In patients treated with continuous axial flow LVADs, 1-year survival was comparable between those with restrictive or hypertrophic cardiomyopathy and dilated or ischemic cardiomyopathy (87.5% vs 73.2%; P=0.77).
Cohort (n=83)
No
Does continuous axial flow LVAD therapy provide comparable survival in patients with end-stage restrictive or hypertrophic cardiomyopathy compared to those with dilated or ischemic cardiomyopathy?
LVAD therapy in patients with end-stage restrictive or hypertrophic cardiomyopathy yields comparable 1-year survival to those with dilated or ischemic cardiomyopathy, though it is associated with higher rates of right heart failure and catheter-related infections.
Absolute Event Rate: 87.5% vs 73.2%
p-value: p=0.77
BACKGROUND: Left ventricular assist device (LVAD) is being increasingly used in patients with end-stage dilated and ischemic cardiomyopathy. There have been no clinical trials addressing the use of LVAD therapy in patients with end-stage heart failure caused by restrictive (RCM) or hypertrophic cardiomyopathy (HCM). The purpose of this study was therefore to analyze the outcome of LVAD therapy in these patients. METHODS AND RESULTS: Eighty-three patients received continuous axial flow LVAD (Heart mate II, Thoratec, Pleasanton, CA) from February 2007 to May 2010 at our institution. We analyzed the baseline characteristics and surgical and long-term impact of LVAD therapy in 8 patients with RCM or HCM and compared their outcomes with the 75 patients with dilated and ischemic cardiomyopathy. Compared with patients with ischemic or dilated cardiomyopathy, patients with RCM and HCM have significantly smaller left ventricular end-diastolic dimensions (52.5±6 mm versus 68.6±8 mm; P<0.0001) and increased thickness of septal (16 12, 19 mm versus 108.5, 11 mm, P=0.0003) and higher left ventricular ejection fraction (21 20, 36% versus 17 15, 22%; P=0.0009). We found no difference in early mortality (12.5% versus 9.3%, P=0.57) or length of hospital stay (11 8, 45 days versus 18.5 12.2, 27.7 days; P=0.51) between the 2 groups. The right atrial pressure was higher (18 15, 20 mm Hg versus 12 9, 15 mm Hg, P=0.03), and pump flow was lower (4.3 3.8, 4.5 L versus 5.2 4.7, 5.5 L, P=0.001) after LVAD implantation in patients with RCM and HCM. Central venous catheter related infections were more common in patients with RCM and HCM (87.5% versus 44.5%, P=0.006). There was no difference in the total number of blood units transfused. Median (min, max) follow-up duration after LVAD implantation was 166 1, 1044 days. The 1-year actuarial survival rate was not different between the 2 groups (87.5% 95% confidence interval, 52.9% to 97.8% versus 73.2 95% confidence interval, 60% to 85%; P=0.77). CONCLUSIONS: Our preliminary data show that patients with end-stage heart failure caused by RCM or HCM may benefit from continuous axial flow LVAD therapy. This small study suggests that mortality is comparable with those patients who have dilated or ischemic cardiomyopathy, but right heart failure, prolonged inotropic use, and central venous catheter infections are more common in patients with RCM and HCM who were treated with LVAD. Because of the small numbers the differences should be interpreted cautiously, and prospective clinical trials would be required to recommend this therapy for these patients as bridge to transplantation or destination treatment.
Topilsky et al. (2011) conducted a cohort in End-stage heart failure (n=83). Restrictive or hypertrophic cardiomyopathy vs. Dilated or ischemic cardiomyopathy was evaluated on 1-year actuarial survival rate (p=0.77). In patients treated with continuous axial flow LVADs, 1-year survival was comparable between those with restrictive or hypertrophic cardiomyopathy and dilated or ischemic cardiomyopathy (87.5% vs 73.2%; P=0.77).