Serial Changes in Renal Function as a Prognostic Indicator in Advanced Heart Failure Patients With Left Ventricular Assist System

摘要

Study PatientsAssessmentLeft Ventricular Assist SystemsFollow-Up After Device ImplantationOutcomesStatistical AnalysisResultsStudy PatientsOutcomesBaseline eGFR as a Predictor of DeathChange in eGFR as Predictor of DeatheGFR at 2 Weeks After Implantation as Predictor of DeathLeft ventricular assist system (LVAS) implantation is an established treatment for patients with advanced heart failure. We investigated the clinical implication of serial changes in renal function after LVAS implantation.MethodsThis study included 110 patients who underwent pulsatile LVAS implantation intended as a bridge to transplantation and were alive more than 2 weeks after implantation. Data collection of demographic and hematologic values was performed 1 day before (baseline) and 2 weeks after implantation. All patients were monitored for 2 years or until death.ResultsThe 2-year postimplantation mortality rate was 31.8%. Multivariate Cox regression analysis showed the baseline estimated glomerular filtration rate (eGFR) was an independent predictor of death (hazard ratio, 0.90 for each 10 mL/min increase, p < 0.05). The eGFR significantly increased at 2 weeks after LVAS implantation (70.5 ± 37.8 to 121.0 ± 78.8 mL/min, p < 0.01). Kaplan-Meier curves with log-rank tests showed significantly poorer event-free survival rates in the group with an inframedian value of change in eGFR at 2 weeks after implantation (ΔeGFR; p = 0.03) as well as in the group with the lowest tertile of eGFR at 2 weeks after implantation (2w-eGFR; p < 0.01). Multivariate Cox regression analysis showed that ΔeGFR (hazard ratio, 0.89 for each 10 mL/min increase) and 2w-eGFR (hazard ratio, 0.92 for each 10 mL/min increase) were independent predictors of death (p < 0.01, respectively).ConclusionsImpaired renal function, and in particular, a poor response of eGFR to LVAS implantation, may have a strong association with worse outcome.Abbreviations and Acronyms: ACE (angiotensin-converting enzyme), ARB (angiotensin II receptor blocker), BSA (body surface area), CI (confidence interval), eGFR (estimated glomerular filtration rate), HR (hazard ratio), LVAS (left ventricular assist system), LVEDD (left ventricular end-diastolic dimension), PCWP (pulmonary capillary wedge pressure), 2w-eGFR (eGFR at 2 weeks after implantation), ΔeGFR (change in eGFR at 2 weeks after implantation)CTSNet classification:27Left ventricular assist systems (LVAS) are becoming a standard therapeutic option for patients with advanced heart failure who require mechanical support as a bridge to heart transplantation [