Key result
De novo moderate or greater aortic regurgitation in patients with continuous flow LVADs was associated with significantly worse survival (HR 3.947, p<0.001) and cardiovascular events (HR 4.666, p<0.001).
Why the study?
The optimal echocardiographic measurement of AR in continuous flow LVADs, as well as the risk factors and clinical implications of de novo AR, needed to be determined.
Does the development of greater than or equal to moderate de novo aortic regurgitation worsen survival and cardiovascular outcomes in patients with continuous flow left ventricular assist devices?
Cohort (n=219)
Does the development of greater than or equal to moderate de novo aortic regurgitation worsen survival and cardiovascular outcomes in patients with continuous flow left ventricular assist devices?
Hazard Ratio: 3.947
p-value: p=<0.001
De novo moderate or greater aortic regurgitation in LVAD patients, predicted by preimplant trivial AR and closed aortic valve, significantly increases the risk of adverse cardiovascular events and mortality.
May warrant closer AR surveillance in LVAD patients; hypothesis-generating and should not yet change practice.
The aim of this study was to identify the optimal echocardiographic measurement of aortic regurgitation (AR) in continuous flow left ventricular assist devices (LVAD) and determine risk factors and clinical implications of de novo AR. Echocardiographic images from consecutive patients who underwent LVAD implantation from February 2007 to March 2017 were reviewed. Severity of de novo AR was determined by vena contracta (VC). Preimplant clinical characteristics, LVAD settings at discharge, and outcomes including heart failure hospitalizations, all-cause mortality, and ventricular arrhythmias of patients with greater than or equal to moderate de novo AR were compared with those with mild or no AR. Among 219 patients, greater than or equal to moderate de novo AR occurred in 65 (29.7%). Left ventricular assist devices support duration was longer with greater than or equal to moderate AR than no or mild AR. In multivariable analysis, preimplant trivial AR and persistent aortic valve (AV) closure were independently associated with de novo AR. By time-varying covariate analysis, survival and freedom from cardiovascular events in greater than or equal to moderate AR were significantly worse (hazard ratio [HR] = 3.947, p < 0.001 and HR = 4.666, p < 0.001). In conclusion, de novo greater than or equal to moderate AR measured by VC increases risk of adverse events. Longer LVAD support duration, preimplant trivial AR, and a closed AV are associated with occurrence of greater than or equal to moderate de novo AR.
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Park et al. (2021) conducted a cohort in Continuous flow left ventricular assist devices (LVAD) (n=219). De novo moderate or greater aortic regurgitation vs. Mild or no aortic regurgitation was evaluated on Survival and freedom from cardiovascular events (HR 3.947 and HR 4.666, p=<0.001). De novo moderate or greater aortic regurgitation in patients with continuous flow LVADs was associated with significantly worse survival (HR 3.947, p<0.001) and cardiovascular events (HR 4.666, p<0.001).
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