A left ventricular LGE burden of ≥16% is negatively associated with achieving optimal echocardiographic (13.3% vs 50.0%) and hemodynamic profiles (7.1% vs 42.9%) post-LVAD.
Does higher left ventricular fibrosis burden (LGE ≥16%) reduce the likelihood of achieving optimal hemodynamic and echocardiographic profiles in patients undergoing LVAD implant?
Higher left ventricular fibrosis burden assessed by CMR prior to LVAD implantation is inversely associated with positive myocardial remodeling and optimal hemodynamics at 6 months.
Absolute Event Rate: 0% vs 0%
Abstract Left Ventricular (LV) fibrosis assesed by late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) is associated with heart failure (HF) outcomes and positive remodeling. The aim of this study is to evaluate its impact in left ventricular device (LVAD) carriers. In this retrospective and single-center study, 278 patients underwent LVAD implant in Harefield Hospital and 44 had a CMR within 2 years before the device implant (median time 74 days, IQR 29-335). Fuor patients were excluded because of insufficient image quality, leading to a final cohort of 40 patients. At this point patients were dichotomized at the median LV LGE burden (16%). The association of pre-LVAD morpho-functional and LGE features with myocardial remodeling was analyzed. Coprimary outcomes were the optimal hemodynamic and echocardiographic profile at 6 months after LVAD implant. Optimal hemodynamic profile was defined as Cardiac Index≥2.2 L/min/m², pulmonary capillary pressure18 mmHg, right atrial pressure12 mmHg at right heart catheterization, while optimal echocardiographic profile was defined as neutral interventricular septum position, mitral regurgitation≤mild, and at least intermittent aortic valve opening. HF outcomes at 3 years were also evaluated. Ischemic heart disease was more common among patients with LGE≥16% (85% vs 30%, p-value0.001). The presence of LGE burden≥16% was negatively associated with the achievement of optimal echocardiographic (13.3% vs 50.0%, p-value 0.029; OR 0.15, 95% CI 0.03-0.91, p-value 0.040) and hemodynamic profile (7.1% vs 42.9%, p-value 0.029; OR 0.11, 95% CI 0.27-0.95, p-value 0.034). In the univariate analysis several CMR variables including LV dimensions and mass, LGE burden, septal LGE involvement and number of segments with LGE were univariate predictors of coprimary outcomes. No difference in clinical outcomes was observed between groups. In conclusion: the burden of LV fibrosis assesed at CMR is inversely associated with positive myocardial remodeling and optimal hemodynamics among advanced HF patients undergoing durable mechanical unloading with an LVAD.Study flowchart Impact of LGE burden
Fini et al. (Sat,) reported a other. A left ventricular LGE burden of ≥16% is negatively associated with achieving optimal echocardiographic (13.3% vs 50.0%) and hemodynamic profiles (7.1% vs 42.9%) post-LVAD.