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Greater Reduction in NT Pro-BNP Levels Post LVAD Is Associated with a Greater Improvement in Diabetes Control
S338
The Journal of Heart and Lung Transplantation, Vol 35, No 4S, April 2016 9( 35)
Reviewed cases, their interventions, and survival Age / Sex / Patient # LVAD
Days Post Implantation
Indication
1
73 / M / HeartMate II
2
RVF
2
72 / M / HVAD
2
3
65 / M / HeartMate II 75 / M / HeartMate II
1
59 / M / HeartMate II 59 / M / HeartMate II
947
4
5 6
899
96
Indication
Survival Status
Expired at 581 days, unknown cause RVF Alive at 204 days RVF Alive at 91 days VT BMS to OM Expired at 43 venous graft days, VT/resp failure RVF BMS to RCA Expired at 26 days, GI bleed LV Recovery DES to LAD Alive at 337 days BMS to ostium of RCA DES to PDA venous graft BMS to RCA
9( 34) Changes in Lipid Profile Subfractions on Continuous-Flow Left Ventricular Assist Device (CF-LVAD) Therapy V.K. Topkara ,1 A.R. Garan,1 M. Yuzefpolskaya,1 K. Takeda,2 H. Takayama,2 J.A. Fried,1 K. Wong,1 D. Jennings,1 R. Te-Frey,2 J. Haythe,1 M. Maurer,1 M.A. Farr,1 D.M. Mancini,1 Y. Naka,2 P.C. Colombo.1 1Medicine, Columbia University, New York, NY; 2Surgery, Columbia University, New York, NY. Purpose: Although dyslipidemia is a well-defined risk factor for coronary artery disease, low serum cholesterol was suggested as a strong independent predictor of mortality in advanced heart failure. Effect of CF-LVAD support on dyslipidemia remains largely unknown. We hypothesized that CF-LVAD support may recover low cholesterol levels in patients with advanced heart failure. Methods: 223 CF-LVAD patients with paired lipid profile data before and after device implantation at a large tertiary center were retrospectively studied. Multiple observations were averaged for each subject. Trends in lipid profile were analyzed using the repeated measures general linear model. Results: CF-LVAD support led to significant increase in all lipid subfractions including total cholesterol (133.8±41.8 to 156.3±47.9 mg/dL), lowdensity lipoprotein (LDL) (78.4±34.8 to 95.5±45.0 mg/dL), high-density lipoprotein (HDL) (33.3±11.2 to 40.7±13.2 mg/dL) and triglycerides (TG) (109.8±56.4 to 149.4±72.3 mg/dL) levels (all p< 0.001). Increases in lipid function following CF-LVAD support were associated with a concurrent reduction in hemoglobin A1c (6.9±1.3 to 5.8±1.1%, p< 0.001). Patients with ischemic cardiomyopathy were more likely to be on statin therapy (53.3% vs. 29.7%, p< 0.001) and had significantly lower total cholesterol (140.1±45.5 vs. 126.6±36.2 mg/dL, p= 0.015) and LDL (71.1±33.1 vs. 87.5±35.0 mg/dL, p= 0.010) levels before device implantation. However, CF-LVAD led to comparable increments in lipid sub-fractions in the ischemic and non-ischemic groups (Figure). Levels of increment in diabetic and obese subgroups were comparable. Conclusion: Restoration of abnormal hemodynamics following LVAD implantation is associated with improvements in all lipid sub-fractions in patients with advanced heart failure. Prognostic significance of changes lipid profile after CF-LVAD implantation remains to be determined.
