PMID- 32618585
OWN - NLM
STAT- MEDLINE
DCOM- 20210426
LR  - 20230821
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 67
IP  - 2
DP  - 2021 Feb 1
TI  - A Modified Grading System for Early Right Heart Failure Matches Functional 
      Outcomes and Survival After Left Ventricular Assist Devices.
PG  - 185-191
LID - 10.1097/MAT.0000000000001203 [doi]
AB  - Early right heart failure (ERHF) remains a common complication after 
      continuous-flow left ventricular assist device (cf-LVAD) and has been associated 
      with increased mortality. The specific criteria used to define ERHF remain 
      somewhat arbitrary. Correlating the degree of ERHF with outcomes after LVAD could 
      inform a more clinically relevant definition. We identified 196 patients who 
      underwent first durable cf-LVAD between 2008 and 2015 at a single center. 
      Postimplant ERHF was graded as absent, mild (requiring inotropic support for 
      14-20 days), moderate (inotropes for >/= 21 days), or severe (requiring unplanned 
      RVAD at any time during the index hospitalization). ERHF was associated with 
      clinical outcomes including 1 year survival and New York Heart Association (NYHA) 
      class and 6 minute walk distance (6MWD) at 3 and 6 months. Survival was assessed 
      using the Kaplan-Meier method with log-rank testing and multivariate Cox 
      proportional-hazards modeling. Compared to patients without ERHF, those with mild 
      ERHF had similar 1 year survival (hazard ratio [HR] 0.69, 95% confidence interval 
      [CI]: 0.26-1.80, p = 0.45), while mortality was substantially increased in 
      patients with moderate (HR 2.65, 95% CI: 1.27-5.54, p = 0.009) and severe ERHF 
      (HR 8.16, 95% CI: 3.97-16.76, p < 0.0001). The severity of ERHF was associated 
      with 6MWD at both 3 months (p = 0.001) and 6 months (p = 0.013). The relationship 
      between ERHF and postimplant survival and functional status persisted in 
      multivariate modeling. A simple, modified grading system for ERHF severity is 
      strongly associated with 1 year survival and functional capacity after cf-LVAD. 
      These results argue against using a binary definition for ERHF and suggest the 
      need to modify definition of ERHF severity.
CI  - Copyright (c) ASAIO 2020.
FAU - Grandin, E Wilson
AU  - Grandin EW
AD  - From the Division of Cardiovascular Medicine, Beth Israel Deaconess Medical 
      Center, Harvard Medical School. Boston, Massachusetts.
FAU - Troutman, Gregory S
AU  - Troutman GS
AUID- ORCID: 0000-0002-2062-7236
AD  - Sidney Kimmel Medical College, Thomas Jefferson University. Philadelphia, 
      Pennsylvania.
FAU - Gulati, Arune A
AU  - Gulati AA
AD  - Department of Medicine, Johns Hopkins University School of Medicine. Baltimore, 
      Maryland.
FAU - Zamani, Payman
AU  - Zamani P
AUID- ORCID: 0000-0002-9345-5834
AD  - Division of Cardiovascular Medicine, University of Pennsylvania, Perelman School 
      of Medicine. Philadelphia, Pennsylvania.
FAU - Mazurek, Jeremy A
AU  - Mazurek JA
AD  - Division of Cardiovascular Medicine, University of Pennsylvania, Perelman School 
      of Medicine. Philadelphia, Pennsylvania.
FAU - Atluri, Pavan
AU  - Atluri P
AD  - Division of Cardiothoracic Surgery, University of Pennsylvania, Perelman School 
      of Medicine, Philadelphia, Pennsylvania.
FAU - Rame, J Eduardo
AU  - Rame JE
AD  - Division of Cardiovascular Medicine, University of Pennsylvania, Perelman School 
      of Medicine. Philadelphia, Pennsylvania.
LA  - eng
GR  - K23 HL130551/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
SB  - IM
MH  - Adult
MH  - Aged
MH  - Female
MH  - Heart Failure/*diagnosis/*etiology/mortality
MH  - Heart-Assist Devices/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Walk Test
EDAT- 2020/07/04 06:00
MHDA- 2021/04/27 06:00
CRDT- 2020/07/04 06:00
PHST- 2020/07/04 06:00 [pubmed]
PHST- 2021/04/27 06:00 [medline]
PHST- 2020/07/04 06:00 [entrez]
AID - 00002480-202102000-00012 [pii]
AID - 10.1097/MAT.0000000000001203 [doi]
PST - ppublish
SO  - ASAIO J. 2021 Feb 1;67(2):185-191. doi: 10.1097/MAT.0000000000001203.