Continuous-Flow Left Ventricular Assist Device Support in Patients with Ischemic Versus Nonischemic Cardiomyopathy

Abstract

To determine whether the cause of cardiomyopathy affects outcomes in patients who undergo continuous-flow left ventricular assist device support, we compared postimplant adverse events and survival between patients with ischemic and nonischemic cardiomyopathy. The inclusion criteria for the ischemic group were a history of myocardial infarction or revascularization (coronary artery bypass grafting or percutaneous coronary intervention), ≥75% stenosis of the left main or proximal left anterior descending coronary artery, or ≥75% stenosis of ≥2 epicardial vessels. From November 2003 through March 2016, 526 patients underwent device support: 256 (48.7%) in the ischemic group and 270 (51.3%) in the nonischemic group. The ischemic group was older (60.0 vs 50.0 yr), included more men than women (84.0% vs 72.6%), and had more comorbidities. More patients in the nonischemic group were able to have their devices explanted after left ventricular recovery (5.9% vs 2.0%; P=0.02). More patients in the ischemic group had gastrointestinal bleeding (31.2% vs 22.6%; P=0.03), particularly from arteriovenous malformations (20.7% vs 11.9%; P=0.006) and ulcers (16.4% vs 9.3%; P=0.01). Kaplan-Meier analysis revealed no difference in overall survival between groups (P=0.24). Older age, previous sternotomy, higher total bilirubin level, and concomitant procedures during device implantation independently predicted death (P ≤0.03), whereas cause of heart failure did not (P=0.08). Despite the similarity in overall survival between groups, ischemic cardiomyopathy was associated with more frequent gastrointestinal bleeding. This information may help guide the care of patients with ischemic cardiomyopathy who receive continuous-flow left ventricular assist device support.

Age Is a Predictor of In-Hospital Outcomes for Left Ventricular Assist Device Implantation: A Nationwide Analysis

“…However, a later propensity score-matched cohort, including 321 patients from 2006 to 2018, showed that redo sternotomy was not a risk factor for LVAD implantation [ 28 ]. Furthermore, Chou et al investigated overall survival of continuous-flow LVAD implantation for patients with and without ischemic etiologies, revealing no difference between the two groups [ 29 ]. Furthermore, an analysis using 2012–2015 NIS data revealed that CKD stage 1–3 and stage 4–5 were associated with increased risk of in-hospital mortality (aOR: 1.33, CI 1.16–1.50; and 8.95, CI 6.90–11.61, respectively) [ 30 ].…”

Identification MNS1, FRZB, OGN, LUM, SERP1NA3 and FCN3 as the potential immune-related key genes involved in ischaemic cardiomyopathy by random forest and nomogram

“…A total of 60 participants were recruited from Hunan Provincial People’s Hospital, including 30 ICM patients and 30 healthy participants. The diagnostic criteria for ICM are as follows: a history of myocardial infarction, coronary revascularization (coronary artery bypass grafting or percutaneous coronary intervention), ≥ 75% stenosis of the left main or proximal left anterior descending coronary artery, or ≥ 75% stenosis of ≥ 2 epicardial vessels [ 61 ]. All enrolled ICM patients had a left ventricular ejection fraction of ≤ 40% and a history of symptomatic heart failure (New York Heart Association [NYHA] functional class II or greater) [ 62 ].…”