) to earlier stage CKD and 39 (84%) to later stage CKD (Fig A). For every increase in CKD stage, there was a 60% increase in the risk of the primary endpoint using CysC-eGFR (p=.02) while the increase in risk did not reach statistical significance using sCr-eGFR (p=.19) (Fig B). CysC-eGFR outperformed sCr-eGFR as predictor of the primary endpoint (AUC 0.68 vs. 0.59, p=0.04, Fig C). In a model including both CysC and sCr: i) higher CysC was associated with an increased risk for the primary endpoint (OR: 1.60 per 0.5 mg/L increase, p=.01); ii) a trend towards a paradoxical association between higher sCr and lower risk was found (OR: 0.42 per 0.5 mg/dL increase, p=.08). Conclusion: CysC-eGFR is a more reliable predictor of sRVF or need for RRT among pts undergoing LVAD implant.
The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019 567 Incidence and Predictors of Long-Term Renal Function Deterioration after Implantation of a Centrifugal, Continuous-Flow Device for Bridge to Transplant N. Kikuchi, A. Yoshimura, H. Hattori, A. Suzuki, T. Shiga, H. Niinami, N. Hagiwara and S. Nunoda. Tokyo Women's Medical University, Tokyo, Japan.
566 Metabolic Vasoreactivity in the Middle Cerebral Artery of Heart Failure Patients with and without Continuous-Flow Left Ventricular Support R. Ji,1 K. Akiyama,2 F. Castagna,1 A. Pinsino,1 J.R. Cockcroft,3 M. Yuzefpolskaya,1 A. Garan,1 V.K. Topkara,1 M.T. Pineda,4 H. Takayama,4 K. Takeda,4 Y. Naka,4 P.C. Colombo,1 B. McDonnell,3 E.J. Stöhr,3 and J.Z. Willey.5 1Medicine, Columbia University Medical Center, New York, NY; 2Surgery, Columbia University Medical Center, New York, NY; 3Physiology & Health, Cardiff Metropolitan University, Cardiff, CF5 2YB, United Kingdom; 4Cardiothoracic Surgery, Columbia University Medical Center, New York, NY; and the 5Neurology Stroke, Columbia University Medical Center, New York, NY. Purpose: In advanced heart failure (HF) patients, a normal cardiac output is restored after continuous-flow left ventricular assist device (CF-LVAD) implantation. Previous studies have suggested that cerebral autoregulation is preserved. However, it is not known whether CF-LVAD therapy affects the cerebrovascular reactivity to a metabolic challenge. Hypothesis: CF-LVAD patients will have a similar cerebrovascular response to a CO2-retention challenge compared with HF patients and healthy controls. Methods: Angle-corrected Doppler ultrasound images of the middle cerebral artery (MCA) were recorded immediately before and at the end of a 30s breathhold in 10 healthy controls, 4 HF and 7 CF-LVAD (HM II) patients. Time-averaged maximum blood velocity (TAMAX), peak flow velocity (Vmax), Pulsatility Index (PI) and Resistance Index (RI) were determined by tracing of the blood velocity envelope. Statistical differences were determined with 2-way ANOVA (% change is illustrated graphically). Results: In the MCA, significant baseline differences in TAMAX, Vmax, PI and RI existed between groups (all P < 0.05). Breathhold increased TAMAX and Vmax, although the difference was significantly greater in healthy controls (P = 0.04). Conversely, the CO2-retention challenge did not affect PI or RI in any group (Fig. 1 & 2). Conclusion: A metabolic challenge has a differential impact on cerebrovascular hemodynamics of HF and CF-LVAD patients compared with healthy controls. The pilot data suggest that cerebrovascular reserve may be altered already in HF and not further modulated after CF-LVAD implantation.
Purpose: Severe heart failure patients often have renal dysfunction (RD) due to low cardiac output. Especially in Japan, left ventricular assist device (LVAD) patients as bridge to transplantation need to wait for cardiac transplant for a long time due to limited donors. The aim of this study was to identify the long-term changes of renal function after implantation of an EVAHEARTÒ which is a centrifugal-type, continuous-flow LVAD, and factors predictive of renal function deterioration. Methods: This study was a retrospective observational cohort study. EVAHEARTÒ (LVAD) implantation was performed in 44 patients as a BTT at our institute between May 2005 and 2018. We investigated changes in renal function over 2 years among 41 patients supported by EVAHEARTÒ over 6 months. Furthermore, we also investigated the predictive factors of worsening renal failure. Results: The patients’ mean age at LVAD implantation was 40 § 12 years; 35 were male. Mean ejection fraction was 20 § 6 %. Mean estimated glomerular filtration rate (eGFR) at LVAD implantation was 66 § 31 ml/min/1.73m2; 20 (49 %) patients had renal impairment (eGFR < 60 ml/min/1.73m2). Changes in eGFR and BNP after LVAD implantation are shown in the Figure. Among patients with RD at implantation, higher right atrial (RA) pressure (13 § 5 vs 8 § 2 mmHg, p = 0.030) before LVAD implantation was associated with renal impairment at 2 years after implantation. Medication before and after LVAD implantation is not associated with renal deterioration. There is no relationship the incidence of re-admission due to some adverse events and RD at 2 years after LVAD implantation. Conclusion: Renal function improved early after EVAHEARTÒ implantation, but, gradually declined in most patients over 2 years. Among patients with renal impairment, high RA pressure, suggested “congestion”, at LVAD implantation had greater deterioration of renal function during a 2year follow-up period.
