TY - JOUR
T1 - Benefits of Neurohormonal Therapy in Patients with Continuous-Flow Left Ventricular Assist Devices
AU - Yousefzai, Rayan
AU - Brambatti, Michela
AU - Tran, Hao A.
AU - Pedersen, Rachel
AU - Braun, Oscar
AU - Baykaner, Tina
AU - Ghashghaei, Roxana
AU - Sulemanjee, Nasir Z.
AU - Cheema, Omar M.
AU - Rappelt, Matthew
AU - Baeza, Carmela
AU - Alkhayyat, Abdulaziz
AU - Shi, Yang
AU - Pretorius, Victor
AU - Greenberg, Barry
AU - Adler, Eric
AU - Thohan, Vinay
N1 - Publisher Copyright:
Copyright ©2019 by the ASAIO.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Left ventricular assist devices (LVADs) have dramatically improved short-term outcomes among patients with advanced heart failure. While neurohormonal blockade (NHB) is the cornerstone of treatment for patients with heart failure with reduced ejection fraction, its effect after LVAD placement has not been established. We reviewed medical records of 307 patients who underwent primary LVAD implantation from January 2006 to September 2015 at two institutions in the United States. Patients were followed for at least 2 years post-LVAD implantation or until explantation, heart transplantation, or death. Cox regression analysis stratifying on center was used to assess associations with mortality. Neurohormonal blockade use was treated as a time-dependent predictor. Stepwise selection indicated treatment with angiotensin- converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) (hazard ratio [HR] = 0.53 [0.30-0.95], p = 0.03), age at the time of implantation (HR = 1.28 [1.05- 1.56] per decade, p = 0.02), length of stay postimplantation (HR = 1.16 [1.11-1.21] per week, p < 0.01) and INTERMACS profile of 1 or 2 (HR = 1.86 [1.17-2.97], p < 0.01) were independent predictors of mortality. In this large, retrospective study, treatment with ACEIs or ARBs was an independent factor associated with decreased mortality post-LVAD placement. ASAIO Journal 2020; 66:409-414.
AB - Left ventricular assist devices (LVADs) have dramatically improved short-term outcomes among patients with advanced heart failure. While neurohormonal blockade (NHB) is the cornerstone of treatment for patients with heart failure with reduced ejection fraction, its effect after LVAD placement has not been established. We reviewed medical records of 307 patients who underwent primary LVAD implantation from January 2006 to September 2015 at two institutions in the United States. Patients were followed for at least 2 years post-LVAD implantation or until explantation, heart transplantation, or death. Cox regression analysis stratifying on center was used to assess associations with mortality. Neurohormonal blockade use was treated as a time-dependent predictor. Stepwise selection indicated treatment with angiotensin- converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) (hazard ratio [HR] = 0.53 [0.30-0.95], p = 0.03), age at the time of implantation (HR = 1.28 [1.05- 1.56] per decade, p = 0.02), length of stay postimplantation (HR = 1.16 [1.11-1.21] per week, p < 0.01) and INTERMACS profile of 1 or 2 (HR = 1.86 [1.17-2.97], p < 0.01) were independent predictors of mortality. In this large, retrospective study, treatment with ACEIs or ARBs was an independent factor associated with decreased mortality post-LVAD placement. ASAIO Journal 2020; 66:409-414.
KW - Left ventricular assist device
KW - Mortality
KW - Neurohormonal blockade
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UR - http://www.scopus.com/inward/citedby.url?scp=85082561399&partnerID=8YFLogxK
U2 - 10.1097/MAT.0000000000001022
DO - 10.1097/MAT.0000000000001022
M3 - Article
C2 - 31192845
AN - SCOPUS:85082561399
SP - 409
EP - 414
JO - ASAIO Journal
JF - ASAIO Journal
SN - 1058-2916
ER -