Palliative Care Integration for Patients Receiving Left Ventricular Assist Device as Destination Therapy H. Groninger ,1 M. Aggarwal,2 K.A. Walker,3 J.T. Panke,1 A.M. Kelemen,1 R.M. Holder,1 G. Ruiz.4 1Medicine, MedStar Washington Hospital Center, Washington, DC; 2Medicine, MedStar Georgetown University Hospital, Washington, DC; 3Palliative Care, MedStar Health, Columbia, MD; 4Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC. Purpose: Left Ventricular Assist Device as Destination Therapy (LVAD-DT) can be life-prolonging therapy available to select patient with advanced heart failure (HF); it is also associated with significant morbidity, mortality and supportive care needs. The Joint Commission now mandates palliative care (PC) participation in accredited centers providing LVAD-DT. MedStar Washington Hospital Center began integrating Palliative Care Services for LVAD-DT patients in January 2015. Considering the paucity of data in this area, this study was designed to describe the first 6 months of palliative care consultative interventions, length of stay and disposition for patients receiving LVAD-DT. Methods: All LVAD-DT patients who received PC consultation between January and July 15, 2015 were reviewed retrospectively using the electronic health record. Data collected included reason for PC consultation, pain and symptom assessment (day 0, day 2), PC interventions, and disposition. Descriptive statistics were used to analyze data. Results: Thirty one LVAD-DT patients received PC consultations and were included in this study. The primary reason for PC consultation was pain (25/31) and median time to consultation was 9 days (median total length of stay was 26 days). Eighty one percent (25/31) of patients had moderate- severe symptoms at time of consult, which decreased to 20% (5/25) on day 2. Additional PC interventions included psychological (19%), spiritual (32%) and/or medication (87%) counseling as well as disease state education (26%), proxy determination (13%) change in code status (3%). Most patients went home (58%) or to rehab (39%) on discharge; 3% died in the hospital. Conclusion: LVAD-DT candidates experienced notable symptom burden and required multiple PC interventions, highlighting the value of PC integration. Future research should further elucidate PC consultation’s role and benefit in LVAD-DT patients. 9( 36) Greater Reduction in NT Pro-BNP Levels Post LVAD Is Associated with a Greater Improvement in Diabetes Control S. Madan , P. Vlismas, O. Saeed, S.R. Patel, J. Shin, S. Murthy, D. Sims, U. Jorde. Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Purpose: Previous studies have shown that Hemoglobin A1C (HgA1c) and NT pro-BNP levels decrease following Left Ventricular Assist Device (LVAD) implantation. However, the relationship between NT pro-BNP levels and improved glycemic control post LVAD is not clear. We evaluated the effects of reduction in NT pro-BNP levels on HgA1C following LVAD implantation. Methods: Single center retrospective review of all adult LVAD patients with history of Diabetes, from 01/2006 to 07/2015 was done. LVAD support < 90 days or unavailable NT pro-BNP levels were main exclusion criteria. Pre-op HgA1C and NT pro-BNP levels were compared to HgA1C and NT pro-BNP levels 3-6 months post LVAD implantation. Results: Of the 239 LVAD patients, 39 met study criteria with age 57.5±10.7 years, 87% males, BMI 29.3±6.7 kg/m2, 95% Heart Mate II, median INTERMACS 3. NT pro-BNP levels decreased post LVAD from 5570(3269-7503) to 1919(1073-3414) pg/ml (p< 0.001). In 25 patients with available HgA1c, there was a reduction post LVAD (7.7±1.7% to 6.9±1.6%, p= 0.021), despite being on lower total daily insulin and oral diabetes medications post LVAD (Table). Further, patients in whom NT pro-BNP reduced to below the median value of 1919 pg/ml, there was greater reduction in HgA1c (8.25±1.75 to 7.16±1.69, p= 0.0185, n= 13) compared to patients who had post LVAD pro-BNP levels above 1919 pg/ml (7.11±1.41 to 6.74±1.54, p= 0.427, n= 12, see Figure). Conclusion: In LVAD patients with diabetes, greater NT pro-BNP reduction was associated with a greater improvement in diabetes control. This data
Abstracts S339 supports existence of the unique and reversible entity of heart failure induced diabetes.
pre-operative interventions to optimize nutritional status can improve the outcomes of patients with poor nutrition.
