Multicenter Study of Favorable Patient Characteristics Associated with Cardiac Reverse Remodeling in Left Ventricular Assist Device Patients
Genovese L, Yin M, Michaels A, Singh R, Tang D, Indaram M, Kanwar M, Cowger J, Drakos S, and Shah P. Multicenter Study of Favorable Patient Characteristics Associated with Cardiac Reverse Remodeling in Left Ventricular Assist Device Patients. J Heart Lung Transplant 2021; 40(4):S176.
J Heart Lung Transplant
Purpose: This study analyzed a multicenter cohort of patients who underwent left ventricular assist device (LVAD) implantation to distinguish favorable characteristics that increase the likelihood for cardiac reverse remodeling and myocardial recovery.
Methods: This was a multicenter study at 4 LVAD implanting sites in the U.S. Baseline patient characteristics, including demographics, medical history and echocardiographic parameters were reviewed. Echocardiographic parameters of LV structure and function were obtained pre-implant and at 1, 3, 6, and 12 months of LVAD support. Responders to LVAD therapy had echocardiographic evidence of reverse cardiac remodeling and achieved an LVEF ≥ 40% and LV ventricular internal diastolic diameter (LVIDd) ≤ 6.0cm. Univariate and multivariate analyses were performed to determine the odds ratio of achieving responder status.
Results: The study retrospectively reviewed 311 chronic HF patients receiving LVAD support. The average patient age was 55.6 ± 12.9 years, 17.7% were female, 53% had an ischemic cardiomyopathy, and the average duration of HF was 3.4 ± 3.0 years pre-implant. In the cohort, 9.32% of patients achieved responder status. Univariate analysis of baseline characteristics was performed to identify predictors of responder status at final echocardiographic time point. Female sex and age ≤ 65 years had improved odds of myocardial recovery (OR 2.31, 95%CI: 1.0 to 5.4, p=0.05 and 2.26, 95%CI: 1.03 to 4.98, p=0.04). Other significant predictors of cardiac reverse remodeling are presented in the figure. In a multivariate analysis, female sex, age ≤ 65 years and an LVIDd ≤ 7.3cm were each individually associated with a 2-fold increase in the odds of cardiac reverse remodeling.
Conclusion: In a contemporary, multicenter study of LVAD patients, we identified a combination of baseline clinical and echocardiographic characteristics associated with significant cardiac reverse remodeling during LVAD support.