Abstract
Heart failure (HF) remains a leading cause of morbidity, hospitalization, and mortality worldwide. Advancement of mechanical circulatory support technology has led to the use of continuous-flow left ventricular assist devices (LVADs), reducing hospitalizations, and improving quality of life and outcomes in advanced HF. Recent studies have highlighted how metabolic and endocrine dysfunction may be a consequence of, or associated with, HF, and may represent a novel (still neglected) therapeutic target in the treatment of HF. On the other hand, it is not clear whether LVAD support, may impact the outcome by also improving organ perfusion as well as improving the neuro-hormonal state of the patients, reducing the endocrine dysfunction. Moreover, endocrine function is likely a major determinant of human homeostasis, and is a key issue in the recovery from critical illness. Care of the endocrine function may contribute to improving cardiac contractility, immune function, as well as infection control, and rehabilitation during and after a LVAD placement. In this review, data on endocrine challenges in patients carrying an LVAD are gathered to highlight pathophysiological states relevant to this setting of patients, and to summarize the current therapeutic suggestions in the treatment of thyroid dysfunction, and vitamin D, erythropoietin and testosterone administration.
Highlights
Chronic heart failure (CHF) remains a leading cause of morbidity, hospitalization, and mortality worldwide [1]
The increased risk of osteoporosis and fractures is clear in such group of patients, but the restoration of adequate bone and muscle metabolism is paramount for the general improvement of patients with cardiac surgery, CHF, heart transplantation, and left ventricular assist devices (LVADs) placement [32]
Swedberg et al evaluated the effect of correcting anemia in patients with systolic heart failure with darbepoetin alfa [65], which led to an increase in the hemoglobin level
Summary
Chronic heart failure (CHF) remains a leading cause of morbidity, hospitalization, and mortality worldwide [1]. The advancements in technology and clinical management have promoted an increased application of continuous-flow left ventricular assist devices (LVADs) as a long-term therapy, either as a bridge-to-transplantation or, increasingly, “bridge to destination” [2] In this picture, LVADs are able to reduce hospitalizations, and improve the quality of life and mid-term outcomes of advanced HF patients [3]. Diabetes is a major comorbidity in the HF setting, and the need for adequate balancing and increase in the therapy to avoid fluctuations of glycemia in the perioperative period are a major issue [12] Both these topics are not covered since they would require a manuscript for each part. Its use in critical care is still sporadic, but has all the potential to be a very important tool in rehabilitating VAD carriers
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
