P226 LONGITUDINAL EVALUATION OF CONGESTION AND RENAL FUNCTION IN ADVANCED HEART FAILURE PATIENTS TREATED WITH A LEFT VENTRICULAR ASSIST DEVICE

Abstract

Abstract Introduction In patients affected by advanced heart failure (advHF) long term mechanical support with left ventricular assist devices (LVADs) is a established therapeutic option. Congestion and renal function in pts treated with a LVAD require expert management. Aim Describe the longitudinal trend of congestion and renal function during a 12th follow–up in advHF pts treated with a LVAD, examine the correlation between congestion and renal function, study predictors of sustained improvement of congestion and renal function. Methods retrospective single–centre analysis of 39 pts treated with a LVAD and followed in ASST–PG23 Hospital for at least 12 months. Biochemical, echocardiographic and clinical parameters were collected at specific time points from baseline to 12 months after hospitalization during which a LVAD was implanted. Congestion was studied with BNP, bilirubin, haematocrit and daily diuretics dosage. Renal function was studied with absolute changes of eGFR (Cockcroft–Gault). Primary endpoint was sustained improvement of congestion and renal function, derived after comparing baseline pre–LVAD and 12th month parameters. Results congestion improved early after LVAD implantation, with steep and high reduction of BNP, bilirubin and daily diuretics dosage. The improvement was higher in those pts with a baseline BNP>median. Bilirubin, haematocrit and daily diuretics dosage showed statistically significant correlations with BNP. Sustained improvement of congestion was present in 59% pts, in particular in those with higher baseline BNP (p = 0.04 after χ²–test). Renal function showed an early steep improvement from baseline pre–LVAD to discharge, more significant in those pts with baseline CKD; during the following months renal function did not show significant changes. Sustained improvement of renal function was present in 54% pts, in particular in those with baseline CKD (p = 0.002 after χ²–test). No significant correlations were found after comparing the trend of congestion and renal function. At multivariable logistic regression, no significant predictors were found for sustained improvement of congestion or renal function. Conclusions A multiparametric evaluation of congestion in pts with a LVAD is feasible. The benefit derived from LVAD support appears to be higher in those pts with a baseline higher risk, both in term of congestion and renal function. No significant correlation between the trend of congestion and renal function was found.