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Pre Heart Transplant Cardiorenal Syndrome Is Associated With Accelerated Progression of Renal Dysfunction After Heart Transplantation
The 20th Annual Scientific Meeting
•
HFSA
S111
frail and non-frail advanced HF patients, suggesting that such measures cannot be used as surrogates for frailty in this population. Further study is needed to better understand how the frailty phenotype responds to advanced HF therapies and how frailty assessments can guide personalized treatment.
Frail (n = 54) Not Frail (n = 15) P Value Age (years) Gender Male Female Race White Black Other Ethnicity (% Latino) # of Comorbidities BMI Labs Hemog lobin (mg/dL) eGFR (mL/min/1.73 m2) Albumin (mg/dL) Bilirubin (mg/dL) INTERMACS Profile (0–7) Length of stay (days) Multidimensional Scale of Perceived Social Support (0–100) Patient Health Questionnaire-9 (Depression, 0–27) Kansas City Cardiomyopathy Questionnaire Overall Clinical Summary Total symptoms Quality of Life Physical Limitation Trail Making Test (seconds)
65 ± 10.5
60.5 ± 9.6
.28
44 (82%) 10 (19%)
10 (67%) 5 (33%)
.29 .29
29 (54%) 20 (37%) 5 (9%) 4 (7%) 6.1 ± 2.7 26.5 ± 5.4
6 (40%) 5 (33%) 4 (27%) 3 (20%) 5.8 ± 2.6 27.3 ± 5.1
.36 .80 .18 .43 .69 .60
11.9 ± 2.5 53.4 ± 20.0 3.7 ± 0.5 1.4 ± 0.9 2.9 ± 1.0 48.0 ± 32.9 71.6 ± 17.2
12.5 ± 2.1 54.1 ± 19.2 4.0 ± 0.4 1.5 ± 1.7 2.9 ± 1.0 35.1 ± 34.7 72.6 ± 11.3
.36 .91 <.01 .72 .96 .23 .18
8.2 ± 6.3
2.7 ± 2.2
<.001
40.6 ± 20.9 49.7 ± 23.3 52.9 ± 24.3 34.1 ± 25.9 46.5 ± 30.3 195 ± 90.8
66.4 ± 25.3 71.9 ± 26.2 77.2 ± 30.1 66.7 ± 23.6 66.5 ± 26.8 160 ± 103.3
<.05 .07 .08 <.01 .11 .43
322 Pre Heart Transplant Cardiorenal Syndrome Is Associated With Accelerated Progression of Renal Dysfunction After Heart Transplantation Jessica Sturgess, Anjan Deka, Enrique P. Campos, Briana Costello, Nikola Dobrilovic, Burhan Mohamedali; Rush University Medical Center, Chicago, IL Case Presentation: Cardiorenal syndrome (CRS) is prevalent in patients requiring heart transplantation (HT) and is often reversed prior to HT through hemodynamic optimization with inotropes. The use of calcineurin inhibitors is known to induce and worsen renal failure post-HT. In this study we evaluated whether pre HT renal dysfunction, as determined by prior diagnosis of CRS, was associated with worse renal function, progression to ESRD, and mortality post HT. In this single center retrospective study, 75 patients who underwent HT were followed for 5 years. Patients were stratified by history of pre-existing CRS based on history of chronic kidney disease (CKD) prior to transplant. Patients who progressed to hemodialysis (HD) (10 patients) were censored in order to not confound laboratory markers of renal dysfunction. In addition to baseline demographics, outcome data for 5 years post HT including renal function, initiation of chronic hemodialysis (HD), stroke, infection, arrhythmia, mortality and graft failure was assessed. Data was analyzed using Mann-Whitney U and X2 analysis. Our final cohort was comprised of 66 patients (No CKD, N = 44 and CKD N = 31). Index labs measured after hemodynamic optimization for HT showed no significant difference in renal function between patients with and without a diagnosis of CRS. As time progressed, patients with pre-HT CRS were noted to have significantly worse renal function compared to patients without a pre-HT diagnosis of CRS (Fig. 1). There was no difference between the number of patients with and without a pre-HT diagnosis of CRS who progressed to end stage renal disease necessitating hemodialysis (12.9% vs 11.4% P = .840). Overall mortality was greater in patients with pre-HT CRS compared to those without, however this did not reach statistical significance (25.8% vs 18.2%, P = .427). A pre-HT diagnosis of CRS was associated with increased progression of renal failure despite similar pre-HT renal function. This suggests that patients with CRS prior to HT require closer follow up and more aggressive management of modifiable risk factors for progression of CRS such as hypertension and diabetes. Additionally, dose reduction of calcineurin inhibitors or transitioning to alternative therapy with proliferation signal inhibitors may be preferable in this subset of patients in order to reduce the progression of renal dysfunction post HT, however further research is necessary.