Changes in diabetes related parameters after LVAD implant (n= 39)
NT pro-BNP (pg/ml) Number of patients on Insulin Daily insulin dose (units) Number of patients on oral medications Number of oral medications per patient HgA1c (%) (n= 25) Creatinine (mg/dL) Serum Sodium (mEq/L) Albumin (g/dL) t= paired t test
Pre-LVAD
Post-LVAD
p values
5570(3269-7503) 20 (51.28%) 28.6±36.8 16 (41.03%)
1919(1073-3414) 14 (35.90%) 14.4±24.3 6 (15.38%)
< 0.001 0.171 0.012 t 0.012
0(1-0)
0(0-0)
0.009
7.7±1.7 1.8±0.7 134±5 3.5±0.5
6.9±1.6 1.5±0.5 137±4 3.9±0.8
0.021 t 0.034 t 0.002 t 0.026 t
9( 38) Sodium Nadir during Left Ventricular Assist Device Implantation Is Not Associated with Increased Mortality S. Gupta ,1 S. Roy,2 R. John,3 R. Cogswell.2 1Medicine, University of Minnesota Health, Minneapolis, MN; 2Cardiology, University of Minnesota Health, Minneapolis, MN; 3Cardiothoracic Surgery, University of Minnesota Health, Minneapolis, MN.
9( 37) Prealbumin as a Predictor of Mortality After LVAD Implantation M.E. Rodrigo , D.T. Majure, F.H. Sheikh, C. Bither, M. Hofmeyer, N. Shah, S.W. Boyce, S.S. Najjar. MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC. Purpose: Serum albumin level is an established risk factor for worse outcomes following LVAD implantation. Prealbumin has a shorter half-life than albumin, is not influenced by hydration status or renal function, and is a more sensitive protein indicator of nutritional status. We evaluated the impact of preoperative serum prealbumin levels on outcomes post LVAD implantation. Methods: Single center retrospective analysis of patients who underwent implantation of a continuous flow LVAD between 1/2010 and 9/2015 and who were stratified according to preoperative prealbumin: low (< 15 mg/dl) vs normal (≥ 15) levels. Results: Of 261 patients who received an LVAD with a mean follow-up of 515 +/- 472 days, 94 (36%) had a low prealbumin level. The baseline clinical characteristics did not differ between the 2 groups except that the low prealbumin group had more Caucasians (39% vs. 26%, p= 0.03), a lower baseline albumin level (2.6 +/- 0.5 vs 3.4 + 0.6, p< 0.01) and higher LFTs. Furthermore, they had a higher likelihood of being INTERMACS 1 (43% vs. 7%, p< 0.01), and had a greater use of preoperative inotropes (93% vs. 80%, p< 0.01) and mechanical circulatory support (19% vs. 2% p < 0.01). Post-operatively, patients with low prealbumin levels had a higher duration of vasopressor use (7.23 +/- 6 vs. 5.03 +/- 5 days, p< 0.01). There were no significant differences between the 2 groups in length of stay (30 +/- 24 vs. 28 +/- 20 days). Importantly, those with low prealbumin had a higher risk of dying during the index hospitalization for LVAD implantation (25% vs. 10%, p= 0.002) and a higher risk of death during follow-up (Figure). ROC analysis shows sensitivity of 56% and specificity of 68% for 1-year mortality with a prealbumin cut-off level of 14.8 (AUC= 0.61). Conclusion: Low preoperative prealbumin level is associated with increased mortality after LVAD implantation. Future studies should evaluate whether
Purpose: Hyponatremia (Sodium level < 135) is known to be a marker in left-sided heart failure for increased short-term and long-term mortality. Our objective was to assess the relationship between sodium nadir during LVAD hospitalization and mortality. Methods: Retrospective review of 303 consecutive patients who underwent CF-LVAD implantation at our institution between 2005 and 2015. Patients were divided into 4 groups based on lowest sodium during the inpatient stay (Gr I: < 125, Gr II: 125-130, Gr III: 131-134, Gr IV: ≥ 135). Kaplan-Meier survival curves were constructed to illustrate mortality as a function of sodium concentration over time, and a Cox-proportional hazards model was constructed to determine if change in serum sodium concentration predicted mortality after adjusting for relevant covariates. Results: Of the 303 patients in the final sample, nadir sodium data was available for 280 patients. The mean age of the population was 57 years (SD: 14), 243 (80.2%) patients were men and 60 (19.8%) were women. There were 41 (14.6 %) patients in Group I, 96 (34.3) in Group II, 104 (37.1%) in Group III, and 39 (12.9%) in Group IV. There was no significant difference in survival between these subgroups (log rank P = 0.71). Using multivariable Cox regression we found no significant effect of hyponatremia on the hazard rate of death. Conclusion: Although hyponatremia is a known marker of increased short and long-term heart failure mortality, our study showed no association between hyponatremia and mortality in LVAD recipients.
