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Benefits of Neurohormonal Therapy in Patients With Continuous-Flow Left Ventricular Assist Devices

Yousefzai, Rayan ; Brambatti, Michela ; Tran, Hao A ; Pedersen, Rachel ; Braun, Oscar Ö LU ; Baykaner, Tina ; Ghashghaei, Roxana ; Sulemanjee, Nasir Z ; Cheema, Omar M and Rappelt, Matthew , et al. (2020) In ASAIO Journal 66(4). p.409-414
Abstract

Left ventricular assist devices (LVADs) have dramatically improved short-term outcomes among patients with advanced heart failure. While neurohormonal blockade (NHB) is the cornerstone of treatment for patients with heart failure with reduced ejection fraction, its effect after LVAD placement has not been established. We reviewed medical records of 307 patients who underwent primary LVAD implantation from January 2006 to September 2015 at two institutions in the United States. Patients were followed for at least 2 years post-LVAD implantation or until explantation, heart transplantation, or death. Cox regression analysis stratifying on center was used to assess associations with mortality. Neurohormonal blockade use was treated as a... (More)

Left ventricular assist devices (LVADs) have dramatically improved short-term outcomes among patients with advanced heart failure. While neurohormonal blockade (NHB) is the cornerstone of treatment for patients with heart failure with reduced ejection fraction, its effect after LVAD placement has not been established. We reviewed medical records of 307 patients who underwent primary LVAD implantation from January 2006 to September 2015 at two institutions in the United States. Patients were followed for at least 2 years post-LVAD implantation or until explantation, heart transplantation, or death. Cox regression analysis stratifying on center was used to assess associations with mortality. Neurohormonal blockade use was treated as a time-dependent predictor. Stepwise selection indicated treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) (hazard ratio [HR] = 0.53 [0.30-0.95], p = 0.03), age at the time of implantation (HR = 1.28 [1.05-1.56] per decade, p = 0.02), length of stay postimplantation (HR = 1.16 [1.11-1.21] per week, p < 0.01) and INTERMACS profile of 1 or 2 (HR = 1.86 [1.17-2.97], p < 0.01) were independent predictors of mortality. In this large, retrospective study, treatment with ACEIs or ARBs was an independent factor associated with decreased mortality post-LVAD placement.

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publishing date
type
Contribution to journal
publication status
published
subject
in
ASAIO Journal
volume
66
issue
4
pages
409 - 414
publisher
Amercian Society of Artificial Internal Organs
external identifiers
  • scopus:85082561399
  • pmid:31192845
ISSN
1538-943X
DOI
10.1097/MAT.0000000000001022
language
English
LU publication?
no
id
4300318c-77ba-4976-b947-500b1e92a921
date added to LUP
2019-06-18 22:26:47
date last changed
2024-06-25 19:08:28
@article{4300318c-77ba-4976-b947-500b1e92a921,
  abstract     = {{<p>Left ventricular assist devices (LVADs) have dramatically improved short-term outcomes among patients with advanced heart failure. While neurohormonal blockade (NHB) is the cornerstone of treatment for patients with heart failure with reduced ejection fraction, its effect after LVAD placement has not been established. We reviewed medical records of 307 patients who underwent primary LVAD implantation from January 2006 to September 2015 at two institutions in the United States. Patients were followed for at least 2 years post-LVAD implantation or until explantation, heart transplantation, or death. Cox regression analysis stratifying on center was used to assess associations with mortality. Neurohormonal blockade use was treated as a time-dependent predictor. Stepwise selection indicated treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) (hazard ratio [HR] = 0.53 [0.30-0.95], p = 0.03), age at the time of implantation (HR = 1.28 [1.05-1.56] per decade, p = 0.02), length of stay postimplantation (HR = 1.16 [1.11-1.21] per week, p &lt; 0.01) and INTERMACS profile of 1 or 2 (HR = 1.86 [1.17-2.97], p &lt; 0.01) were independent predictors of mortality. In this large, retrospective study, treatment with ACEIs or ARBs was an independent factor associated with decreased mortality post-LVAD placement.</p>}},
  author       = {{Yousefzai, Rayan and Brambatti, Michela and Tran, Hao A and Pedersen, Rachel and Braun, Oscar Ö and Baykaner, Tina and Ghashghaei, Roxana and Sulemanjee, Nasir Z and Cheema, Omar M and Rappelt, Matthew and Baeza, Carmela and Alkhayyat, Abdulaziz and Shi, Yang and Pretorius, Victor and Greenberg, Barry and Adler, Eric and Thohan, Vinay}},
  issn         = {{1538-943X}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{409--414}},
  publisher    = {{Amercian Society of Artificial Internal Organs}},
  series       = {{ASAIO Journal}},
  title        = {{Benefits of Neurohormonal Therapy in Patients With Continuous-Flow Left Ventricular Assist Devices}},
  url          = {{http://dx.doi.org/10.1097/MAT.0000000000001022}},
  doi          = {{10.1097/MAT.0000000000001022}},
  volume       = {{66}},
  year         = {{2020}},
}