Structural and Functional Echocardiographic Responses to Left Ventricular Assist Device Implantation: Focus on the Right Ventricle

Abstract

Background: Renal dysfunction is common among patients with either Diabetes Mellitus or end-stage heart failure. It has been established that renal function improves after continuous-flow left ventricular assist device (CF-LVAD) implantation. However, it is unknown if this improvement is also observed in diabetic patients who are at risk of renal disease at baseline. Thus, the aim of this study was to examine if patients with diabetes experienced the same improvement in renal function after CF-LVAD as non-diabetics. Method: A retrospective chart review of pts implanted with a CF-LVAD at Columbia University Medical Center from Jan 2007-December 2014 was completed. Calculated glomerular filtration rate (GFR) was used to assess renal function, and was measured on admission 1, 3 and 6 months after CF-LVAD implantation. Renal dysfunction at baseline was defined as a GFR ! 60 ml/min/ m. Diabetic status was assessed at the time of CF-LVAD evaluation. Results: During the study period, 178 patients were implanted with a CF-LVAD (148 Heartmate II, 30 Heartware). Fifteen patients were on dialysis at the time of implant and were excluded from the analysis. Of the remaining 163 patients, 81(49.7%) were diabetic and 83 (51.4%) were non-diabetic. Patients with diabetes were more likely to be older and have a history of hypertension, but were otherwise comparable at baseline. The median GFR at the time of CF-LVAD implant was not significantly different in diabetics and non-diabetics, at 46.8 ml/min/ m2 (IQR 5 39.1-70.3) and 53.9