Clinical impact of guideline-directed medical therapy in patients with left ventricular assist device: an international multicentre study.
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Cherbi Miloud, Delmas Clément, Gautier Paul, Benali Karim, Bode Kerstin, Efimova Elena, Dashkevich Alexey, Liang Jackson, Larson John, Mondesert Blandine, Boulet Jacinthe, Noly Pierre-Emmanuel, Picard François, Pasquié Jean Luc, Gourraud Jean-Baptiste, Ninni Sandro, Jesel Laurence, Sebestyen Alexandre, Para Marylou, Deharo Jean-Claude, Anselme Frederic, Champ-Rigot Laure, M'Rabet Soundous, Pierre Bertrand, Eschalier Romain, Echivard Mathieu, Martin Anne-Céline, Lellouche Nicolas, Pozzi Matteo, Groussin Pierre, Flecher Erwan, Galand Vincent, Martins Raphael
Аннотация
METHODS: This international retrospective multicentre study included 875 LVAD patients from 22 centres. Patients were categorized based on the number of GDMT (ACE-I/ARBs, beta-blockers, MRAs) prescribed. Primary outcome was 6-month all-cause mortality. Secondary outcome was late ventricular arrhythmias (VAs) (>30 days post-implant). Multivariable Cox regression and ordinal logistic regression analyses were performed.
RESULTS: Overall, only 261 patients (29.8%) received triple GDMT, while 97 (11.1%) received no GDMT. After multivariable adjustment, the number of prescribed GDMTs was independently associated with improved survival, with aHRs for all-cause mortality of 0.51 (0.33-0.75, P < .01) for triple therapy, 0.39 (0.26-0.59, P < .01) for dual therapy, and 0.45 (0.30-0.67, P < .01) for single therapy, all compared with no GDMT. Similarly, ACE-I/ARB were associated with a lower risk of late VAs (aHR 0.65 [0.50-0.84], P < .01). Female sex, diabetes, early VAs, and higher bilirubin levels were associated with lower GDMT prescription rates. Major LVEDD improvement (≥10 mm reduction) increased progressively from 51.5% without GDMT to 66.1% with triple therapy.
CONCLUSION: In this large international study, the use of GDMT in LVAD patients was associated with improved survival, with benefits observed even with single-agent therapy. Despite these benefits, only 30% of patients received optimal triple therapy, highlighting the need for improved implementation strategies and standardized protocols in this population.