Abstract

<h3>Purpose</h3> Although significant reverse cardiac remodeling is required for an LVAD-supported patient to be considered for device weaning, multiple factors including patient willingness, physician expertise, and center experience influence this complex decision. Existing predictive models defining cardiac recovery as device removal might underestimate reverse remodeling rates and lack accuracy in identifying patients prone to improve cardiac structure and function. We sought to develop a predictive tool to identify patients with such potential, independent of the decision to deactivate a durable, surgically deployed device. <h3>Methods</h3> Chronic HF patients (N=703) requiring continuous-flow LVADs were evaluated. After excluding patients with acute HF and/or <3 months post-LVAD follow up, 3 US programs contributed 390 patients (derivation cohort), while 5 US programs formed the validation cohort (n=245). We defined responders as patients with an LVEF ≥40% and LVEDD ≤6.0 cm within a year on LVAD support. Multivariable logistic regression on the derivation set yielded a predictive model, which was externally tested; a predictive score was developed. <h3>Results</h3> Overall, 18.5% of the patients were responders. Compared to the validation, patients in the derivation cohort were more likely white (83 vs 69%; p<0.001), with ischemic HF (42 vs 33%; p=0.04), and longer HF duration (88 vs 66 months; p<0.001). Multivariable predictors of responders and the derived scoring system are shown in the <b>Figure</b> (c-statistic 0.74 [95% CI: 0.66-0.83] and 0.71 [95% CI: 0.59-0.77] in the derivation and validation set). <h3>Conclusion</h3> We propose a novel score to predict significant cardiac improvement on LVAD support achieving good discriminative performance in distinct, heterogeneous, contemporary cohorts. This tool can be useful in selecting patients to implement diagnostic and therapeutic protocols to promote reverse remodeling and myocardial recovery.

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