568 Baseline LVAD Flow is an Important Risk for Hemoresponse to Blood Stream Infection in LVAD Patients with Fixed Cardiac Output N. Bart,1 S. Emmanuel,2 D. Andresen,3 K. Muthiah,1 and C.S. Hayward.1 1Heart Transplant and Failure, St Vincents Hospital, Sydney, Australia; 2Cardiothoracic Surgery, St Vincents Hospital, Sydney, Australia; and the 3Infectious Disease, St Vincents Hospital, Sydney, Australia. Purpose: Patients with left ventricular assist devices (LVAD) are at particular risk during sepsis due to an inability to augment cardiac output due to impaired ventricular function and fixed pump speed. Aims: To profile the flow, power and pulsatility index of patients who develop a blood stream infection (BSI) using LVAD log files as a marker of hemodynamic response, and to compare the response of those patients that require ICU admission with those that stay on the ward.
Abstracts Methods: Patients with HeartWare HVAD devices implanted between November 2007 and June 2016 with available log file data were studied for flow, power and speed. A subset of 13 patients who had pulsatility data available was also analysed. All patients included had BSIs during their time on pump, and patients were used as their own controls. Baseline data was defined as the 24-hour period 7 days after LVAD implant, and BSI data was the 48-hour period around a positive blood culture. Results: A total of 48 patients (male=39, female=9) were studied. Average patient age at implant was 49.2 § 13.4 and average INTERMACS score of 2 § 0.6. With constant LVAD speed, there was an expected increase in flow from a baseline median of 4795 (IQR 4399.9- 5531.3) to 5251 (IQR (4522.3-5806.9) (p<0.01) at the time of BSI. There was also an increase in power from 3760 (IQR 3233.6-4517.1)-3977 (IQR 3478.0-4660.9) (p<0.01). There was a non-significant decrease in pulsatility index from 1.06 at baseline to 0.94 at BSI time. A total of 29/48 (60%) patients were managed in the intensive care unit (ICU), with 13/29 (14/29) sent to ICU due to the BSI, and the remainder already in ICU. Flow was significantly lower at baseline in the group in ICU 4765.4 § 809 (baseline flow of 4471.4 § 785.9 in the subset sent to ICU with BSI), compared with ward patients 5260.0 § 830 (p<0.05) potentially indicating less cardiovascular reserve. Flow increased in both the ward and ICU groups at the time of BSI, with the delta flow being significant for those in ICU (p<0.05) but not those on the ward. Conclusion: To our knowledge, this is the first study using LVAD log files for flow, power and pulsatility index as hemodynamic makers of sepsis. This study shows that LVAD flow in the 48 hours of a positive blood culture is an important physiological marker and may also be a marker of patients more susceptible to ICU admission when confronted with a hemodynamic insult.
