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Amyloid Cardiomyopathy and Waitlist Mortality in the United States: Implications for Organ Allocation
The 21st Annual Scientific Meeting
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HFSA
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351 Fig. 1. Kaplan-Meier survival curves for patients with HFrEF vs HFpEF undergoing TAVR using a minimally invasive strategy (MIS).
outcomes were mortality 24 hours post-procedure, re-admissions at 1 month and mortality at 1 month. Outcomes were defined per the Valve Academic Research Consortium-2 consensus statement. Results: Of the 516 patients studied, 37% had HFrEF. Seven patients in the HFpEF group died within 24-hours compared to 2 patients in the HFrEF group (1.9% vs 1.4%, P = .47). Patients with HFrEF had higher mortality at 1 year (19.6% vs 10.9%, P = .009, Fig. 1). Patients with HFpEF had fewer readmissions due to cardiac causes at 1 month (6% vs 11%, P = .05), but not all-cause readmissions (11% vs 15%, P = .24). Patients with HFpEF had lower mortality at 1 month, but this difference was not statistically significant (4.8% vs 8.4%, P = .12). Conclusion: The use of EF may be useful as an early predictor of HF exacerbations and mortality immediately after TAVR when using an MIS. These findings may have implications in the treatment and management of individuals after TAVR.
350 Left Ventricular Assist Device-Related Infections are Not Associated with Higher One-Year Mortality after Heart Transplant Xiaowen Wang, Merilda Blanco-Guzman, David S. Raymer, Eric Novak, Erik R. Dubberke, Justin M. Vader; Washington University in St. Louis, St Louis, Missouri Introduction: A recent analysis of the United Network of Organ Sharing (UNOS) database showed that among the patients who were listed for heart transplant due to left ventricular assist device (LVAD)-related complications, patients with device infections had worse survival at 1-year and 10-year after transplant. Several other studies have also demonstrated that infections—in particular sepsis, LVAD-related endocarditis, and bloodstream infections—are associated with higher post-transplant mortality. Hypothesis: In patients who underwent heart transplantation after LVAD, LVADrelated infections are associated with higher 1-year mortality and higher complication rates after heart transplant. Methods: We performed a retrospective case-control study using advanced heart failure patients (N = 106) who underwent LVAD implantation between 1/1/2010 and 5/31/2015 and subsequently underwent heart transplant before 12/31/2016. Fisher’s exact test was used to evaluate the association between presence of LVAD-related infections and 1-year mortality, need for dialysis within 14 days of transplant, need for prolonged dialysis, need for prolonged ventilation, and prolonged length of stay during index hospitalization. Results: Among 106 patients who underwent LVAD implantation prior to heart transplant, 43 (40.6%) had LVADrelated infections. At 1-year follow up, 3/43 (7%) patients with an LVAD-associated infection died versus 7/63 (11%) of those without an LVAD-associated infection (P = .737). Patients with LVAD-related infections did not have higher incidence of prolonged dialysis (>7 days, 33.3% vs. 37.2%, P = .68), prolonged ventilator support (>7 days, 36.5% vs. 37.2%, P = 1.00), or median length of stay (20.0 vs. 26.0, P = .35). Patients without LVAD-related infections were more likely to have shorter length of stay (≤15 days, 28.6% vs. 12.5%, P = .080) and less likely to require dialysis (30.4% vs. 47.5%, P = .094) during index hospitalization. Kaplan-Meier survival analyses also showed no difference between patients with and without LVAD-related infections at 1-year and 5-year follow up (figure). Conclusion: In well-selected LVAD patients who underwent heart transplantation, LVAD-associated infections did not increase mortality at 1-year after transplant.
