JACC. Heart failure · 2026
Frailty Patterns, Reversibility, and Outcomes With a Magnetically Levitated Left Ventricular Assist Device.
СтатьяНазвание и аннотация: Перевод в очереди
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Wang Nelson, Isath Ameesh, Netuka Ivan, Jorde Ulrich, Connors Jean M, Uriel Nir, Katz Jason N, Pagani Francis, Cleveland Joseph C, Goldstein Daniel J, Gustafsson Finn, Collins Morgan, Porter Sydney, Mehra Mandeep R
Аннотация
BACKGROUND: Frailty is common in advanced heart failure (HF) and influences decisions regarding durable left ventricular assist device (LVAD) therapy.
OBJECTIVES: This study aims to characterize the prevalence, prognostic significance, and reversibility of frailty in patients receiving contemporary LVAD therapy.
METHODS: Pooled analysis of HeartMate 3 LVAD recipients from the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3) trial portfolio and ARIES-HM3 (Antiplatelet Removal and Hemocompatibility Events with the HeartMate 3 Pump) trial. Frailty was quantified using the Rockwood cumulative deficit score and defined as a frailty index (FI) ≥0.21. The authors further stratified frail participants into tertiles of increasing frailty: mildly frail (FI: 0.21-0.324), moderately frail (FI: 0.325-0.39), and severely frail (FI: ≥0.40). The primary outcome was a composite of death, hemocompatibility-related adverse events, renal dysfunction, or right HF.
RESULTS: Among 2,724 LVAD recipients, 95% met criteria for frailty at baseline. Increasing frailty severity was associated with progressively higher risk of the primary composite outcome and a >6-fold increase in mortality in the most severely frail group than in nonfrail patients (HR: 6.26; 95% CI: 2.32-16.90). Frailty improved substantially after LVAD implantation, with the greatest absolute reductions observed among patients with severe baseline frailty. Recovery to a nonfrail state occurred in 15% of patients by 3 months and was associated with significantly lower subsequent risk of the primary endpoint (rate ratio: 0.53; 95% CI: 0.36-0.79). A multivariable model predicted recovery from frailty with good discrimination (area under the curve: 0.78-0.81).
CONCLUSIONS: Frailty is highly prevalent among patients undergoing LVAD implantation but is often dynamic and partially reversible after restoration of circulatory support. In advanced HF, frailty may reflect physiological vulnerability related to circulatory insufficiency rather than irreversible decline and may represent a modifiable risk state when evaluating candidates for durable mechanical circulatory support.
OBJECTIVES: This study aims to characterize the prevalence, prognostic significance, and reversibility of frailty in patients receiving contemporary LVAD therapy.
METHODS: Pooled analysis of HeartMate 3 LVAD recipients from the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3) trial portfolio and ARIES-HM3 (Antiplatelet Removal and Hemocompatibility Events with the HeartMate 3 Pump) trial. Frailty was quantified using the Rockwood cumulative deficit score and defined as a frailty index (FI) ≥0.21. The authors further stratified frail participants into tertiles of increasing frailty: mildly frail (FI: 0.21-0.324), moderately frail (FI: 0.325-0.39), and severely frail (FI: ≥0.40). The primary outcome was a composite of death, hemocompatibility-related adverse events, renal dysfunction, or right HF.
RESULTS: Among 2,724 LVAD recipients, 95% met criteria for frailty at baseline. Increasing frailty severity was associated with progressively higher risk of the primary composite outcome and a >6-fold increase in mortality in the most severely frail group than in nonfrail patients (HR: 6.26; 95% CI: 2.32-16.90). Frailty improved substantially after LVAD implantation, with the greatest absolute reductions observed among patients with severe baseline frailty. Recovery to a nonfrail state occurred in 15% of patients by 3 months and was associated with significantly lower subsequent risk of the primary endpoint (rate ratio: 0.53; 95% CI: 0.36-0.79). A multivariable model predicted recovery from frailty with good discrimination (area under the curve: 0.78-0.81).
CONCLUSIONS: Frailty is highly prevalent among patients undergoing LVAD implantation but is often dynamic and partially reversible after restoration of circulatory support. In advanced HF, frailty may reflect physiological vulnerability related to circulatory insufficiency rather than irreversible decline and may represent a modifiable risk state when evaluating candidates for durable mechanical circulatory support.