Abstract
Left ventricular assist device (LVAD) is well established as an alternative treatment for end-stage heart failure (HF) patients. The aim of the study was to determine the prognostic value of oxidative stress markers and the modified Model for End-Stage Liver Disease (modMELD) in patients receiving bridged therapy with continuous-flow LVAD. We prospectively analyzed 36 end-stage HF patients who received LVAD therapy between 2015 and 2018. The total antioxidant capacity (TAC) and total oxidant status (TOS) were measured by the methods described by Erel. The oxidative stress index (OSI) was defined as the ratio of the TOS to TAC levels. The modMELD scores were calculated based on the serum bilirubin, creatinine, and albumin levels. The patients’ median age was 58 (50–63.0) years. During the 1.5-years follow-up, a major adverse cardiac event—MACE (death, stroke, or pump thrombosis) was observed in 17 patients (47.2%). The area under the receiver operating characteristics curves (AUCs) indicated a good prognostic power of TAC (AUC 0.7183 (0.5417–0.8948)), TOS (AUC 0.9149 (0.8205–0.9298)), OSI (AUC 0.9628 (0.9030–0.9821)), and modMELD (AUC 0.87 (0.7494–0.9905)) to predict a MACE. Oxidative stress markers serum concentrations, as well as the modMELD score, allow the identification of patients with a risk of MACE.
Highlights
All included patient were classified in New York Heart Association (NYHA) functional class IV and profiles 2 to 3 according to the INTERMACS classification
Our study has shown that patients with initially higher levels of oxidative stress identified as higher total oxidant status (TOS) and oxidative stress index (OSI) levels, as well as lower total antioxidant capacity (TAC) levels, have worse clinical outcomes after an Left ventricular assist device (LVAD) implantation in a 1.5-year follow-up, despite comparable oxidative stress parameters after 6 months in both analyzed groups
Our findings suggest that a modified Model for End-Stage Liver Disease (modMELD) score above the cut-off value is associated with a higher risk of death, cerebral event, and pump thrombosis within a 1.5-year followup
Summary
Despite continuous advances in medicine, heart transplantation (HT) is the most effective treatment for end-stage heart failure (HF) patients who are refractory to medical therapy. Because of a limited number of suitable donor organs available, the mortality on waiting lists remains high [1,2]. Implantable left ventricular assist devices (LVADs) have become an alternative treatment for advanced. HF patients, and their use as a bridge to transplant has been widely increasing [3,4]. The shift away from pulsatile flow technology and toward continuous technology
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