Low Serum Cholesterol Levels Predict High Perioperative Mortality in Patients Supported by a Left-Ventricular Assist System

Abstract

Background: Although the use of a left-ventricular assist system (LVAS) provides circulatory support for end-stage heart failure patients awaiting heart transplantation, this procedure is accompanied by a relatively high perioperative mortality. The aim of this retrospective study was to identify those patients preoperatively which have the highest perioperative mortality. Methods and Results: Forty-five consecutive patients undergoing LVAS implantation were evaluated for preoperative risk factors, including body mass index, hemodynamic data, and blood chemistry studies by multivariate analysis. They were divided into (1) patients who were successfully transplanted (n = 25) and (2) patients who died before transplantation (n = 20). The nonsurvivors were subclassified into patients who died within 14 days after surgery (n = 11) and patients who died after 2 weeks of device implantation (n = 9). Hemodynamic parameters were the same in both groups, but total cholesterol was significantly lower in the nonsurvivors than in the survivors (90 ± 7 vs. 144 ± 8 mg/dl, respectively, p < 0.0001). The sensitivity of predicting perioperative death with a serum cholesterol below 100 mg/dl was 100%, the specificity of predicting survival with a serum cholesterol above 120 mg/dl was 87%. Conclusion: In this small retrospective study, there was a correlation between total cholesterol levels and survival of patients with advanced heart failure on mechanical support. A cholesterol level below 100 mg/dl was accompanied by a high perioperative mortality. In contrast, a cholesterol level above 120 mg/dl was accompanied by a 87% chance of survival. The results suggest a predictive value of cholesterol which is independent of the hemodynamic status.

Decreased Serum Lipoprotein Levels as a Guide for Clinical Severity in Patients with Idiopathic Dilated Cardiomyopathy

“…Serum TG, LDL-C, HDL-C and apo B levels were lower in patients with IDC than the controls but these were also not statistically different. Our findings confirm the paradox that total cholesterol levels are decreased proportionally with the severity of HF (Richartz et al 1998;Vredevoe et al 1998;Rauchhaus et al 2000). This inverse relationship between mortality and lipid lipoprotein levels has been observed in other disease states and populations (Lowrie and Lew 1990;Gui et al 1996;Elliot and Wiles 1997;Fraunberger et al 2000).…”

“…It would be reasonable to expect that high cholesterol would be a risk factor and have deleterious effects on mortality in patients with established HF. However, preliminary reports have suggested that there is an increased mortality in HF patients with low cholesterol (Richartz et al 1998;Vredevoe et al 1998;Rauchhaus et al 2000).…”

Low Levels of Low-Density Lipoprotein Cholesterol: A Negative Predictor of Survival in Elderly Patients with Advanced Heart Failure

“…Several studies reported that patients with ischemic and nonischemic HF appear to have an opposite pattern (‘reverse epidemiology'), with low levels being associated with a worse prognosis independent of other prognostic factors [13,20]. Rauchhaus et al [16] studied 414 patients with HF and found a 36% decreased risk of mortality with each millimole per liter increase in total cholesterol, independent of other risk factors.…”

“…Ubiquinone (Q10), an essential product of cardiac mitochondrial respiration, is reduced in patients with congestive HF [14,15,16,17,20,26]. Treatment with statins was shown to reduce ubiquinone levels and could thus be potentially harmful [14,15,16,17,20].…”

Cholesterol Paradox in Patients With Chronic Cardiac Insufficiency Modern State of the Problem

“…В том же году опубликованы результаты исследова-ния, проведенного B.M. Richartz и соавт., где ретроспек-тивно оценивали прогностическую роль ОХ у пациентов с ХСН, которым была выполнена операция по поводу имплантации искусственного левого желудочка сердца (ИЛЖС) [5]. С этой целью пациентов, перенесших имплан-тацию ИЛЖС, разделили на 2 группы: пациенты, которым впоследствии успешно провели операцию по пересадке сердца (n = 25) и пациенты, которые умерли до транс-плантации сердца (n = 20).…”