323 Effect of Vitamin D Level on Readmission Rates in Patients With Left Ventricular Assist Devices Geetha Bhat, Fadi Abou Obeid, Anup Kumar, Abdelhadi Rifai, Sunil Pauwaa, William Cotts, Erin Drever, Gardner Yost, Antone Tatooles; Advocate Christ Medical Center, Oak Lawn, IL Background: Vitamin D is an important hormone that regulates cardiac myocytes. Low levels have contributed to the development of cardiovascular disease. In addition, Vitamin D has been implicated in the immune system and the inflammatory cascade led by B and T cells. It is not yet clear whether these effects may have a clinical impact on patients undergoing left ventricular assist device (LVAD) implantation. Patients who undergo LVAD implantation are at increased risk of gastrointestinal bleeding, stroke and driveline infection. These complications in addition to other reasons are some of the leading causes of recurrent hospitalization after the procedure. The goal of our study was to determine if Vitamin D levels are associated with increased risk of readmission. Methods: We retrospectively reviewed the medical records of 212 continuous-flow LVAD patients between Jan 1, 2010 and Jan 1, 2015. We excluded patients who were on ECMO and had a biventricular VAD. The 25-OH vitamin D level was measured prior to LVAD implantation. The vitamin D level was classified into 3 categories listed as Normal (>30 ng/mL), Insufficient (20–30 ng/mL) and Deficient (<20 ng/mL). We assessed its association with the rate of readmissions during a one year follow up period. The rate of readmissions in both insufficient and deficient categories were compared to the normal category. Demographics are shown in Table 1. Results: Lower vitamin D levels were associated with a 2.5 times increase in rate of readmissions, Table 2. Conclusion: These findings reflect a clinical impact of vitamin D levels on patients undergoing LVAD implantation. Patients with decreased vitamin D levels were more likely to be readmitted than those with normal levels. Frequent hospital readmissions after LVAD implantation can lead to increased costs and decreased quality of life. Further studies are needed to determine if vitamin D repletion regimens could result in decreased readmissions after LVAD.
Table 1. Gender Male 76.76% Female 23.23%
Race
Age at Implant
AA—41.4% Caucasian—51.5% Other—8.1%
59.67 yo ; 95% CI (56.45; 62.9)
Table 2. 25-OH Vitamin D Sufficiency (>30 ng/mL) Insufficiency (20–30 ng/mL) Deficiency (<20 ng/mL)
Readmission (0–1)
Readmission (2 or More)
16 (50%) 15 (29.49%)
16 (50%) 36 (70.51%)
29 (29%)
71 (71%)
Odds Ratio (OR)
2.5 (95% CI: 0.970–6.443) P = .07 2.46 (95% CI: 1.067–5.769) P = .03
•
HFSA
S111
frail and non-frail advanced HF patients, suggesting that such measures cannot be used as surrogates for frailty in this population. Further study is needed to better understand how the frailty phenotype responds to advanced HF therapies and how frailty assessments can guide personalized treatment.
Frail (n = 54) Not Frail (n = 15) P Value Age (years) Gender Male Female Race White Black Other Ethnicity (% Latino) # of Comorbidities BMI Labs Hemog lobin (mg/dL) eGFR (mL/min/1.73 m2) Albumin (mg/dL) Bilirubin (mg/dL) INTERMACS Profile (0–7) Length of stay (days) Multidimensional Scale of Perceived Social Support (0–100) Patient Health Questionnaire-9 (Depression, 0–27) Kansas City Cardiomyopathy Questionnaire Overall Clinical Summary Total symptoms Quality of Life Physical Limitation Trail Making Test (seconds)
65 ± 10.5
60.5 ± 9.6
.28
44 (82%) 10 (19%)
10 (67%) 5 (33%)
.29 .29
29 (54%) 20 (37%) 5 (9%) 4 (7%) 6.1 ± 2.7 26.5 ± 5.4
6 (40%) 5 (33%) 4 (27%) 3 (20%) 5.8 ± 2.6 27.3 ± 5.1
.36 .80 .18 .43 .69 .60
11.9 ± 2.5 53.4 ± 20.0 3.7 ± 0.5 1.4 ± 0.9 2.9 ± 1.0 48.0 ± 32.9 71.6 ± 17.2
12.5 ± 2.1 54.1 ± 19.2 4.0 ± 0.4 1.5 ± 1.7 2.9 ± 1.0 35.1 ± 34.7 72.6 ± 11.3
.36 .91 <.01 .72 .96 .23 .18
8.2 ± 6.3
2.7 ± 2.2
<.001
40.6 ± 20.9 49.7 ± 23.3 52.9 ± 24.3 34.1 ± 25.9 46.5 ± 30.3 195 ± 90.8
66.4 ± 25.3 71.9 ± 26.2 77.2 ± 30.1 66.7 ± 23.6 66.5 ± 26.8 160 ± 103.3
<.05 .07 .08 <.01 .11 .43
