Author + information
- Received May 21, 2015
- Revision received July 28, 2015
- Accepted July 29, 2015
- Published online October 20, 2015.
- Jerry D. Estep, MD∗∗ (, )
- Randall C. Starling, MD, MPH†,
- Douglas A. Horstmanshof, MD‡,
- Carmelo A. Milano, MD§,
- Craig H. Selzman, MD‖,
- Keyur B. Shah, MD¶,
- Matthias Loebe, MD, PhD∗,
- Nader Moazami, MD†,
- James W. Long, MD, PhD‡,
- Josef Stehlik, MD, MPH‖,
- Vigneshwar Kasirajan, MD¶,
- Donald C. Haas, MD#,
- John B. O'Connell, MD∗∗,
- Andrew J. Boyle, MD††,
- David J. Farrar, PhD∗∗,
- Joseph G. Rogers, MD§,
- ROADMAP Study Investigators
- ∗Houston Methodist Hospital, Houston, Texas
- †Cleveland Clinic, Cleveland, Ohio
- ‡INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
- §Duke University, Durham, North Carolina
- ‖University of Utah, Salt Lake City, Utah
- ¶Virginia Commonwealth University, Richmond, Virginia
- #Abington Memorial Hospital, Abington, Pennsylvania
- ∗∗Thoratec Corporation, Pleasanton, California
- ††Piedmont Hospital, Atlanta, Georgia
- ↵∗Reprint requests and correspondence:
Dr. Jerry D. Estep, Methodist DeBakey Heart & Vascular Center, Houston Methodist, Department of Cardiology, 6550 Fannin Street, Suite 1901, Houston, Texas 77030.
Background Data for left ventricular assist devices (LVADs) in patients with noninotrope-dependent heart failure (HF) are limited.
Objectives The goal of this study was to evaluate HeartMate II (HMII) LVAD support versus optimal medical management (OMM) in ambulatory New York Heart Association functional class IIIB/IV patients meeting indications for LVAD destination therapy but not dependent on intravenous inotropic support.
Methods This was a prospective, multicenter (N = 41), observational study of 200 patients (97 LVAD, 103 OMM). Entry criteria included ≥1 hospitalization for HF in the last 12 months and 6-min walk distance (6MWD) <300 m. The primary composite endpoint was survival on original therapy with improvement in 6MWD ≥75 m at 12 months.
Results LVAD patients were more severely ill, with more patients classified as Interagency Registry for Mechanically Assisted Circulatory Support profile 4 (65% LVAD vs. 34% OMM; p < 0.001) than 5 to 7. More LVAD patients met the primary endpoint (39% LVAD vs. 21% OMM; odds ratio: 2.4 [95% confidence interval: 1.2 to 4.8]; p = 0.012). On the basis of as-treated analysis, 12-month survival was greater for LVAD versus OMM (80 ± 4% vs. 63 ± 5%; p = 0.022) patients. Adverse events were higher in LVAD patients, at 1.89 events/patient-year (EPPY), primarily driven by bleeding (1.22 EPPY), than with OMM, at 0.83 EPPY, primarily driven by worsening HF (0.68 EPPY). Most patients (80% LVAD vs. 62% OMM; p < 0.001) required hospitalizations. Health-related quality of life (HRQol) and depression improved from baseline more significantly with LVADs than with OMM (Δ visual analog scale: 29 ± 25 vs. 10 ± 22 [p < 0.001]; Δ Patient Health Questionnaire–9: –5 ± 7 vs. –1 ± 5 [p < 0.001]).
Conclusions Survival with improved functional status was better with HMII LVAD compared with OMM. Despite experiencing more frequent adverse events, LVAD patients improved more in HRQol and depression. The results support HMII use in functionally limited, noninotrope-dependent HF patients with poor HRQoL. (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device [LVAD] and Medical Management [ROADMAP]; NCT01452802)
The ROADMAP trial was sponsored and conducted by Thoratec Corporation. Drs. Estep, Starling, Horstmanshof, Shah, Loebe, Moazami, Long, Milano, Stehlik, Kasirajan, Haas, and Rogers have received grant/research support from Thoratec. Drs. Estep, Horstmanshof, and Boyle have served as consultants for Thoratec. Dr. Estep has served as a consultant for Maquet. Dr. Starling has served as a member of the steering committee for Thoratec. Dr. Haas served on the Thoratec speakers bureau. Dr. Kasirajan served as a consultant for Syncardia. Drs. O’Connell and Farrar are Thoratec employees. Dr. Farrar is a Thoratec stockholder. Dr. Selzman has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received May 21, 2015.
- Revision received July 28, 2015.
- Accepted July 29, 2015.
- 2015 American College of Cardiology Foundation