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Timing of Right Heart Failure after Left Ventricular Assist Device is Associated with Survival after Heart Transplantation
Abstracts
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Timing of Right Heart Failure after Left Ventricular Assist Device is Associated with Survival after Heart Transplantation E.M. Senser,1 F. Cabezas,2 and E.W. Grandin.2 1Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA; and the 2Cardiology, Beth Israel Deaconess Medical Center, Boston, MA.
Right Heart Function Worsens in LVAD Patients with Decoupling between Pulmonary Artery and Wedge Pressures T. Imamura, B. Smith, J. Raikhelkar, D. Rodgers, G. Kim, S. Kalantari, A. Nguyen, N. Narang, B. Chung, I. Ebong, L. Holzhauser, D. Nitta, T. Fujino, C. Juricek, P. Combs, D. Onsager, T. Song, T. Ota, V. Jeevanandam, G. Sayer and N. Uriel. University of Chicago, Chicago, IL.
Purpose: Right heart failure (RHF) after left ventricular assist device (LVAD) occurs in a spectrum of severity and can occur both early and late after implant. Our recent work demonstrated that patients requiring IS after LVAD have reduced survival following heart transplant (OHT), but whether this extends to patients with early and late RHF is unknown. Methods: We queried the UNOS registry from 1/00 - 9/17 for adults bridged to OHT with LVAD, excluding those with total artificial heart, dual-organ transplant, prior transplant, or congenital heart disease. We divided patients into 4 groups based on the need for IS at listing and at OHT: 1) No RHF = LVAD; LVAD, 2) early RHF = LVAD + IS; LVAD, 3) persistent RHF = LVAD + IS; LVAD + IS, and 4) late RHF = LVAD; LVAD + IS. We compared 1-year post-OHT survival using the KaplanMeier method and Cox proportional hazards models. Results: Among 5080 patients bridged to OHT with LVAD, 4348 (86%) had no RHF, 343 (7%) early RHF, 194 (4%) persistent RHF, and 195 (4%) late RHF. Compared to patients without RHF at the time of OHT, those with persistent and late RHF had similar creatinine and total bilirubin but a higher proportion of ventilator support and lower Karnofsky performance scores (Table). Compared to patients with no RHF, 1-year post-OHT survival was similar for patients with isolated early RHF but was significantly lower among those with persistent and late RHF, and this relationship persisted in multivariate modeling (Figure). Conclusion: Patients with persistent or late RHF requiring IS after LVAD have reduced post-OHT survival, similar to patients bridged with BiVAD.
Purpose: Decoupling between diastolic pulmonary artery pressure (dPAP) and pulmonary capillary wedge pressure (PCWP) is an index of pulmonary vascular damage and is associated with recurrence of heart failure during LVAD support. This study aimed to investigate the impact of decoupling on right heart function. Methods: In this prospective study, LVAD patients underwent invasive hemodynamic testing. Decoupling was defined as >5 mmHg of difference between dPAP and PCWP. We compared right heart function between those with and without decoupling, as assessed by transthoracic echocardiography at the time of catheterization and one year later. Results: 69 patients (mean age 61 years, 49% male) were enrolled. 33 patients (48%) had decoupling. At baseline, all investigated right heart parameters were worse in the decoupling group (p <0.05) except for the tricuspid annular systolic velocity and tricuspid regurgitation (Figure 1AF). One year later, all right heart parameters, including hemodynamics and echocardiographic parameters, worsened significantly in the decoupling group (p <0.05 for all). Conclusion: Presence of decoupling has a negative impact on right heart function during LVAD support. Therapeutic strategies to address decoupling may reduce right heart failure post-LVAD.
554 Post-Implant Phosphodiesterase-5 Inhibitor Use is Associated with Increased Rates of Late Right Heart Failure after LVAD: An INTERMACS Analysis E. Grandin,1 G. Gulati,2 K. Kennedy,3 F. Cabezas,1 E.Y. Birati,4 J. Rame,4 P. Atluri,5 F.D. Pagani,6 J.K. Kirklin,7 D.C. Naftel,7 R.L. Kormos,8 J. Teuteberg,9 and M. Kiernan.2 1Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA; 2Division of Cardiovascular Medicine, Tufts Medical Center, Boston, MA; 3BIDMC Smith Center for Outcomes Research in Cardiology, St. Luke's MidAmerica Heart Institute, Kansas City, MO; 4Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA; 5 Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, MA; 6Division of Cardiothoracic Surgery, University of Michigan, Ann Arbor, MI; 7Division of Cardiothoracic Surgery, University of Alabama Birmingham, Birmingham, AL; 8Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; and the 9Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA. Purpose: Late right heart failure (LRHF) is a major cause of morbidity after LVAD. Phosphodiesterase-5 inhibitors (PDE5i) are often used for post-LVAD right heart dysfunction, but their impact on LRHF is unknown. Methods: We identified adult patients from the INTERMACS registry undergoing continuous-flow LVAD (CFLVAD) after 2012 and stratified them by use of PDE5i at 1 month. Early RHF (ERHF) was defined as the
S229
552
553
Timing of Right Heart Failure after Left Ventricular Assist Device is Associated with Survival after Heart Transplantation E.M. Senser,1 F. Cabezas,2 and E.W. Grandin.2 1Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA; and the 2Cardiology, Beth Israel Deaconess Medical Center, Boston, MA.