322 Pre Heart Transplant Cardiorenal Syndrome Is Associated With Accelerated Progression of Renal Dysfunction After Heart Transplantation Jessica Sturgess, Anjan Deka, Enrique P. Campos, Briana Costello, Nikola Dobrilovic, Burhan Mohamedali; Rush University Medical Center, Chicago, IL Case Presentation: Cardiorenal syndrome (CRS) is prevalent in patients requiring heart transplantation (HT) and is often reversed prior to HT through hemodynamic optimization with inotropes. The use of calcineurin inhibitors is known to induce and worsen renal failure post-HT. In this study we evaluated whether pre HT renal dysfunction, as determined by prior diagnosis of CRS, was associated with worse renal function, progression to ESRD, and mortality post HT. In this single center retrospective study, 75 patients who underwent HT were followed for 5 years. Patients were stratified by history of pre-existing CRS based on history of chronic kidney disease (CKD) prior to transplant. Patients who progressed to hemodialysis (HD) (10 patients) were censored in order to not confound laboratory markers of renal dysfunction. In addition to baseline demographics, outcome data for 5 years post HT including renal function, initiation of chronic hemodialysis (HD), stroke, infection, arrhythmia, mortality and graft failure was assessed. Data was analyzed using Mann-Whitney U and X2 analysis. Our final cohort was comprised of 66 patients (No CKD, N = 44 and CKD N = 31). Index labs measured after hemodynamic optimization for HT showed no significant difference in renal function between patients with and without a diagnosis of CRS. As time progressed, patients with pre-HT CRS were noted to have significantly worse renal function compared to patients without a pre-HT diagnosis of CRS (Fig. 1). There was no difference between the number of patients with and without a pre-HT diagnosis of CRS who progressed to end stage renal disease necessitating hemodialysis (12.9% vs 11.4% P = .840). Overall mortality was greater in patients with pre-HT CRS compared to those without, however this did not reach statistical significance (25.8% vs 18.2%, P = .427). A pre-HT diagnosis of CRS was associated with increased progression of renal failure despite similar pre-HT renal function. This suggests that patients with CRS prior to HT require closer follow up and more aggressive management of modifiable risk factors for progression of CRS such as hypertension and diabetes. Additionally, dose reduction of calcineurin inhibitors or transitioning to alternative therapy with proliferation signal inhibitors may be preferable in this subset of patients in order to reduce the progression of renal dysfunction post HT, however further research is necessary.
323 Effect of Vitamin D Level on Readmission Rates in Patients With Left Ventricular Assist Devices Geetha Bhat, Fadi Abou Obeid, Anup Kumar, Abdelhadi Rifai, Sunil Pauwaa, William Cotts, Erin Drever, Gardner Yost, Antone Tatooles; Advocate Christ Medical Center, Oak Lawn, IL Background: Vitamin D is an important hormone that regulates cardiac myocytes. Low levels have contributed to the development of cardiovascular disease. In addition, Vitamin D has been implicated in the immune system and the inflammatory cascade led by B and T cells. It is not yet clear whether these effects may have a clinical impact on patients undergoing left ventricular assist device (LVAD) implantation. Patients who undergo LVAD implantation are at increased risk of gastrointestinal bleeding, stroke and driveline infection. These complications in addition to other reasons are some of the leading causes of recurrent hospitalization after the procedure. The goal of our study was to determine if Vitamin D levels are associated with increased risk of readmission. Methods: We retrospectively reviewed the medical records of 212 continuous-flow LVAD patients between Jan 1, 2010 and Jan 1, 2015. We excluded patients who were on ECMO and had a biventricular VAD. The 25-OH vitamin D level was measured prior to LVAD implantation. The vitamin D level was classified into 3 categories listed as Normal (>30 ng/mL), Insufficient (20–30 ng/mL) and Deficient (<20 ng/mL). We assessed its association with the rate of readmissions during a one year follow up period. The rate of readmissions in both insufficient and deficient categories were compared to the normal category. Demographics are shown in Table 1. Results: Lower vitamin D levels were associated with a 2.5 times increase in rate of readmissions, Table 2. Conclusion: These findings reflect a clinical impact of vitamin D levels on patients undergoing LVAD implantation. Patients with decreased vitamin D levels were more likely to be readmitted than those with normal levels. Frequent hospital readmissions after LVAD implantation can lead to increased costs and decreased quality of life. Further studies are needed to determine if vitamin D repletion regimens could result in decreased readmissions after LVAD.
Table 1. Gender Male 76.76% Female 23.23%
Race
Age at Implant
AA—41.4% Caucasian—51.5% Other—8.1%
59.67 yo ; 95% CI (56.45; 62.9)
Table 2. 25-OH Vitamin D Sufficiency (>30 ng/mL) Insufficiency (20–30 ng/mL) Deficiency (<20 ng/mL)
Readmission (0–1)
Readmission (2 or More)
16 (50%) 15 (29.49%)
16 (50%) 36 (70.51%)
29 (29%)
71 (71%)
Odds Ratio (OR)
2.5 (95% CI: 0.970–6.443) P = .07 2.46 (95% CI: 1.067–5.769) P = .03