Normalization of Hemodynamics Following LVAD Implantation May be Related to Improved Long Term Outcome

Anyanwu, Emeka; Patel, Kershaw V.; Henderson, Cory; Fedson, Savitri; Kim, Gene; Sarswat, Nitasha; Juricek, C.; Ota, Takeyoshi; Jeevanandam, Valluvan; Sayer, Gabriel; Uriel, Nir

doi:10.1016/j.cardfail.2015.06.294

Cited by 7 publications

(1 citation statement)

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“…In part, the variability in performing invasive speed optimization studies, particularly in stable outpatients, may be partly due to a paucity of data showing long‐term benefit, in spite of commonly identified abnormalities 8 . Although some newer data may suggest an association between improved hemodynamics and outcomes, 9‐11 to date, no specific parameter has been identified that elucidates this link. Rigorous scoring systems exist to predict outcomes after LVAD implant but these estimate risk from a preoperative perspective 12‐14 .…”

Section: Introductionmentioning

confidence: 99%

Inadequate left ventricular unloading during ramp is associated with hospitalization or death during left ventricular assist device support

et al. 2020

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A combined right and left‐sided heart catheterization (RHC/LHC) protocol was recently reported to optimize patients supported by left ventricular assist device (LVAD). Using this platform, we sought to evaluate the prognostic significance of several hemodynamic indices, including left ventricular end‐diastolic pressure (LVEDP) and transaortic gradient (peak aortic pressure ‐ peak left ventricular pressure in systole, TAG). We evaluated all patients undergoing RHC/LHC at our institution from 2015 through 2018, and comprehensive clinical data were obtained. Primary end points were (1) a composite outcome that included hospitalization or death and (2) 1‐year overall survival after catheterization. Forty‐two patients were included in the analysis. Optimization resulted in normalization of hemodynamic parameters; all variables were significantly improved from baseline (P ≤ .05). On univariate modeling, final LVEDP was associated with the primary end point (hazard ratio [HR], 1.2 per 1‐mm Hg increase; 95% CI, 1.1‐1.3; P = .002). After adjusting for LVAD speed, TAG, and cardiac index in a multivariate model, the association between LVEDP and the composite end point remained significant (HR, 1.2 per 1‐mm Hg increase; 95% CI, 1.1‐1.4; P = .001). In the setting of LVAD support, inadequate LV unloading was a significant marker of poor outcomes with time, suggesting that LVEDP is a central prognostic marker in this population.

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Section: Introductionmentioning

confidence: 99%