Left ventricular functional improvement appears to contribute to lower rates of device thrombosis in patients on durable mechanical circulatory support

Kyriakopoulos, Christos P.; Horne, Benjamin D.; Sideris, Konstantinos; Taleb, Iosif; Griffin, Rachel J.; Sheffield, Eric; Alharethi, Rami; Hanff, Thomas C.; Stehlik, Josef; Selzman, Craig H.; Drakos, Stavros G.

doi:10.1016/j.healun.2023.03.004

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…A longer duration of HF symptoms might suggest more advanced disease, but at the same time it can be linked to the potential for myocardial recovery. HF duration has been identified as a predictor of myocardial recovery [11][12][13][14], and recent data have indicated superior outcomes in patients with improved native left ventricular function on LVAD support, including HF rehospitalizations [15,16]. Pre-LVAD inotrope dependence and MCS with a percutaneous LVAD or VA-ECMO suggest more advanced disease, which might be accompanied by neurohormonal and end-organ derangements, affecting the probability of future readmissions.…”

Section: Discussionmentioning

confidence: 99%

Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices

Kyriakopoulos,

Selzman,

Giannouchos

et al. 2024

JCM

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Background: Centrifugal-flow left ventricular assist devices (CF-LVADs) have improved morbidity and mortality for their recipients. Hospital readmissions remain common, negatively impacting quality of life and survival. We sought to identify risk factors associated with hospital readmissions among patients with CF-LVADs. Methods: Consecutive patients receiving a CF-LVAD between February 2011 and March 2021 were retrospectively evaluated using prospectively maintained institutional databases. Hospital readmissions within three years post-LVAD implantation were dichotomized into heart failure (HF)/LVAD-related or non-HF/LVAD-related readmissions. Multivariable Cox regression models augmented using a machine learning algorithm, the least absolute shrinkage and selection operator (LASSO) method, for variable selection were used to estimate associations between HF/LVAD-related readmissions and pre-, intra- and post-operative clinical variables. Results: A total of 204 CF-LVAD recipients were included, of which 138 (67.7%) had at least one HF/LVAD-related readmission. HF/LVAD-related readmissions accounted for 74.4% (436/586) of total readmissions. The main reasons for HF/LVAD-related readmissions were major bleeding, major infection, HF exacerbation, and neurological dysfunction. Using pre-LVAD variables, HF/LVAD-related readmissions were associated with substance use, previous cardiac surgery, HF duration, pre-LVAD inotrope dependence, percutaneous LVAD/VA-ECMO support, LVAD type, and the left ventricular ejection fraction in multivariable analysis (Harrell’s concordance c-statistic; 0.629). After adding intra- and post-operative variables in the multivariable model, LVAD implant hospitalization length of stay was an additional predictor of readmission. Conclusions: Using machine learning-based techniques, we generated models identifying pre-, intra-, and post-operative variables associated with a higher likelihood of rehospitalizations among patients on CF-LVAD support. These models could provide guidance in identifying patients with increased readmission risk for whom clinical strategies to mitigate this risk may further improve LVAD recipient outcomes.

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Section: Discussionmentioning

confidence: 99%

Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices

Kyriakopoulos,

Selzman,

Giannouchos

et al. 2024

JCM

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“…By unloading the failing heart, LVADs create a favorable environment for the reversal of adverse structural and functional cardiac changes, 10 , 11 , 12 , 13 , 14 , 15 with functional cardiac improvement recently shown to associate with improved outcomes on LVAD support. 33 , 34 Clinical factors previously shown to associate with LVAD‐mediated cardiac recovery include a younger age, an underlying NICM, a shorter duration of HF, and smaller left ventricle dimensions. 12 , 14 , 15 , 22 At the cellular and molecular level, it has been suggested that glucose metabolism, mitochondrial function, and myocardial and systemic inflammation might influence cardiac recovery upon mechanical unloading.…”

Section: Discussionmentioning

confidence: 99%

Impact of Diabetes and Glycemia on Cardiac Improvement and Adverse Events Following Mechanical Circulatory Support

Kyriakopoulos,

Taleb,

Tseliou

et al. 2024

JAHA

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Background Type 2 diabetes is prevalent in cardiovascular disease and contributes to excess morbidity and mortality. We sought to investigate the effect of glycemia on functional cardiac improvement, morbidity, and mortality in durable left ventricular assist device (LVAD) recipients. Methods and Results Consecutive patients with an LVAD were prospectively evaluated (n=531). After excluding patients missing pre‐LVAD glycated hemoglobin (HbA1c) measurements or having inadequate post‐LVAD follow‐up, 375 patients were studied. To assess functional cardiac improvement, we used absolute left ventricular ejection fraction change (ΔLVEF: LVEF post‐LVAD−LVEF pre‐LVAD). We quantified the association of pre‐LVAD HbA1c with ΔLVEF as the primary outcome, and all‐cause mortality and LVAD‐related adverse event rates (ischemic stroke/transient ischemic attack, intracerebral hemorrhage, gastrointestinal bleeding, LVAD‐related infection, device thrombosis) as secondary outcomes. Last, we assessed HbA1c differences pre‐ and post‐LVAD. Patients with type 2 diabetes were older, more likely men suffering ischemic cardiomyopathy, and had longer heart failure duration. Pre‐LVAD HbA1c was inversely associated with ΔLVEF in patients with nonischemic cardiomyopathy but not in those with ischemic cardiomyopathy, after adjusting for age, sex, heart failure duration, and left ventricular end‐diastolic diameter. Pre‐LVAD HbA1c was not associated with all‐cause mortality, but higher pre‐LVAD HbA1c was shown to increase the risk of intracerebral hemorrhage, LVAD‐related infection, and device thrombosis by 3 years on LVAD support ( P <0.05 for all). HbA1c decreased from 6.68±1.52% pre‐LVAD to 6.11±1.33% post‐LVAD ( P <0.001). Conclusions Type 2 diabetes and pre‐LVAD glycemia modify the potential for functional cardiac improvement and the risk for adverse events on LVAD support. The degree and duration of pre‐LVAD glycemic control optimization to favorably affect these outcomes warrants further investigation.

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Left ventricular functional improvement appears to contribute to lower rates of device thrombosis in patients on durable mechanical circulatory support

Cited by 2 publications

References 11 publications

Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices

Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices

Impact of Diabetes and Glycemia on Cardiac Improvement and Adverse Events Following Mechanical Circulatory Support

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