The Journal of Heart and Lung Transplantation, Vol 35, No 4S, April 2016 9( 35)
Reviewed cases, their interventions, and survival Age / Sex / Patient # LVAD
Days Post Implantation
Indication
1
73 / M / HeartMate II
2
RVF
2
72 / M / HVAD
2
3
65 / M / HeartMate II 75 / M / HeartMate II
1
59 / M / HeartMate II 59 / M / HeartMate II
947
4
5 6
899
96
Indication
Survival Status
Expired at 581 days, unknown cause RVF Alive at 204 days RVF Alive at 91 days VT BMS to OM Expired at 43 venous graft days, VT/resp failure RVF BMS to RCA Expired at 26 days, GI bleed LV Recovery DES to LAD Alive at 337 days BMS to ostium of RCA DES to PDA venous graft BMS to RCA
9( 34) Changes in Lipid Profile Subfractions on Continuous-Flow Left Ventricular Assist Device (CF-LVAD) Therapy V.K. Topkara ,1 A.R. Garan,1 M. Yuzefpolskaya,1 K. Takeda,2 H. Takayama,2 J.A. Fried,1 K. Wong,1 D. Jennings,1 R. Te-Frey,2 J. Haythe,1 M. Maurer,1 M.A. Farr,1 D.M. Mancini,1 Y. Naka,2 P.C. Colombo.1 1Medicine, Columbia University, New York, NY; 2Surgery, Columbia University, New York, NY. Purpose: Although dyslipidemia is a well-defined risk factor for coronary artery disease, low serum cholesterol was suggested as a strong independent predictor of mortality in advanced heart failure. Effect of CF-LVAD support on dyslipidemia remains largely unknown. We hypothesized that CF-LVAD support may recover low cholesterol levels in patients with advanced heart failure. Methods: 223 CF-LVAD patients with paired lipid profile data before and after device implantation at a large tertiary center were retrospectively studied. Multiple observations were averaged for each subject. Trends in lipid profile were analyzed using the repeated measures general linear model. Results: CF-LVAD support led to significant increase in all lipid subfractions including total cholesterol (133.8±41.8 to 156.3±47.9 mg/dL), lowdensity lipoprotein (LDL) (78.4±34.8 to 95.5±45.0 mg/dL), high-density lipoprotein (HDL) (33.3±11.2 to 40.7±13.2 mg/dL) and triglycerides (TG) (109.8±56.4 to 149.4±72.3 mg/dL) levels (all p< 0.001). Increases in lipid function following CF-LVAD support were associated with a concurrent reduction in hemoglobin A1c (6.9±1.3 to 5.8±1.1%, p< 0.001). Patients with ischemic cardiomyopathy were more likely to be on statin therapy (53.3% vs. 29.7%, p< 0.001) and had significantly lower total cholesterol (140.1±45.5 vs. 126.6±36.2 mg/dL, p= 0.015) and LDL (71.1±33.1 vs. 87.5±35.0 mg/dL, p= 0.010) levels before device implantation. However, CF-LVAD led to comparable increments in lipid sub-fractions in the ischemic and non-ischemic groups (Figure). Levels of increment in diabetic and obese subgroups were comparable. Conclusion: Restoration of abnormal hemodynamics following LVAD implantation is associated with improvements in all lipid sub-fractions in patients with advanced heart failure. Prognostic significance of changes lipid profile after CF-LVAD implantation remains to be determined.
