Temporal Change in PEACE Heart Failure Risk Score and Association with Natriuretic Peptides in the MESA Population

S62 Journal of Cardiac Failure Vol. 25 No. 8S August 2019 should be closely observed during the first few weeks after initiation of treatment. Additional studies with larger samples are needed to validate these findings.

disease were followed for a median of 8 years. Patients were at low risk based on PEACE score and NTproBNP [median 46 (IQR 21-91)pg/mL]. Proportion of patients with PEACE risk score at average (n=227, 12.5%) or high risk (n=10, 0.6%) increased over time, which correlated with the increase in overall NT-proBNP levels over time (Figure, p<0.01). Interestingly, a subset of patients (n=196, 10%) at low risk by PEACE risk score had NTproBNP levels above 125 pg/mL despite eGFR >60. Conclusions: Proportion of patients at average and high risk for HF increase with time which correlated with NTproBNP levels. Mismatch between PEACE HF risk and NTproBNP was seen among low risk patients warranting further investigation.

162 Sacubitril-Valsartan Initiation Post-Left Ventricular Assist Device is Safe and Effective Varinder K. Randhawa, Lucianne West, Jacob Luthman, Jerry Estep, Edward G. Soltesz, Randall C. Starling; Cleveland Clinic Foundation, Cleveland, OH Introduction and Aim: Guideline-directed medical therapy for heart failure (HF) with reduced ejection fraction includes demonstrated benefit from the combination drug sacubitril-valsartan in acute and chronic heart failure. However, little is known of its’ tolerability in patients with stage D HF requiring durable left ventricular assist device (LVAD) implantation. Our aim was to determine its’ safety and efficacy in patients with durable LVADs. Methods: We retrospectively reviewed patients who were initiated on sacubitril-valsartan post-LVAD implantation at our institution for baseline characteristics and drug tolerability. Results: We identified 10 patients with a mean age of 57.5 § 8.7 years who were initiated on sacubitril-valsartan post-LVAD implantation, 80% for destination therapy. Of these, 4 had axial and 6 had centrifugal flow pumps. The majority were Caucasian (60%) and male (70%). The initiation of sacubitril-valsartan reduced MAP by 20.0 § 14.0 mmHg (p=0.002), and NT-proBNP from 2,929 pg/mL to 1,530 pg/mL (p=0.36). By contrast, mean serum creatinine and potassium were unaltered (Table 1). Only one patient experienced hyperkalemia, and no patients developed drug-related acute kidney injury (decline in eGFR >25%), hypotension or angioedema. Following the initiation of sacubitril-valsartan, there was a concomitant reduction in the use of other oral vasodilators (30-50%), mineralocorticoid receptor antagonists (20%), and non-potassium sparing diuretics (10%). Conclusions: Sacubitril-valsartan initiation in patients after LVAD implantation is tolerated, and reduces MAP. Elevated MAP has been related to adverse events post-LVAD and sacubitril-valsartan appears safe and effective in our preliminary experience in patients supported with continuous flow LVAD. Table 1. Table 1. Impact of Sacubitril-Valsartan on Clinical Variables.

Clinical Variable MAP (mm Hg) Potassium (mM) Creatinine (mg/dL) NT-proBNP (pg/mL)

Prior to SacubitrilValsartan Initiation

After SacubitrilValsartan Initiation

Delta Change With SacubitrilValsartan

P-value

98.8 § 12.2 4.14 § 0.66 1.28 § 0.26 2,929.5 § 5,013.26

78.4 § 12.1 4.34 § 0.36 1.39 § 0.26 1,530.0 § 1,676.34

(-) 20.0 § 14.0 (+) 0.11 § 0.44 (+) 0.08 § 0.17 (-) 1,631 § 5,194.18

p=0.002 p=0.46 p=0.21 p=0.36

163 Temporal Change in PEACE Heart Failure Risk Score and Association with Natriuretic Peptides in the MESA Population Abhinav Sood, Wilson W.H. Tang; Cleveland Clinic, Cleveland, OH Introduction: We assessed temporal evolution of the PEACE score, a validated heart failure (HF) prediction score, in the MESA population and its correlation with NTproBNP Hypothesis: PEACE risk score will increase with time and have a positive correlation with NTproBNP Methods: PEACE HF risk score was calculated for patients with available left ventricular ejection fraction and NTproBNP examined at the 1stand 5thvisit. Temporal change in PEACE score was analyzed and correlated with available NTproBNP levels Results: 1,840 ambulatory patients (60§9 years, 49% males) without a history of HF, coronary artery disease and cerebrovascular

164 Clinical Differences between Methamphetamine and Non-Methamphetamine Associated Non-Ischemic Dilated Cardiomyopathy Pavan Reddy, Kyle O’Meara, Sagar Patel, Edward Chau, Merije Chukumerije, Anil Mehra, Tien Ng, Uri Elkayam; University of Southern California, Keck Medical Center, Los Angeles, CA Background: Methamphetamine associated cardiomyopathy (MACM) is an increasingly recognized form of dilated cardiomyopathy around the globe which remains poorly characterized. Purpose: To compare the clinical characteristics of MACM to those of non-MA associated dilated CM (NMACM). Methods: Consecutive patients with MACM presenting to our institution between Jun 2018 and Jan 2019 were prospectively studied and compared to an age and gender matched cohort of dilated nonischemic CM cases. Results: Seventy patients were studied (35 MACM and 35 NMACM). Mean age was similar between groups (49§9 vs. 48§10 years, p=0.465) and 97% of patients were male. Median duration of MA use prior to cardiomyopathy diagnosis was 5 years (range 0-30). Patients were predominantly Hispanic in both