1031-31 Prognosis of Patients with Symptomatic Heart Failure (HF) Considered Too Well for Cardiac Transplantation (Htx): Predictors of Adverse Outcome

Abstract

Donor organ shortage demands limiting the selection of candidates for Htx to patients (pts) with the worst prognosis. Current pharmacological treatment strategies for HF have been shown to improve survival. The purpose of this study was to assess the prognosis of pts with symptomatic HF considered too well for Htx and to identify predictors of an adverse outcome. Of 645 consecutive pts referred for Htx evaluation, 116 (age 46.6 ± 10.3 years, 24% females) with symptomatic HF and an ejection fraction of ≤35% (mean, 20 ± 7%) were considered too well for the procedure and formed the study population. During a mean follow-up of 25.0 ± 14.8 months (followup 99% complete), 8 (7%) cardiac deaths (7 sudden) occurred and 9 pts (8%) required listing for Htx. Actuarial 1-and 4-year cardiac survival was 98 ± 1% and 84 ± 7% and freedom from listing for Htx was 95 ± 2% and 84 ± 7% respectively. By multivariate regression analysis including base-line clinical, hemodynamic and exercise variables, only a history of sustained VT/aborted SCD (VT/SCD) was an independent predictor of cardiac death (p < 0.03) and longer duration of HF symptoms predicted the need for later Htx (p = 0.004). Actuarial survival curves for patients with vs without history of VT/SCD and with HF symptoms for > 12 months vs ≤12 months are shown below: In the current treatment era, prognosis is favorable in carefully selected pts considered too well for Htx despite symptomatic heart failure. A history of VT/SCD helps in identifying a subgroup at risk for sudden cardiac death. Close observation of pts with longer duration of HF allows timely referral for Htx if hemodynamic deterioration occurs.