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Improved survival with statin therapy in ischemic and non-ischemic heart failure
The Journal of Heart and Lung Transplantation Volume 22, Number 1S Results: Multivariate analysis found MCS support duration of less than 90 days was a significant predictor of mortality (odds ratio 2.48, confidence interval 1.96-3.13, p ⬍ 0.001). In patients supported ⬍ 90 days, only 49% achieved a favorable outcome (i.e. transplantation or weaning), whereas, 70-75% of those supported ⬎90 days achieved a favorable outcome. Significant differences were noted between those supported ⬍ 90 days and all other implant durations; 90 days to 1 year (70% transplant/weaned, p ⬍ 0.0001), 1 to 2 years (74% transplant/ weaned, p ⬍ 0.0001) and over 2 years (75% transplant/weaned, p ⫽ 0.022). No significant differences in outcome were noted between each of the groups supported for greater than 90 days. Conclusions: Extended support duration has no negative impact on clinical outcomes and is instead associated with a significant improvement in outcome after the initial high-risk period post-implant. These findings in this group of patients, suggests no additional risks when extending the use of MCS from the relatively short-term bridge to transplant application to long-term use as a destination therapy. Conflict of Interest This work was funded in part by World Heart Corporation 263 TISSUE DOPPLER ECHOCARDIOGRAPHY PREDICTS POSITIVE LEFT VENTRICULAR REMODELING AFTER BIVENTRICULAR PACING IN SEVERE HEART FAILURE M. Penicka, J. Bartunek, M. Vanderheyden, B. De Bruyne, M. De Zutter, P. Geelen, E. Barbato, M. Goethals, Cardiovascular Center, OLV Ziekenhuis, Aalst, Aalst, Belgium Background: Resynchronization of contractions by biventricular pacing has been shown to reverse negative left ventricular (LV) remodeling in some patients with severe heart failure. Nevertheless, the prediction of benefit is controversial. Therefore, the purpose of the study was to investigate predictive factors of positive LV remodeling after biventricular pacing. Methods: Forty-three consecutive patients with severe heart failure and a wide QRS complex (181⫾42 ms) were studied by echocardiography prior to resynchronization. Sum of intra- and interventricular asynchrony was assessed by pulsed-wave tissue Doppler by adding the difference between regional electromechanical coupling times in the basal LV segments to the difference between basal left and right ventricular lateral segment. During follow-up (mean 191 days), responders were defined by an increase in LV ejection fraction ⱖ 25% or a decrease in LV end-diastolic diameter ⱕ 10 mm (n ⫽ 23). Results: Accordingly, ejection fraction increased (24⫾5 to 36⫾8%, p ⬍ 0.0001) and diameter decreased (73⫾9 to 67⫾8mm, p ⬍ 0.0001) in responders but not in nonresponders (27⫾6 to 25⫾7%, ns; 74⫾7 to 74⫾10mm, ns; respectively). The QRS duration and conventional echo-Doppler indices were similar in both groups. In contrast, responders showed greater sum of intra- and interventricular asynchrony than nonresponders (143⫾35 vs. 70⫾29ms, p ⬍ 0.0001). Moreover, degree of asynchrony correlated significantly with improvements in both LV ejection fraction (r ⫽ 0.72, p ⬍ 0.0001) and end-diastolic diameter (r ⫽ -0.68, p ⬍ 0.0001) during follow-up. Conclusions: The sum of intra-and interventricular asynchrony is a novel tissue Doppler-derived index that seems to be superior to conventional parameters in predicting the positive effects of resynchronization on the LV remodeling. 264 IMPROVED SURVIVAL WITH STATIN THERAPY IN ISCHEMIC AND NON-ISCHEMIC HEART FAILURE
Abstracts
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T.B. Horwich, J.K. Patel, M.A. Hamilton, W.R. MacLellan, M. Lesniewski, G.C. Fonarow, Cardiology, The David Geffen School of Medicine at UCLA, Los Angeles, CA Background: Although HMG CoA reductase inhibitors (statins) are known to decrease mortality in coronary artery disease (CAD), concern has been raised about potential negative effects in patients with advanced heart failure. The impact of statins on the progression of advanced heart failure (HF) has not been studied. Methods: We retrospectively studied a cohort of 251 pts with advanced HF referred for management and transplant evaluation. Patients without adequate documentation of medical regimen (n ⫽ 33) were excluded from analysis. Survival free from death or urgent transplant was determined. Results: Mean age, left ventricular ejection fraction (LVEF), and total cholesterol (TC) were 52, 25%, and 165 mg/dl, respectively. Fifty-one % of pts were on statin therapy. CAD was etiology of HF in 52% of patients, 79% of whom were on statin therapy. In non-CAD HF pts, 28% were on statin therapy. Patients on statins were significantly older, and had higher rates of CAD, smoking, hypertension, and diabetes. Treated and non-treated patients were similar in NYHA, LVEF, sex, body mass index, TC, and HF medications. Patients on statin therapy had improved survival over a 22 month follow-up (74% vs 56%, p ⫽ 0.008). In subsets of patients without CAD and with TC ⬍165 mg/dl, statins were similarly associated with improved survival (p ⫽ 0.006, p ⫽ 0.04 respectively). Statin therapy was an independent predictor of improved survival after risk-adjustment for age, sex, LVEF, ACE inhibitor therapy, renal function, and serum cardiac troponin I. Conclusions: Statin therapy was associated with improved survival in ischemic and non-ischemic heart failure. Randomized trials are needed for confirmation of therapeutic benefit.
