Multicenter Study of Favorable Patient Characteristics Associated with Cardiac Reverse Remodeling in Left Ventricular Assist Device Patients

Abstract

<h3>Purpose</h3> This study analyzed a multicenter cohort of patients who underwent left ventricular assist device (LVAD) implantation to distinguish favorable characteristics that increase the likelihood for cardiac reverse remodeling and myocardial recovery. <h3>Methods</h3> This was a multicenter study at 4 LVAD implanting sites in the U.S. Baseline patient characteristics, including demographics, medical history and echocardiographic parameters were reviewed. Echocardiographic parameters of LV structure and function were obtained pre-implant and at 1, 3, 6, and 12 months of LVAD support. Responders to LVAD therapy had echocardiographic evidence of reverse cardiac remodeling and achieved an LVEF ≥ 40% and LV ventricular internal diastolic diameter (LVIDd) ≤ 6.0cm. Univariate and multivariate analyses were performed to determine the odds ratio of achieving responder status. <h3>Results</h3> The study retrospectively reviewed 311 chronic HF patients receiving LVAD support. The average patient age was 55.6 ± 12.9 years, 17.7% were female, 53% had an ischemic cardiomyopathy, and the average duration of HF was 3.4 ± 3.0 years pre-implant. In the cohort, 9.32% of patients achieved responder status. Univariate analysis of baseline characteristics was performed to identify predictors of responder status at final echocardiographic time point. Female sex and age ≤ 65 years had improved odds of myocardial recovery (OR 2.31, 95%CI: 1.0 to 5.4, p=0.05 and 2.26, 95%CI: 1.03 to 4.98, p=0.04). Other significant predictors of cardiac reverse remodeling are presented in the figure. In a multivariate analysis, female sex, age ≤ 65 years and an LVIDd ≤ 7.3cm were each individually associated with a 2-fold increase in the odds of cardiac reverse remodeling. <h3>Conclusion</h3> In a contemporary, multicenter study of LVAD patients, we identified a combination of baseline clinical and echocardiographic characteristics associated with significant cardiac reverse remodeling during LVAD support.