Right Ventricular Assist Device Support After Continuous Flow Left Ventricular Assist Device Implantation: Predicting a Poor Predictor
| Autor: | Jatin Anand, E. Sandoval Martinez, Andrew C.W. Baldwin, R. Hernandez, O.H. Frazier, Steve K. Singh, Hari R. Mallidi, William E. Cohn |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Pulmonary and Respiratory Medicine
Inotrope Transplantation medicine.medical_specialty business.industry medicine.medical_treatment medicine.disease Right Ventricular Assist Device Weight loss Heart failure Ventricular assist device Internal medicine Epidemiology Heart rate Cohort Cardiology Medicine Surgery medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Heart and Lung Transplantation. 33:S237-S238 |
| ISSN: | 1053-2498 |
| DOI: | 10.1016/j.healun.2014.01.913 |
| Popis: | s S237 Pittsburgh, PA; 2Departments of Psychiatry, Epidemiology, & Biostatistic, University of Pittsburgh Medical Center, Pittsburgh, PA. Purpose: Right ventricular failure (RVF) after left ventricular assist device (LVAD) placement is often perilous. It has been hypothesized that in patients with advanced heart failure, RVF is linked to weight loss and measures of abnormal body composition, such as low body mass index (BMI). This postulate is examined in a cohort of LVAD supported patients. Methods: A retrospective analysis was performed of 114 continuous flow LVAD supported patients from 2004-2011. RVF was defined as need for right ventricular mechanical support or > 14 days of inotropic support postimplant. Three patient groups were identified based on the sample’s BMI distribution: lowest group (lowest quintile, BMI 33, n= 23). Kaplan-Meier analysis was used to compare the freedom from RVF; multivariate Coxregression analysis was performed to determine risk factors for RVF. Results: The BMI groups (lowest, intermediate, highest) were similar with regards to all pre-operative characteristics except age (56y, 59y, 47y, p= 0.002), non-ischemic/idiopathic diagnosis (22%, 1%, 9%, p= 0.004), emergent LVAD implantation (0%, 4%, 17%, p= 0.032), and pre-implant heart rate ( 104, 85, 95, p= 0.001). Figure 1 shows that freedom from RVF was significantly worse for the lowest BMI group compared to the intermediate BMI group (p= 0.019) and the intermediate and highest BMI groups combined (p= 0.021). There was no difference between the intermediate and highest BMI groups (p= 0.500) or the lowest and highest BMI groups (p= 0.185). Coxregression analysis revealed lowest BMI group (HR 2.519, p= 0.016, CI 1.187-5.347) and emergent device placement (HR 3.392, p= 0.028, CI 1.141-10.09) were independent risk factors for RVF. Conclusion: In LVAD patients, a low BMI is associated with heightened risk for RVF after device placement. Investigation of other potential markers of abnormal body composition may broaden our understanding of post-LVAD RVF. |
| Databáze: | OpenAIRE |
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