Advanced Heart Failure Therapy In The Middle East; Case Series, With Clinical, Imaging & Pathological Correlation, From A Nascent Program

Abstract

Background The global prevalence of heart failure continues to increase, with more patients presenting with advance heart failure that requires durable left ventricular (LVAD) placement and or orthotopic heart transplantation (OHT). Aim To describe the characteristics (clinical, imaging, pathological) and outcomes of patients undergoing LVAD or OHT at Cleveland Clinic Abu Dhabi (CCAD); a relatively new program from the UAE. Methods Retrospective chart review of all patients who had undergone LVAD or OHT at CCAD. The time period is May 2017 to current. Clinical data, imaging findings (echo, cardiac MRI, cardiac PET) and pathology findings were analyzed and correlated. Results Baseline characteristics and long term outcomes are shown in Table 1. Non Ischemic Cardiomyopathy was the predominant type of cardiomyopathy requiring LVAD or OHT. Ischemic Cardiomyopathy, as an etiology, was disproportionately noted in patients who received LVAD therapy compared to those who underwent OHT. Myocarditis was disproportionately noted in patients who underwent OHT, compared to the patients receiving LVAD. Table 2 shows the percentage of concordance or discordance between clinical, imaging and pathological diagnoses. The patients are separated by treatment strategy (LVAD, BTT or OHT). Importantly, clinical and imaging diagnoses of myocarditis were less likely to be corroborated on pathological examination. The concordance was excellent in the OHT group, modest in the LVAD group and poor in the BTT group. Conclusions We report the positive outcomes of patients seeking LVAD or OHT at our young program from the UAE. In spite of the low INTERMACS profiles, the outcomes are comparable to those reported to international databases. Concordance between clinical, imaging and pathological diagnoses of cardiomyopathy varied based on the treatment strategy. The global prevalence of heart failure continues to increase, with more patients presenting with advance heart failure that requires durable left ventricular (LVAD) placement and or orthotopic heart transplantation (OHT). To describe the characteristics (clinical, imaging, pathological) and outcomes of patients undergoing LVAD or OHT at Cleveland Clinic Abu Dhabi (CCAD); a relatively new program from the UAE. Retrospective chart review of all patients who had undergone LVAD or OHT at CCAD. The time period is May 2017 to current. Clinical data, imaging findings (echo, cardiac MRI, cardiac PET) and pathology findings were analyzed and correlated. Baseline characteristics and long term outcomes are shown in Table 1. Non Ischemic Cardiomyopathy was the predominant type of cardiomyopathy requiring LVAD or OHT. Ischemic Cardiomyopathy, as an etiology, was disproportionately noted in patients who received LVAD therapy compared to those who underwent OHT. Myocarditis was disproportionately noted in patients who underwent OHT, compared to the patients receiving LVAD. Table 2 shows the percentage of concordance or discordance between clinical, imaging and pathological diagnoses. The patients are separated by treatment strategy (LVAD, BTT or OHT). Importantly, clinical and imaging diagnoses of myocarditis were less likely to be corroborated on pathological examination. The concordance was excellent in the OHT group, modest in the LVAD group and poor in the BTT group. We report the positive outcomes of patients seeking LVAD or OHT at our young program from the UAE. In spite of the low INTERMACS profiles, the outcomes are comparable to those reported to international databases. Concordance between clinical, imaging and pathological diagnoses of cardiomyopathy varied based on the treatment strategy.