Key result
Preimplantation cachexia was independently associated with higher mortality during LVAD support (adjusted HR 1.23; 95% CI 1.0-1.42; P=0.005).
Why the study?
Severe cardiac cachexia or malnutrition are commonly considered relative contraindications to LVAD implantation, but post-LVAD prognosis for patients with cachexia is uncertain.
Does baseline cachexia or early weight gain affect mortality in patients receiving a left ventricular assist device?
Cohort (n=20,332)
Yes
Does baseline cachexia or early weight gain affect mortality in patients receiving a left ventricular assist device?
Hazard Ratio: 1.23 (95% CI 1–1.42)
p-value: p=0.005
Baseline cachexia is a risk factor for mortality in LVAD recipients, but early weight gain after implantation is associated with improved survival.
Cachexia before LVAD may identify higher-risk patients; leaves open whether nutritional interventions improve survival.
Background Severe cardiac cachexia or malnutrition are commonly considered relative contraindications to left ventricular assist device (LVAD) implantation, but post‐LVAD prognosis for patients with cachexia is uncertain. Methods and Results Intermacs (Interagency Registry for Mechanically Assisted Circulatory Support) 2006 to 2017 was queried for the preimplantation variable cachexia/malnutrition. Cox proportional hazards modeling examined the relationship between cachexia and LVAD outcomes. Of 20 332 primary LVAD recipients with available data, 516 (2.54%) were reported to have baseline cachexia and had higher risk baseline characteristics. Cachexia was associated with higher mortality during LVAD support (unadjusted hazard ratio [HR], 1.36 [95% CI, 1.18–1.56]; P <0.0001), persisting after adjustment for baseline characteristics (adjusted HR, 1.23 [95% CI, 1.0–1.42]; P =0.005). Mean weight change at 12 months was +3.9±9.4 kg. Across the cohort, weight gain ≥5% during the first 3 months of LVAD support was associated with lower mortality (unadjusted HR, 0.90 [95% CI, 0.84–0.98]; P =0.012; adjusted HR, 0.89 [95% CI, 0.82–0.97]; P =0.006). Conclusions The proportion of LVAD recipients recognized to have cachexia preimplantation was low at 2.5%. Recognized cachexia was independently associated with higher mortality during LVAD support. Early weight gain ≥5% was independently associated with lower mortality during subsequent LVAD support.
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Vest et al. (2023) conducted a cohort in Left ventricular assist device (LVAD) recipients (n=20,332). Baseline cachexia vs. No baseline cachexia was evaluated on Mortality during LVAD support (adjusted HR 1.23, 95% CI 1.0-1.42, p=0.005). Preimplantation cachexia was independently associated with higher mortality during LVAD support (adjusted HR 1.23; 95% CI 1.0-1.42; P=0.005).
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