Journal of the American Heart Association · 2025
Association of Kidney Function With Myocardial Recovery and Adverse Events Following Left Ventricular Assist Device Circulatory Support.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Bansal Nisha, Maneta Eleni, Zelnick Leila, Kyriakopoulos Christos P, Beddhu Srinivasan, Hartsell Sydney, Stempien-Otero April, Welt Fred, Tseliou Eleni, Hanff Thomas, Nelson Marisca, Sideris Konstantinos, Kyriakoulis Ioannis, Goldstein Jake, Mendenhall Taylor, Deol Amrit, Alharethi Rami, Selzman Craig, Drakos Stavros
Аннотация
BACKGROUND: Whether preleft ventricular assist device (LVAD) kidney function relates to myocardial recovery and LVAD-related adverse events remains uncertain. We evaluated the association of baseline estimated glomerular filtration rate (eGFR) with recovery and adverse events after LVAD implantation.
METHODS: We studied participants who underwent LVAD implantation between 2008 and 2021 at any of the 3 institutions comprising the Utah Cardiac Recovery Program. eGFR at implant was categorized as <60 versus ≥60 mL/min per 1.73 m2. Myocardial recovery was defined after ≥3 months of support as LV ejection fraction ≥40% and LV internal diameter in diastole ≤6.0 cm. Logistic regression was used to estimate the odds of myocardial recovery, and log-linear models to estimate incidence rate ratios for adverse events.
RESULTS: Among 385 patients (mean age 56 years, 84% men, 44% ischemic cardiomyopathy), 50 (13%) achieved recovery. Median time to echocardiogram with maximum LV ejection fraction was 120 (IQR, 71-199) days. Preimplant eGFR<60 versus ≥60 mL/min per 1.73 m2 was not significantly associated with recovery (odds ratio [OR], 0.61 [95% CI, 0.34-1.11]). Lower eGFR was associated with a higher rate of major bleeding but did not reach statistical significance (incidence rate ratio, 1.41 [95% CI, 0.99-2.01]). There were no significant associations between lower eGFR and neurologic or device complications.
CONCLUSIONS: Pre-LVAD low eGFR was not associated with lower rates of myocardial recovery. As the population of patients with concomitant advanced heart failure and cardiorenal syndrome continues to grow, these findings may help guide the management of these challenging patients.
METHODS: We studied participants who underwent LVAD implantation between 2008 and 2021 at any of the 3 institutions comprising the Utah Cardiac Recovery Program. eGFR at implant was categorized as <60 versus ≥60 mL/min per 1.73 m2. Myocardial recovery was defined after ≥3 months of support as LV ejection fraction ≥40% and LV internal diameter in diastole ≤6.0 cm. Logistic regression was used to estimate the odds of myocardial recovery, and log-linear models to estimate incidence rate ratios for adverse events.
RESULTS: Among 385 patients (mean age 56 years, 84% men, 44% ischemic cardiomyopathy), 50 (13%) achieved recovery. Median time to echocardiogram with maximum LV ejection fraction was 120 (IQR, 71-199) days. Preimplant eGFR<60 versus ≥60 mL/min per 1.73 m2 was not significantly associated with recovery (odds ratio [OR], 0.61 [95% CI, 0.34-1.11]). Lower eGFR was associated with a higher rate of major bleeding but did not reach statistical significance (incidence rate ratio, 1.41 [95% CI, 0.99-2.01]). There were no significant associations between lower eGFR and neurologic or device complications.
CONCLUSIONS: Pre-LVAD low eGFR was not associated with lower rates of myocardial recovery. As the population of patients with concomitant advanced heart failure and cardiorenal syndrome continues to grow, these findings may help guide the management of these challenging patients.