Higher Body Mass Index Associated with Decreased Exchange-Free Survival at One Year in Patients with Left Ventricular Assist Devices

Abstract

Introduction: Ventricular tachycardia (VT) is common in patients with end-stage heart failure, and pose additional risks in patients who have left ventricular assist devices (LVAD). We set out to examine if development of VT increases risk of mortality post-LVAD and the odds of developing right ventricular failure (RVF). Hypothesis: New onset VT increases both the risk of 1-year mortality post-LVAD and the odds of developing RVF. Methods: We performed a single-center retrospective analysis of 295 patients who received a continuous-flow durable LVAD (Heart-Mate II or HeartWare VAD) between Jan. 1 st 2006 through Dec. 31 st 2016. We stratified patients to 2 cohorts: those who had positive or negative history of VT pre-LVAD and those who developed VT post-LVAD. A survival analysis based on 1year survival was performed to find predictors of mortality and association with RVF. RVF severity was defined according to the new INTERMACS criteria. Results: In patients with and without a history of VT, 113 (67%) and 74 (58%) respectively developed VT post-LVAD. Baseline characteristics were similar among all cohorts (Table 1). Survival analysis demonstrated that both new onset VT ( Figure 1) and recurrence of VT did not increase the risk of 1 year mortality post-LVAD. Additionally, univariable analysis in patients without history of VT pre-LVAD showed that VT increased the odds of developing severe RVF (Table 2) (OR 6.20, p=0.020, 95%CI [1.33 -29.0]), but this was no longer significant in multivariable analysis. Conclusions: New onset and recurrent VT do not appear to be associated with increased mortality in LVAD patients. While there is a signal that new onset VT may increase the odds of severe RVF in patients without VT history pre-LVAD, this needs to be addressed prospectively and in larger cohorts.Introduction: Heart failure and obesity are two growing epidemics in the United States with significant overlap in patient populations. Morbid obesity is currently a relative contraindication to cardiac transplantation as previous data has shown decreased survival with extremes of body mass index (BMI). However, there is limited data that explores the relationship between BMI and adverse outcomes following left ventricular assist device (LVAD) implantation. This study aims to determine if there is an association between higher BMI and exchange-free survival at one year post LVAD implantation. Methods: This was a single-center, retrospective cohort study with patients who had undergone LVAD implantation at Barnes-Jewish Hospital between 2005 and 2018. Patients with age<18, BMI<18.5, or no available BMI information were excluded. Patients were divided into four groups: 18.5BMI<30 (BMI<30 group), 30BMI<35 (BMI 30-35 group), 35BMI<40 (BMI 35-40 group), and BMI 40 group. Subjects were censored for heart transplant. The groups were compared for death or LVAD exchange using the log-rank test. Results: We examined 734 patients who underwent LVAD implantation, including 574 HeartMate II devices (78%), 124 HeartWare HVAD devices (17%), ...