Post-Implant Phosphodiesterase-5 Inhibitor Use is Associated with Increased Rates of Late Right Heart Failure after LVAD: An INTERMACS Analysis

Abstract

Purpose Late right heart failure (LRHF) is a major cause of morbidity after LVAD. Phosphodiesterase-5 inhibitors (PDE5i) are often used for post-LVAD right heart dysfunction, but their impact on LRHF is unknown. Methods We identified adult patients from the INTERMACS registry undergoing continuous-flow LVAD (CFLVAD) after 2012 and stratified them by use of PDE5i at 1 month. Early RHF (ERHF) was defined as the need for RVAD within 1 month or inotropes for > 2 weeks. Among patients surviving > 1 month after discharge from the index LVAD implant, LRHF was defined as any of the following: death from RHF, need for RVAD or inotropes, re-hospitalization for RHF or volume overload , or fulfilling INTERMACS criteria of documentation and manifestation of RHF. Freedom from LRHF was compared with the Kaplan-Meier method and Cox proportional hazards modeling. Results Among 9627 CFLVAD patients surviving >1 month after discharge, 2463 (26%) were treated with PDE5i at 1 month. Patients on PDE5i were more likely to require >2 weeks of inotropic support (27% vs 14%), be INTERMACS Profile 1 or 2 (52% vs 46%), and have higher pulmonary vascular resistance (2.8 vs 2.2 WU), p Conclusion Irrespective of ERHF, post-implant PDE5i use is associated with an increased risk of LRHF after LVAD. Further studies are required to determine if selective pulmonary vasodilator therapy has a role in preventing LRHF after LVAD.