Worsening Creatinine Trend in the Year Prior to LVAD Implantation is Associated with Lower Pectoralis Muscle Measures and Increased Post LVAD Mortality

Abstract

The association between renal function at the time of left ventricular assist device (LVAD) implantation and post LVAD mortality has been previously established. The association between the slope of renal function change in the year prior to LVAD implantation has not been reported. A single center retrospective analysis was performed. Inclusion criteria were patients with chest CT scans performed ≤3 months prior to LVAD implantation with renal function trend available for a year prior to LVAD (n=102). Renal function was smoothed using mixed effects modeling from 365 to 60 days prior to LVAD and a slope was calculated for each patient. The slope of the renal function was assessed as a predictor of post LVAD mortality using multivariable cox regression. Patients with the largest deterioration in renal function in the year prior to LVAD were more likely to be INTERMACS 1 and 2 at the time of surgery (Table). A 1 mg/dl increase in creatinine between -365 days and -60 days increased the hazards rate of death after LVAD by a factor of 2.6 (adjusted HR 2.6, 95 % CI 1.03-6.7, p = 0.04). Patients with the largest decline in renal function had lower pectoralis muscle tissue attenuation by CT imaging in the 3 months prior to LVAD (Table). Renal function deterioration over the course of the year prior to LVAD was associated with pectoralis muscle sarcopenia and higher post LVAD mortality, even after adjustment for other variables. The change in renal function paired with muscle tissue attenuation by CT scan may further define ideal implantation timing.