Amyloid Cardiomyopathy and Waitlist Mortality in the United States: Implications for Organ Allocation Muhammad S. Panhwar1, Sadeer G. Al-Kindi1, Guilherme H. Oliveira2, Mahazarin Ginwalla2; 1Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio; 2Division of Heart Failure and Cardiac Transplant, Harrington Heart and Vascular Institute, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio Background: While outcomes of patients with amyloid cardiomyopathy (ACM) undergoing heart transplantation have been studied, there is scant data on the wait-list mortality of these patients. We sought to investigate whether patients with amyloid cardiomyopathy had higher wait-list mortality compared to those with other types of cardiomyopathies. Methods: We queried the United Network for Organ Sharing (UNOS) registry for all patients (age ≥ 18 years) listed for heart transplantation between 2008 and 2015. We compared patients with ACM to those with dilated cardiomyopathy (DCM) or idiopathic restrictive cardiomyopathy (RCM) for waitlist mortality (WLM) and waitlist mortality or delisting for deterioration (WLMD). Results: We identified 306 patients with ACM, 183 with RCM and 8416 with DCM. Patients with ACM were older (ACM 61 vs RCM 49 vs DCM 51 years, P < .001), were more likely to be male (82% vs 60% vs 73%, P < .001), but less likely to be listed as status 1A (16% vs 18% vs 23%, P < .001). Compared with DCM, patients with ACM had increased WLM (adjusted HR 2.71 [1.94– 3.78], P < .001, Fig. 1) and WLMD (adjusted HR 2.57 [2.02–3.27], P < .001). There was no difference between ACM and RCM in WLM (P = .14) or WLMD (P = .52). Conclusion: Patients with amyloid cardiomyopathy are listed with lower acuity, and have higher waitlist mortality compared with dilated cardiomyopathies. These findings should be considered for listing priority and organ allocation in AC.
Fig. 1. Cumulative incidence of waitlist mortality (left) and waitlist mortality or delisting (right) by type of cardiomyopathy.
352 Quantifying the Accuracy of Heart Failure Decompensation Classification Using Wearable Seismocardiography and Graph Mining Algorithms Maziyar Bran Pouyan1, Sean Dowling2, Teresa De Marco2, Liviu Klein2, Omer T. Inan1; 1 Georgia Institute of Technology, Atlanta, Georgia; 2University of California San Francisco, San Francisco, California Background: Remote monitoring of heart failure (HF) patients (pts) using wearable devices may allow for personalized titration of care, and thereby potentially reduce
•
HFSA
S125
351 Fig. 1. Kaplan-Meier survival curves for patients with HFrEF vs HFpEF undergoing TAVR using a minimally invasive strategy (MIS).
outcomes were mortality 24 hours post-procedure, re-admissions at 1 month and mortality at 1 month. Outcomes were defined per the Valve Academic Research Consortium-2 consensus statement. Results: Of the 516 patients studied, 37% had HFrEF. Seven patients in the HFpEF group died within 24-hours compared to 2 patients in the HFrEF group (1.9% vs 1.4%, P = .47). Patients with HFrEF had higher mortality at 1 year (19.6% vs 10.9%, P = .009, Fig. 1). Patients with HFpEF had fewer readmissions due to cardiac causes at 1 month (6% vs 11%, P = .05), but not all-cause readmissions (11% vs 15%, P = .24). Patients with HFpEF had lower mortality at 1 month, but this difference was not statistically significant (4.8% vs 8.4%, P = .12). Conclusion: The use of EF may be useful as an early predictor of HF exacerbations and mortality immediately after TAVR when using an MIS. These findings may have implications in the treatment and management of individuals after TAVR.