Palliative Care Integration for Patients Receiving Left Ventricular Assist Device as Destination Therapy H. Groninger ,1 M. Aggarwal,2 K.A. Walker,3 J.T. Panke,1 A.M. Kelemen,1 R.M. Holder,1 G. Ruiz.4 1Medicine, MedStar Washington Hospital Center, Washington, DC; 2Medicine, MedStar Georgetown University Hospital, Washington, DC; 3Palliative Care, MedStar Health, Columbia, MD; 4Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC. Purpose: Left Ventricular Assist Device as Destination Therapy (LVAD-DT) can be life-prolonging therapy available to select patient with advanced heart failure (HF); it is also associated with significant morbidity, mortality and supportive care needs. The Joint Commission now mandates palliative care (PC) participation in accredited centers providing LVAD-DT. MedStar Washington Hospital Center began integrating Palliative Care Services for LVAD-DT patients in January 2015. Considering the paucity of data in this area, this study was designed to describe the first 6 months of palliative care consultative interventions, length of stay and disposition for patients receiving LVAD-DT. Methods: All LVAD-DT patients who received PC consultation between January and July 15, 2015 were reviewed retrospectively using the electronic health record. Data collected included reason for PC consultation, pain and symptom assessment (day 0, day 2), PC interventions, and disposition. Descriptive statistics were used to analyze data. Results: Thirty one LVAD-DT patients received PC consultations and were included in this study. The primary reason for PC consultation was pain (25/31) and median time to consultation was 9 days (median total length of stay was 26 days). Eighty one percent (25/31) of patients had moderate- severe symptoms at time of consult, which decreased to 20% (5/25) on day 2. Additional PC interventions included psychological (19%), spiritual (32%) and/or medication (87%) counseling as well as disease state education (26%), proxy determination (13%) change in code status (3%). Most patients went home (58%) or to rehab (39%) on discharge; 3% died in the hospital. Conclusion: LVAD-DT candidates experienced notable symptom burden and required multiple PC interventions, highlighting the value of PC integration. Future research should further elucidate PC consultation’s role and benefit in LVAD-DT patients. 9( 36) Greater Reduction in NT Pro-BNP Levels Post LVAD Is Associated with a Greater Improvement in Diabetes Control S. Madan , P. Vlismas, O. Saeed, S.R. Patel, J. Shin, S. Murthy, D. Sims, U. Jorde. Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Purpose: Previous studies have shown that Hemoglobin A1C (HgA1c) and NT pro-BNP levels decrease following Left Ventricular Assist Device (LVAD) implantation. However, the relationship between NT pro-BNP levels and improved glycemic control post LVAD is not clear. We evaluated the effects of reduction in NT pro-BNP levels on HgA1C following LVAD implantation. Methods: Single center retrospective review of all adult LVAD patients with history of Diabetes, from 01/2006 to 07/2015 was done. LVAD support < 90 days or unavailable NT pro-BNP levels were main exclusion criteria. Pre-op HgA1C and NT pro-BNP levels were compared to HgA1C and NT pro-BNP levels 3-6 months post LVAD implantation. Results: Of the 239 LVAD patients, 39 met study criteria with age 57.5±10.7 years, 87% males, BMI 29.3±6.7 kg/m2, 95% Heart Mate II, median INTERMACS 3. NT pro-BNP levels decreased post LVAD from 5570(3269-7503) to 1919(1073-3414) pg/ml (p< 0.001). In 25 patients with available HgA1c, there was a reduction post LVAD (7.7±1.7% to 6.9±1.6%, p= 0.021), despite being on lower total daily insulin and oral diabetes medications post LVAD (Table). Further, patients in whom NT pro-BNP reduced to below the median value of 1919 pg/ml, there was greater reduction in HgA1c (8.25±1.75 to 7.16±1.69, p= 0.0185, n= 13) compared to patients who had post LVAD pro-BNP levels above 1919 pg/ml (7.11±1.41 to 6.74±1.54, p= 0.427, n= 12, see Figure). Conclusion: In LVAD patients with diabetes, greater NT pro-BNP reduction was associated with a greater improvement in diabetes control. This data
Abstracts S339 supports existence of the unique and reversible entity of heart failure induced diabetes.
pre-operative interventions to optimize nutritional status can improve the outcomes of patients with poor nutrition.
Changes in diabetes related parameters after LVAD implant (n= 39)
NT pro-BNP (pg/ml) Number of patients on Insulin Daily insulin dose (units) Number of patients on oral medications Number of oral medications per patient HgA1c (%) (n= 25) Creatinine (mg/dL) Serum Sodium (mEq/L) Albumin (g/dL) t= paired t test
Pre-LVAD
Post-LVAD
p values
5570(3269-7503) 20 (51.28%) 28.6±36.8 16 (41.03%)
1919(1073-3414) 14 (35.90%) 14.4±24.3 6 (15.38%)
< 0.001 0.171 0.012 t 0.012
0(1-0)
0(0-0)
0.009
7.7±1.7 1.8±0.7 134±5 3.5±0.5
6.9±1.6 1.5±0.5 137±4 3.9±0.8
0.021 t 0.034 t 0.002 t 0.026 t
9( 38) Sodium Nadir during Left Ventricular Assist Device Implantation Is Not Associated with Increased Mortality S. Gupta ,1 S. Roy,2 R. John,3 R. Cogswell.2 1Medicine, University of Minnesota Health, Minneapolis, MN; 2Cardiology, University of Minnesota Health, Minneapolis, MN; 3Cardiothoracic Surgery, University of Minnesota Health, Minneapolis, MN.
