Abstract 13566: Blood Volume Analysis Phenotypes in Heart Failure Patients Supported With Left Ventricular Assist Device

Abstract

Introduction: Left ventricular assist device (LVAD) offers advanced heart failure (HF) patients increased survival, life quality and functional status however little information is available regarding the underlying deranged circulatory physiology of LVAD patients. In patients with HF, wide variations in intravascular volumes (total blood volume (TBV), plasma volume (PV) and red blood cell volume (RBCV)) have been measured with blood volume analysis (BVA) and distinct phenotypes have emerged. Methods: BVA used in a single center to evaluate 22 LVAD patients (17M/5W), aged 32-70yrs, BMI 37.5(avg), LVADs implanted 42-1912 days before BVA. All patients had successful completion of BVA. Results: Only 4/23(17%) had normal TBV and RBCV. Graph1. Eleven patients (50%) were anemic, 3 (14%) with hypovolemia. Overall, 6 patients (27%) were hypervolemic with variances reaching +80%, including 2 patients (9%) with significant hypervolemia and polycythemia indicating heightened risk of thrombosis. Three patients (14%) presented with hypovolemia indicating increased risk for organ failure. Figure 1. shows these variances in more recently implanted LVAD patients as more extreme compared to more remotely. Conclusions: As in patients with advanced HF, wide TBV derangements are seen in LVAD patients up to 64 months post LVAD placement. Anemia persists in 50% and polycythemia is present in 9%, both of which are prognostic in HF patients. An early signal is some lesser variances over long time periods, indicating that long-term survival may be associated with lesser volume derangements. These variances, not suspected clinically, inform clinicians of additional therapeutic approaches that may improve host and device outcomes including recovery, safety, and device durability. Patient and clinician acceptance and adoption of BVA was excellent and BVA phenotypes add significant value to centers implanting LVADs.