Background
The significance of recovered left ventricular ejection fraction (LVEF) in LVAD recipients,
outside of pump explantation, is unclear.
Methods
Patients undergoing first LVAD implantation at Duke University Hospital between 2006
and 2017 were evaluated for LVEF recovery up to 2 years following implant. Occurrence
of gastrointestinal bleeding (GIB), hospitalization for heart failure (HF), pump thrombosis
and death were assessed before and after LVEF recovery.
Results
Of 286 patients who met inclusion criteria, 9.8% reached a “threshold” of recovery
with an LVEF 40%. 17.4% achieved “relative” recovery with an increase in LVEF 10% since LVAD implantation. For either definition, recovered patients had a lower
incidence of a composite endpoint of GIB, HF hospitalization, pump thrombosis, or
death compared to patients without recovery. Patients with “threshold” recovery had
4.7 events per 100 patient-years (95% CI, 0.7-33.6) compared to 48.8 events per 100
patient-years (95% CI, 39.5-60.3) without “threshold” recovery [p = .020]. Those with “relative” recovery had 14.1 events per 100 patient-years [95%
CI, 5.9-33.8] versus 50.7 events per 100 patient-years (95% CI, 40.7-63.0) without
“relative” recovery [p = 0.005]. However, improved outcomes in the “relative” recovery group were limited
to those who also met the “threshold” definition. Importantly, among patients who
achieved “threshold” recovery, the incidence of the composite endpoint declines in
the postrecovery period, suggesting that LVEF recovery mechanistically results in
improved outcomes.
Conclusions
An LVEF 40% associates with better outcomes in LVAD recipients. Methods to promote recovery
could reduce morbidity and mortality related to LVAD support.
Keywords
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Article info
Publication history
Published online: March 16, 2022
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