Author + information
- Usama Daimee,
- Meng Wang,
- Anna Papernov,
- Saadia Sherazi,
- Scott McNitt,
- Himabindu Vidula,
- Leway Chen,
- Jeffrey Alexis and
- Valentina Kutyifa
Background: Change in renal function during extended follow-up and its impact on outcomes after left ventricular assist device (LVAD) implantation is not well understood.
Methods: Our cohort consisted of 184 patients with HeartMate II LVADs implanted between May 2008 and November 2014. Serial assessment of renal function was performed prior to LVAD implantation (baseline) and at day 1, day 7, 1 month, 3 months, 6 months, 1 year, and 2 years post-implantation. At each time point, three categories were created using estimated glomerular filtration rate (GFR): GFR < 45, GFR 45 to <60, and GFR ≥ 60 mL/min/1.73 m2. We evaluated the effects of GFR at these time points on long-term mortality.
Results: There were 30 patients with GFR < 45, 44 with GFR 45 to <60, and 110 with GFR ≥ 60 at baseline. Only patients with baseline GFR < 45 experienced sustained improvement in renal function (Figure 1A). After LVAD implantation, 1 month was the earliest time point at which GFR stabilized. At 1 month, each category increment in GFR was significantly associated with a 31% reduction in mortality (HR=0.69, CI=0.49 – 0.98, p=0.036; Figure 1B). Improvement in GFR category from baseline to 1 month was significantly associated with lower mortality (improve vs. stable: HR=0.47, CI=0.23 – 0.93, p=0.032; improve vs. worsen: HR=0.34, CI=0.14 – 0.86, p=0.022).
Conclusions: Renal function after LVAD implantation improves in patients with very low baseline GFR. Renal function at 1 month is a powerful surrogate for long-term outcomes in LVAD patients.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: The Evolving World of LVADs, Transplant and Other Novel Discoveries
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1294-268
- 2017 American College of Cardiology Foundation