569 What Happens to Right Ventricular Strain and Function Following Tricuspid Valve Repair in Patients Undergoing Implantation of a Left Ventricular Assist Device? O.N. Kislitsina,1 A.S. Anderson,1 J.D. Thomas,1 J.D. Rich,1 J.E. Wilcox,1 E.E. Vorovich,1 A. Zhou,2 A.C. Andrei,3 R. Harap,1 P.M. McCarthy,4 C.W. Yancy,1 and D.T. Pham.4 1Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL; 2CTU, Northwestern University Feinberg School of Medicine, Chicago, IL; 3Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; and the 4Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Purpose: Pre- and post-operative RV function were analyzed by echocardiography, including RV longitudinal strain in 80 patients with moderate or higher pre-implant TR to evaluate the impact of concomitant tricuspid valve repair during LVAD implantation on post-operative RV function. Methods: Between 2008 and 2017, 100 patients with moderate (Mod), moderate-severe (M/S), or severe (Sev) TR underwent LVAD implantation at our institution. Forty-four (44) patients had concomitant TV repair (TVR) and 56 did not have TV repair (No-TVR). Preoperative and postoperative clinical, echocardiographic and hemodynamic parameters were recorded in 80 of the patients and included right ventricular (RV) freewall longitudinal strain (FLS) and RV Fractional Area Change (FAC) calculated retrospectively using speckle-tracking echocardiography. Results: Preoperatively, 41% of patients in the TVR group and 77% in the No-TVR group had Mod TR (p<0.001), while 59% in the TVR group and 23% in the No-TVR group had M/S or Sev TR (p<0.001). Preoperative and postoperative invasive hemodynamic parameters were not significantly different between the two groups. Preoperative RV-FLS was -6.7% in the
S235 TVR group and -5.0% in the No-TVR group (p=0.35). RV-FAC was 19.6% in the TVR group and 15.9% in the No-TVR group (p=0.50). 51% of the TVR group versus 75% of the No-TVR group were discharged directly home, avoiding an inpatient rehab or nursing home (p=0.021). However, 44% of the TVR group and only 18% of the No-TVR group were readmitted within 30 days (p=0.021). 3 months postop, RV-FLS was -6.0% in the TVR group and -6.7% in the No-TVR group (p=0.15). RVFAC was 17.5% in the TVR group and 21.5% in the No-TVR group (p=0.08). RV size was stable or more dilated at 3 months in 44% of the TVR group and in 15% of the No-TVR group (p=0.005) with RV size improving in 5% of the TVR group and in 20% of the No-TVR group (p=0.005). Five-year survival was 28% for the TVR group and 57% for the No-TVR group. Conclusion: RV strain analysis tracks hemodynamic and echocardiographic parameters and does not add to the assessment of RV function in patients undergoing LVAD implantation with or without TVR. Repairing moderate TV regurgitation at the time of LVAD implantation is not associated with improved outcomes and emphasizes the need for a definitive prospective trial.
570 Cystatin C is Superior to Creatinine for Prediction of Adverse Events in Heart Failure Patients Undergoing LVAD Implant A. Pinsino,1 A. Gaudig,2 E.A. Royzman,2 M.B. Dominguez,2 J. Radhakrishnan,2 K. Toma,2 A.M. Zuver,2 M. Tiburcio,3 V. Topkara,2 A. Masoumi,2 A.R. Garan,2 H. Takayama,3 K. Takeda,3 Y. Naka,3 R.T. Faillace,1 R.T. Demmer,4 P.C. Colombo,2 and M. Yuzefpolskaya.2 1Medicine, Jacobi AECOM, Bronx, NY; 2Department of Medicine, Columbia University Medical Center, New York, NY; 3 Department of Surgery, Columbia University Medical Center, New York, NY; and the 4Epidemiology and Community Health, University of Minnesota, Minneapolis, MN. Purpose: Accurate estimation of renal function using glomerular filtration rate (eGFR) is key for prediction of adverse events among HF pts undergoing LVAD implant. Changes in muscle mass are frequent among HF pts and represent a known confounder of serum creatinine (sCr) based equations. Cystatin C (CysC) is independent of muscle mass and provides an alternative measure of eGFR. We aimed to prospectively compare the value of CysC vs. sCr based eGFR in the prediction of postoperative outcomes among pts undergoing LVAD implant. Methods: sCr and CysC were concurrently measured pre-LVAD in 73 pts (age 61§13, F 16%). CKD stages were defined by sCr-eGFR and CysCeGFR using MDRD4 and CysC-CKD-EPI equations, respectively. The primary endpoint was a composite of severe right ventricular failure (sRVF) or renal replacement therapy (RRT) on the index admission. Predictive values of sCr-eGFR and CysC-eGFR were compared. The independent effect of sCr and CysC on the primary endpoint was assessed using multivariable models. Results: Compared to pre-LVAD sCr-eGFR, CysC-eGFR reclassified 46 (63%) pts: 7 (16%) to earlier stage CKD and 39 (84%) to later stage CKD (Fig A). For every increase in CKD stage, there was a 60% increase in the risk of the primary endpoint using CysC-eGFR (p=.02) while the increase in risk did not reach statistical significance using sCr-eGFR (p=.19) (Fig B). CysC-eGFR outperformed sCr-eGFR as predictor of the primary endpoint (AUC 0.68 vs. 0.59, p=0.04, Fig C). In a model including both CysC and sCr: i) higher CysC was associated with an increased risk for the primary endpoint (OR: 1.60 per 0.5 mg/L increase, p=.01); ii) a trend towards a paradoxical association between higher sCr and lower risk was found (OR: 0.42 per 0.5 mg/dL increase, p=.08). Conclusion: CysC-eGFR is a more reliable predictor of sRVF or need for RRT among pts undergoing LVAD implant.