학술논문
Abstract 17340: Pre-LVAD QRS as an Independent Predictor of Myocardial Recovery in Chronic Heart Failure Patients Supported With Left Ventricular Assist Device
Document Type
Academic Journal
Author
Source
Circulation. Nov 17, 2020 142(Suppl_3 Suppl 3):A17340-A17340
Subject
Language
English
ISSN
0009-7322
Abstract
Introduction: Left ventricular assist device (LVAD) therapy aims to improve LV reverse remodeling, but still >50% of chronic heart failure (CHF) patients show ‘no’ recovery. The current clinical paradigm to assess post-LVAD myocardial recovery relies on ventricular rotational and deformational mechanics. Investigating the role of a pre-LVAD QRS as a potential indicator for post-LVAD LV recovery in CHF patients may help clinicians develop optimal care plans for LVAD patients.Hypothesis: Pre-LVAD short QRS has potential value to be useful as an independent predictor for early myocardial recovery following LVAD implantation.Methods: Chronic and dilated cardiomyopathy patients (n=315) undergoing LVAD implantation were retrospectively studied. Acute HF etiology and post-LVAD follow up (<3 months) were exclusion criteria. Post-LVAD myocardial recovery criteria for responders (R) is defined as post-LVAD implant follow-up LVEF ≥40% and LVIDd ≤6 cm. Non-recovery (NR) criteria is defined as follow-up LVEF <40% and LVIDd < or >6 cm. From 315 LVAD patients, 39 fulfilled the criteria of myocardial recovery as ‘R’.Results: Based on univariate logistic regression, pre-LVAD QRS duration is found to be a predictor of myocardial recovery following LVAD implantation (OR:0.986, 95% CI:0.976-0.996, p=0.005) in LVAD patients. QRS duration is 14.5% longer in the ‘NR’ group as compared with the ‘R’ group (145±36 ms vs 124±37 ms). In multivariate logistic regression, after adjusting for previous thoracotomy, beta-blockers, and a previously evaluated composite score (UCARS) including age, HF duration, and LVEDD, pre-LVAD QRS remains a significant predictor of ‘R’ status (OR:0.983, 95% CL:0.973-0.994, p=0.003). The model shows an accuracy of 0.74 with a p-value of <0.001.Conclusions: Pre-LVAD short QRS interval is associated with post-LVAD LV reverse remodeling in the ‘R’ group, and thus could be of use in a clinical setting for predicting post-LVAD early myocardial recovery.