Partial Recovery of Ejection Fraction with Neurohormonal Blockade Improves Long-Term Event Free Survival for Patients with Continuous Flow LVAD

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The use of neurohormonal blockade (NHB) therapy with mechanical unloading via continuous-flow Left Ventricular Assist Device (cf-LVAD) has been shown to reverse cardiac remodeling and in some instances lead to successful explantation of the device. Despite the effects on LVEF among patients with cf-LVAD, long-term event free survival differences in those using NHB therapy has not been studied. We undertook a single center retrospective cohort study of 189 cf-LVAD adult patients from 2008 to 2018 who had a minimum of 90 days of support. Patients were assessed at 6 months post-LVAD implantation and categorized as "High NHB" (n=101) if medical regimen included both beta-adrenergic and renin-angiotensin-aldosterone blockade and "Low NHB" (n=88) if they did not have both. LVEF was assessed at 12-months post LVAD implant and was stratified by median. Event-free survival was determined using Kaplan Meier methods with adverse event was defined as death, RV failure, GI bleed, pump thrombosis, or CVA that led to hospitalization. The High NHB cohort was younger (median age 55 vs. 62, p=0.002), was more likely to have NICM (71% vs. 47%, p=0.001), had lower INTERMACS score at time of implant (median score 3 vs. 2, p=0.037), and had greater LVEF improvement at 12 months (5% vs. -1.25%, p<0.0001). Gender and duration of heart failure diagnosis prior to LVAD implant were similar in both groups. Survival free from adverse events was greater for patients with High NHB who had LVEF change above median, p=0.0018 (Figure 1). The use of NHB therapy that includes both beta-adrenergic and renin-angiotensin-aldosterone blockade is associated with a reduction in adverse events in our population and was also associated with improvement of LVEF. Prospective studies are warranted to investigate if the strategy of maximizing NHB therapy, to both promote myocardial reverse remodeling and reduced morbidity after LVAD implant.