Right Heart Function Worsens in LVAD Patients with Decoupling between Pulmonary Artery and Wedge Pressures T. Imamura, B. Smith, J. Raikhelkar, D. Rodgers, G. Kim, S. Kalantari, A. Nguyen, N. Narang, B. Chung, I. Ebong, L. Holzhauser, D. Nitta, T. Fujino, C. Juricek, P. Combs, D. Onsager, T. Song, T. Ota, V. Jeevanandam, G. Sayer and N. Uriel. University of Chicago, Chicago, IL.
Purpose: Right heart failure (RHF) after left ventricular assist device (LVAD) occurs in a spectrum of severity and can occur both early and late after implant. Our recent work demonstrated that patients requiring IS after LVAD have reduced survival following heart transplant (OHT), but whether this extends to patients with early and late RHF is unknown. Methods: We queried the UNOS registry from 1/00 - 9/17 for adults bridged to OHT with LVAD, excluding those with total artificial heart, dual-organ transplant, prior transplant, or congenital heart disease. We divided patients into 4 groups based on the need for IS at listing and at OHT: 1) No RHF = LVAD; LVAD, 2) early RHF = LVAD + IS; LVAD, 3) persistent RHF = LVAD + IS; LVAD + IS, and 4) late RHF = LVAD; LVAD + IS. We compared 1-year post-OHT survival using the KaplanMeier method and Cox proportional hazards models. Results: Among 5080 patients bridged to OHT with LVAD, 4348 (86%) had no RHF, 343 (7%) early RHF, 194 (4%) persistent RHF, and 195 (4%) late RHF. Compared to patients without RHF at the time of OHT, those with persistent and late RHF had similar creatinine and total bilirubin but a higher proportion of ventilator support and lower Karnofsky performance scores (Table). Compared to patients with no RHF, 1-year post-OHT survival was similar for patients with isolated early RHF but was significantly lower among those with persistent and late RHF, and this relationship persisted in multivariate modeling (Figure). Conclusion: Patients with persistent or late RHF requiring IS after LVAD have reduced post-OHT survival, similar to patients bridged with BiVAD.
Purpose: Decoupling between diastolic pulmonary artery pressure (dPAP) and pulmonary capillary wedge pressure (PCWP) is an index of pulmonary vascular damage and is associated with recurrence of heart failure during LVAD support. This study aimed to investigate the impact of decoupling on right heart function. Methods: In this prospective study, LVAD patients underwent invasive hemodynamic testing. Decoupling was defined as >5 mmHg of difference between dPAP and PCWP. We compared right heart function between those with and without decoupling, as assessed by transthoracic echocardiography at the time of catheterization and one year later. Results: 69 patients (mean age 61 years, 49% male) were enrolled. 33 patients (48%) had decoupling. At baseline, all investigated right heart parameters were worse in the decoupling group (p <0.05) except for the tricuspid annular systolic velocity and tricuspid regurgitation (Figure 1AF). One year later, all right heart parameters, including hemodynamics and echocardiographic parameters, worsened significantly in the decoupling group (p <0.05 for all). Conclusion: Presence of decoupling has a negative impact on right heart function during LVAD support. Therapeutic strategies to address decoupling may reduce right heart failure post-LVAD.
554 Post-Implant Phosphodiesterase-5 Inhibitor Use is Associated with Increased Rates of Late Right Heart Failure after LVAD: An INTERMACS Analysis E. Grandin,1 G. Gulati,2 K. Kennedy,3 F. Cabezas,1 E.Y. Birati,4 J. Rame,4 P. Atluri,5 F.D. Pagani,6 J.K. Kirklin,7 D.C. Naftel,7 R.L. Kormos,8 J. Teuteberg,9 and M. Kiernan.2 1Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA; 2Division of Cardiovascular Medicine, Tufts Medical Center, Boston, MA; 3BIDMC Smith Center for Outcomes Research in Cardiology, St. Luke's MidAmerica Heart Institute, Kansas City, MO; 4Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA; 5 Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, MA; 6Division of Cardiothoracic Surgery, University of Michigan, Ann Arbor, MI; 7Division of Cardiothoracic Surgery, University of Alabama Birmingham, Birmingham, AL; 8Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; and the 9Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA. Purpose: Late right heart failure (LRHF) is a major cause of morbidity after LVAD. Phosphodiesterase-5 inhibitors (PDE5i) are often used for post-LVAD right heart dysfunction, but their impact on LRHF is unknown. Methods: We identified adult patients from the INTERMACS registry undergoing continuous-flow LVAD (CFLVAD) after 2012 and stratified them by use of PDE5i at 1 month. Early RHF (ERHF) was defined as the