Right heart failure hemodynamic-related events after dLVAD implantation were associated with increased risk of HF hospitalization or cardiovascular death (HR 2.69; 95% CI 1.14-6.34; P=0.024).
Cohort (n=183)
Does the Hemodynamic Classification System for HDREs predict HF hospitalization or cardiovascular death in patients with dLVAD?
The dLVAD Hemodynamic Classification System for HDREs successfully identifies patients at higher risk for HF hospitalization or cardiovascular death, validating its prognostic utility.
Effect estimate: HR 2.69 (95% CI 1.14-6.34)
p-value: p=0.024
Background Durable left ventricular assist device (dLVAD) physiology predisposes to right heart failure (RHF) and aortic insufficiency (AI), recently labeled hemodynamic‐related events (HDREs). We sought to validate the recently proposed dLVAD Hemodynamic Classification System for HDREs. Methods RHF and AI HDREs were adjudicated, staged, and phenotyped on the basis of the Hemodynamic Classification System assessed at 6 months after dLVAD implantation. The primary outcome was a composite of HF hospitalization or cardiovascular death between 6 and 24 months after dLVAD implantation. Results Among 183 qualifying consecutive patients with 6‐month assessments, RHF HDRE was adjudicated in all cases and AI HDRE in 161 (88.0%). Overall, 53 (29.0%) patients developed an RHF HDRE and 26 (16.0%) an AI HDRE (phenotypes: 39 isolated RHF, 15 isolated AI, 11 combined RHF–AI, 3 not adjudicated). At pre‐dLVAD assessment, age and pulmonary artery pulsatility index were independently associated with RHF HDRE and pre‐dLVAD AI and systolic pulmonary artery pressure with AI HDRE. RHF HDRE (adjusted hazard ratio HR, 2.69 95% CI, 1.14–6.34; P =0.024), AI HDRE (adjusted HR, 4.21 95% CI, 1.70–10.40; P =0.002), and HDRE phenotypes (isolated RHF/AI HDRE versus no HDRE: adjusted HR, 2.80 95% CI, 1.03–7.62; P =0.044; combined RHF/AI HDRE versus no HDRE: adjusted HR, 4.53 95% CI, 1.33–15.35; P =0.015) were associated with the primary outcome. A graded increase in primary outcome was observed with increasing RHF and AI stages. Conclusions We validated the dLVAD Hemodynamic Classification System for HDREs as a valuable tool to identify pathophysiological and clinical clusters of patients, linking it with significant prognostic implications. Its adoption may pave the way for targeted strategies aimed at mitigating HDREs and enhancing the long‐term success of dLVAD support.
Gallone et al. (Tue,) conducted a cohort in Durable left ventricular assist device (dLVAD) (n=183). Hemodynamic Classification System for Hemodynamic-Related Events (HDREs) vs. No HDRE was evaluated on Composite of HF hospitalization or cardiovascular death between 6 and 24 months after dLVAD implantation (HR 2.69, 95% CI 1.14-6.34, p=0.024). Right heart failure hemodynamic-related events after dLVAD implantation were associated with increased risk of HF hospitalization or cardiovascular death (HR 2.69; 95% CI 1.14-6.34; P=0.024).