Long-Term Neurocognitive Outcomes in LVAD Recipients

PURPOSE: Data on long-term cognitive outcome in patients with LVAD is limited. We examined the neurocognitive outcome in patients receiving the HeartwareTM HVADTM system for destination therapy. METHODS: HVAD patients enrolled in the ENDURANCE and ENDURANCE Supplemental trials were eligible. Cognition domains were evaluated through 24 months with Hopkins Verbal Learning Test, Trail Making Tests, Clock Drawing, and Boston Naming Test. Change in neurocognitive function, quality of life, and functional capacity were examined at 2 years and compared to baseline. Patients were further categorized into two groups: those having neurologic events and those having none. RESULTS: For HVAD patients enrolled in the trials (n=604), 178 (29.5%) had neurologic events (both stroke and non-stroke) on original device. Neurocognitive, functional capacity, and quality of life measures are listed in Table 1. Examining the entire cohort reveals that most measures improved from baseline through 24 months. Patients who suffered at least one stoke also showed improvement from baseline to 24 months in some domains, Hopkins Trail 2 (6.3 vs 6.7, p=0.04), Total for Learning Trial (18.3 vs 19.5, p=0.02), Delayed Recall (6.2 vs 7.1, p=0.009), Delayed Recognition Discrimination Correct (10.4 vs 10.9, p=0.04), Six-minute Walk (107.7 vs 196.1 m, p<0.0001) and KCCQ (39.9 vs 66.1, p<0.0001) (Table 1). There were no differences in neurocognitive outcome between ENDURANCE and ENDURANCE Supplemental patients despite the blood pressure difference. CONCLUSION: Neurocognitive function, quality of life, and functional capacity improved for all patients on HVAD support surviving to 24 months even among those that suffered neurologic events.