265 MEDIUM TERM RESULTS OF ECMO FOR SEVERE ACUTE LUNG INJURY FOLLOWING LUNG TRANSPLANTATION P.S. Dahlberg,1 M.E. Prekker,1 M.I. Hertz,2 C.S. Herrington,1 S.J. Park,1 1 Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN; 2 Pulmonary Medicine, University of Minnesota, Minneapolis, MN Purpose: Extracorporeal membrane oxygenation (ECMO) has been used successfully for early, severe, reperfusion injury (RI) following lung transplantation. The purposes of this study are (1) to document the medium-term outcomes of patients treated with ECMO, (2) to assess the impact of ECMO use on survival in our lung transplant program. Procedures: We retrospectively reviewed charts of 172 patients having lung transplants at our institution from 1997 through 2002. The group included 16 patients (9% of total; 10 bilateral, 5 single, 1 living lobar) treated with ECMO for severe early RI. Survival and BOS-free survivals were calculated. We estimated the maximal impact of ECMO on patient survival by assuming that all patients in the ECMO group would have died on the day that ECMO was initiated. Results: Median hospital stay was 39 days for ECMO group and 16 days for the overall group (p ⬍ 0.05). The 90-day survival of the ECMO group was 63%; in the overall group 88%. The 2-year survival of the ECMO group was 50%; in the overall group 69% (Figure). Neither severe RI nor ECMO support were risk factors for developing bronchiolitis obliterans syndrome. When we assumed that all patients in the ECMO group would have died on the day that ECMO was initiated; survival rates for the overall group dropped to 81% at 90 days and 64%
Abstracts
S159
T.B. Horwich, J.K. Patel, M.A. Hamilton, W.R. MacLellan, M. Lesniewski, G.C. Fonarow, Cardiology, The David Geffen School of Medicine at UCLA, Los Angeles, CA Background: Although HMG CoA reductase inhibitors (statins) are known to decrease mortality in coronary artery disease (CAD), concern has been raised about potential negative effects in patients with advanced heart failure. The impact of statins on the progression of advanced heart failure (HF) has not been studied. Methods: We retrospectively studied a cohort of 251 pts with advanced HF referred for management and transplant evaluation. Patients without adequate documentation of medical regimen (n ⫽ 33) were excluded from analysis. Survival free from death or urgent transplant was determined. Results: Mean age, left ventricular ejection fraction (LVEF), and total cholesterol (TC) were 52, 25%, and 165 mg/dl, respectively. Fifty-one % of pts were on statin therapy. CAD was etiology of HF in 52% of patients, 79% of whom were on statin therapy. In non-CAD HF pts, 28% were on statin therapy. Patients on statins were significantly older, and had higher rates of CAD, smoking, hypertension, and diabetes. Treated and non-treated patients were similar in NYHA, LVEF, sex, body mass index, TC, and HF medications. Patients on statin therapy had improved survival over a 22 month follow-up (74% vs 56%, p ⫽ 0.008). In subsets of patients without CAD and with TC ⬍165 mg/dl, statins were similarly associated with improved survival (p ⫽ 0.006, p ⫽ 0.04 respectively). Statin therapy was an independent predictor of improved survival after risk-adjustment for age, sex, LVEF, ACE inhibitor therapy, renal function, and serum cardiac troponin I. Conclusions: Statin therapy was associated with improved survival in ischemic and non-ischemic heart failure. Randomized trials are needed for confirmation of therapeutic benefit.
265 MEDIUM TERM RESULTS OF ECMO FOR SEVERE ACUTE LUNG INJURY FOLLOWING LUNG TRANSPLANTATION P.S. Dahlberg,1 M.E. Prekker,1 M.I. Hertz,2 C.S. Herrington,1 S.J. Park,1 1 Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN; 2 Pulmonary Medicine, University of Minnesota, Minneapolis, MN Purpose: Extracorporeal membrane oxygenation (ECMO) has been used successfully for early, severe, reperfusion injury (RI) following lung transplantation. The purposes of this study are (1) to document the medium-term outcomes of patients treated with ECMO, (2) to assess the impact of ECMO use on survival in our lung transplant program. Procedures: We retrospectively reviewed charts of 172 patients having lung transplants at our institution from 1997 through 2002. The group included 16 patients (9% of total; 10 bilateral, 5 single, 1 living lobar) treated with ECMO for severe early RI. Survival and BOS-free survivals were calculated. We estimated the maximal impact of ECMO on patient survival by assuming that all patients in the ECMO group would have died on the day that ECMO was initiated. Results: Median hospital stay was 39 days for ECMO group and 16 days for the overall group (p ⬍ 0.05). The 90-day survival of the ECMO group was 63%; in the overall group 88%. The 2-year survival of the ECMO group was 50%; in the overall group 69% (Figure). Neither severe RI nor ECMO support were risk factors for developing bronchiolitis obliterans syndrome. When we assumed that all patients in the ECMO group would have died on the day that ECMO was initiated; survival rates for the overall group dropped to 81% at 90 days and 64%