Poor Left Ventricular Loading Predictive of Hospitalization or Death after LVAD

Left ventricular offloading was found to be a significant marker of adverse outcomes in patients receiving invasive optimization of their LVAD, according to new research.

Presented at HFSA, 2019 the Heart Failure of Society of America Scientific Meeting in Philadelphia, and published in a meeting supplement of the Journal of Cardiac Failure, the research team hypothesized that not achieving adequate ventricular unloading would result in worst heart failure hospitalization-free survival. The authors enrolled 31 patients undergoing combined left and right heart catheterization optimization protocols, and ascertained comprehensive clinical data. The primary study outcome was a composite of hospitalization or death and overall survival. Patients were excluded if their left ventricles were inaccessible or if they underwent non-standard procedures.

According to the study results, left heart catheterization optimization led to normalization of hemodynamic parameters, which was a significant improvement from baseline for all variables (P≤0.05). Only left ventricular end diastolic pressure (LVDEP) was significantly associated with the primary study endpoint (HR=1.2 per 1 mm Hg increase; 95% CI, 1.1 to 1.3; P<0.01). When LVAD speed, transaortic gradient, and cardiac index were taken into account, the relationship between LVDEP and the primary study outcome remained significant (P<0.001)

“Left ventricular offloading as measured by LVDEP was a significant marker of poor outcomes over time,” the authors concluded. “Further research should focus on pathophysiology corresponding to poor unloading.”

Rosenbaum A, Clavell A, Stulak J, et al. J Card Fail. 2019;25(85):S10. Abstract 024.