9( 37) Prealbumin as a Predictor of Mortality After LVAD Implantation M.E. Rodrigo , D.T. Majure, F.H. Sheikh, C. Bither, M. Hofmeyer, N. Shah, S.W. Boyce, S.S. Najjar. MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC. Purpose: Serum albumin level is an established risk factor for worse outcomes following LVAD implantation. Prealbumin has a shorter half-life than albumin, is not influenced by hydration status or renal function, and is a more sensitive protein indicator of nutritional status. We evaluated the impact of preoperative serum prealbumin levels on outcomes post LVAD implantation. Methods: Single center retrospective analysis of patients who underwent implantation of a continuous flow LVAD between 1/2010 and 9/2015 and who were stratified according to preoperative prealbumin: low (< 15 mg/dl) vs normal (≥ 15) levels. Results: Of 261 patients who received an LVAD with a mean follow-up of 515 +/- 472 days, 94 (36%) had a low prealbumin level. The baseline clinical characteristics did not differ between the 2 groups except that the low prealbumin group had more Caucasians (39% vs. 26%, p= 0.03), a lower baseline albumin level (2.6 +/- 0.5 vs 3.4 + 0.6, p< 0.01) and higher LFTs. Furthermore, they had a higher likelihood of being INTERMACS 1 (43% vs. 7%, p< 0.01), and had a greater use of preoperative inotropes (93% vs. 80%, p< 0.01) and mechanical circulatory support (19% vs. 2% p < 0.01). Post-operatively, patients with low prealbumin levels had a higher duration of vasopressor use (7.23 +/- 6 vs. 5.03 +/- 5 days, p< 0.01). There were no significant differences between the 2 groups in length of stay (30 +/- 24 vs. 28 +/- 20 days). Importantly, those with low prealbumin had a higher risk of dying during the index hospitalization for LVAD implantation (25% vs. 10%, p= 0.002) and a higher risk of death during follow-up (Figure). ROC analysis shows sensitivity of 56% and specificity of 68% for 1-year mortality with a prealbumin cut-off level of 14.8 (AUC= 0.61). Conclusion: Low preoperative prealbumin level is associated with increased mortality after LVAD implantation. Future studies should evaluate whether
Purpose: Hyponatremia (Sodium level < 135) is known to be a marker in left-sided heart failure for increased short-term and long-term mortality. Our objective was to assess the relationship between sodium nadir during LVAD hospitalization and mortality. Methods: Retrospective review of 303 consecutive patients who underwent CF-LVAD implantation at our institution between 2005 and 2015. Patients were divided into 4 groups based on lowest sodium during the inpatient stay (Gr I: < 125, Gr II: 125-130, Gr III: 131-134, Gr IV: ≥ 135). Kaplan-Meier survival curves were constructed to illustrate mortality as a function of sodium concentration over time, and a Cox-proportional hazards model was constructed to determine if change in serum sodium concentration predicted mortality after adjusting for relevant covariates. Results: Of the 303 patients in the final sample, nadir sodium data was available for 280 patients. The mean age of the population was 57 years (SD: 14), 243 (80.2%) patients were men and 60 (19.8%) were women. There were 41 (14.6 %) patients in Group I, 96 (34.3) in Group II, 104 (37.1%) in Group III, and 39 (12.9%) in Group IV. There was no significant difference in survival between these subgroups (log rank P = 0.71). Using multivariable Cox regression we found no significant effect of hyponatremia on the hazard rate of death. Conclusion: Although hyponatremia is a known marker of increased short and long-term heart failure mortality, our study showed no association between hyponatremia and mortality in LVAD recipients.