Dynamic BMI Changes in Patients Implanted with Continuous Flow Left Ventricular Assist Devices: Evidence for Reversibility of Cardiac Cachexia and Impact on Survival

Abstract

Purpose Pre-implant body mass index (BMI) is not associated with overall survival in patients receiving continuous flow left ventricular assist devices (CF LVAD). We sought to characterize the changes in BMI after implantation of a CF LVAD and hypothesized that weight change status is associated with survival. Methods and Materials 3499 subjects implanted with a CF LVAD were identified from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) and grouped according to World Health Organization BMI categories. Significant weight gain was defined as a gain of greater than 3% of the baseline weight. Weight change status at follow-up periods for underweight, normal weight, and obese BMI categories was compared using fisher’s exact test and cumulative survival comparing weight change at 6 months was performed with Kaplan-Meier analysis. Results Subjects classified as underweight or normal weight at baseline were more likely to increase weight at 3 months, 6 months, 1 year, and 2 years (All p = figure 1 ] Conclusions Weight loss due to end-stage heart failure may be reversible with CF LVAD support. Rapid early weight gain is expected in patients with pre-implant normal or underweight BMI and the absence of weight gain at 6 months post-implant is associated with decreased survival in this group of patients.