Key result
LVAD in HCM/RCM is linked to ~56% higher short-term mortality versus DCM/ICM.
Why the study?
LVAD implantation in patients with advanced heart failure due to hypertrophic or restrictive cardiomyopathy presents technical and physiologic challenges, and its utilization and outcomes compared to DCM/ICM required evaluation.
Does LVAD implantation have different utilization rates and clinical outcomes in patients with HCM/RCM compared to those with DCM/ICM?
Systematic Review (n=2,766)
Does LVAD implantation have different utilization rates and clinical outcomes in patients with HCM/RCM compared to those with DCM/ICM?
Absolute Event Rate: 14% vs 9%
p-value: p=<0.001
LVAD implantation is less frequently utilized and is associated with significantly higher rates of adverse clinical outcomes in patients with hypertrophic or restrictive cardiomyopathy compared to those with dilated or ischemic cardiomyopathy.
May warrant caution in LVAD selection for HCM/RCM; leaves open whether tailored strategies improve outcomes.
Left ventricular assist device (LVAD) implantation in patients with advanced heart failure due to hypertrophic or restrictive cardiomyopathy (HCM/RCM) presents technical and physiologic challenges. We conducted a systematic review of observational studies to evaluate the utilization and clinical outcomes associated with LVAD implantation in patients with HCM/RCM and compared these to patients with dilated or ischemic cardiomyopathy (DCM/ICM). We searched MEDLINE, EMBASE, and Scopus from inception through May 2019 and included appropriate studies describing the use of an LVAD in patients with HCM/RCM. We identified six studies with a total of 2,766 patients with HCM/RCM and advanced heart failure, among whom 338 patients (12.2%) underwent LVAD implantation. In patients listed for transplant, the rate of LVAD implantation was significantly lower in patients with HCM/RCM compared to that in patients with DCM/ICM (4.4% vs. 18.2%, p < 0.001). Adverse clinical outcomes were significantly higher in HCM/RCM than in DCM/ICM, including operative/short-term mortality (14.0% vs. 9.0%), right ventricular failure (50.0% vs. 21.0%), infection (15.5% vs. 11.2%), bleeding (40.2% vs. 12.5%), renal failure (15.0% vs. 5.1%), stroke (5.0% vs. 2.4%), and arrhythmias (18.0% vs. 7.7%) (all p values <0.001).
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Sreenivasan et al. (2020) conducted a systematic review in Hypertrophic or restrictive cardiomyopathy (HCM/RCM) and advanced heart failure (n=2,766). Left ventricular assist device (LVAD) implantation vs. Dilated or ischemic cardiomyopathy (DCM/ICM) was evaluated on Operative/short-term mortality (p=<0.001). LVAD implantation in patients with HCM/RCM was associated with significantly higher operative/short-term mortality compared to those with DCM/ICM (14.0% vs. 9.0%, p<0.001).
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