350 Left Ventricular Assist Device-Related Infections are Not Associated with Higher One-Year Mortality after Heart Transplant Xiaowen Wang, Merilda Blanco-Guzman, David S. Raymer, Eric Novak, Erik R. Dubberke, Justin M. Vader; Washington University in St. Louis, St Louis, Missouri Introduction: A recent analysis of the United Network of Organ Sharing (UNOS) database showed that among the patients who were listed for heart transplant due to left ventricular assist device (LVAD)-related complications, patients with device infections had worse survival at 1-year and 10-year after transplant. Several other studies have also demonstrated that infections—in particular sepsis, LVAD-related endocarditis, and bloodstream infections—are associated with higher post-transplant mortality. Hypothesis: In patients who underwent heart transplantation after LVAD, LVADrelated infections are associated with higher 1-year mortality and higher complication rates after heart transplant. Methods: We performed a retrospective case-control study using advanced heart failure patients (N = 106) who underwent LVAD implantation between 1/1/2010 and 5/31/2015 and subsequently underwent heart transplant before 12/31/2016. Fisher’s exact test was used to evaluate the association between presence of LVAD-related infections and 1-year mortality, need for dialysis within 14 days of transplant, need for prolonged dialysis, need for prolonged ventilation, and prolonged length of stay during index hospitalization. Results: Among 106 patients who underwent LVAD implantation prior to heart transplant, 43 (40.6%) had LVADrelated infections. At 1-year follow up, 3/43 (7%) patients with an LVAD-associated infection died versus 7/63 (11%) of those without an LVAD-associated infection (P = .737). Patients with LVAD-related infections did not have higher incidence of prolonged dialysis (>7 days, 33.3% vs. 37.2%, P = .68), prolonged ventilator support (>7 days, 36.5% vs. 37.2%, P = 1.00), or median length of stay (20.0 vs. 26.0, P = .35). Patients without LVAD-related infections were more likely to have shorter length of stay (≤15 days, 28.6% vs. 12.5%, P = .080) and less likely to require dialysis (30.4% vs. 47.5%, P = .094) during index hospitalization. Kaplan-Meier survival analyses also showed no difference between patients with and without LVAD-related infections at 1-year and 5-year follow up (figure). Conclusion: In well-selected LVAD patients who underwent heart transplantation, LVAD-associated infections did not increase mortality at 1-year after transplant.
Amyloid Cardiomyopathy and Waitlist Mortality in the United States: Implications for Organ Allocation Muhammad S. Panhwar1, Sadeer G. Al-Kindi1, Guilherme H. Oliveira2, Mahazarin Ginwalla2; 1Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio; 2Division of Heart Failure and Cardiac Transplant, Harrington Heart and Vascular Institute, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio Background: While outcomes of patients with amyloid cardiomyopathy (ACM) undergoing heart transplantation have been studied, there is scant data on the wait-list mortality of these patients. We sought to investigate whether patients with amyloid cardiomyopathy had higher wait-list mortality compared to those with other types of cardiomyopathies. Methods: We queried the United Network for Organ Sharing (UNOS) registry for all patients (age ≥ 18 years) listed for heart transplantation between 2008 and 2015. We compared patients with ACM to those with dilated cardiomyopathy (DCM) or idiopathic restrictive cardiomyopathy (RCM) for waitlist mortality (WLM) and waitlist mortality or delisting for deterioration (WLMD). Results: We identified 306 patients with ACM, 183 with RCM and 8416 with DCM. Patients with ACM were older (ACM 61 vs RCM 49 vs DCM 51 years, P < .001), were more likely to be male (82% vs 60% vs 73%, P < .001), but less likely to be listed as status 1A (16% vs 18% vs 23%, P < .001). Compared with DCM, patients with ACM had increased WLM (adjusted HR 2.71 [1.94– 3.78], P < .001, Fig. 1) and WLMD (adjusted HR 2.57 [2.02–3.27], P < .001). There was no difference between ACM and RCM in WLM (P = .14) or WLMD (P = .52). Conclusion: Patients with amyloid cardiomyopathy are listed with lower acuity, and have higher waitlist mortality compared with dilated cardiomyopathies. These findings should be considered for listing priority and organ allocation in AC.
Fig. 1. Cumulative incidence of waitlist mortality (left) and waitlist mortality or delisting (right) by type of cardiomyopathy.
352 Quantifying the Accuracy of Heart Failure Decompensation Classification Using Wearable Seismocardiography and Graph Mining Algorithms Maziyar Bran Pouyan1, Sean Dowling2, Teresa De Marco2, Liviu Klein2, Omer T. Inan1; 1 Georgia Institute of Technology, Atlanta, Georgia; 2University of California San Francisco, San Francisco, California Background: Remote monitoring of heart failure (HF) patients (pts) using wearable devices may allow for personalized titration of care, and thereby potentially reduce