Predictors and Outcomes of Hemodynamic and Functional LVAD Non-Responders: An Analysis of the INTERMACS Registry

PURPOSE: Despite recent advancements in left ventricular assist device (LVAD) technology, there remains a population of patients who experience ongoing signs and symptoms of heart failure during LVAD support. We sought to describe risk factors and outcomes for LVAD Non-Responders (NR). METHODS: The INTERMACS database was used to identify LVAD recipients from 2010-2018. Follow up data at 3 and 6 months were assessed for NYHA functional class and invasive hemodynamic data. Patients were considered functional NR if they had NYHA III-IV symptoms and hemodynamic NR if they met 2 of the 3 criteria: CVP <=12, PCWP>=18, or CI<=2.2. Patients with primary RV failure were excluded. Kaplan-Meier survival estimates were used to describe 2-year outcomes by NR category and logistic regression analysis was used to identify pre-implant predictors of combined hemodynamic and functional NR. RESULTS: 1544 patients had sufficient data to be included in the final study population. Eight percent of patients were both hemodynamic and functional NR, with an additional 30% either hemodynamic or functional NR (Figure 1A). On-device survival was strongly related to degree of NR (Figure 1B) with combined functional and hemodynamic NR associated with inferior 2-year survival. Functional NR appeared to portend a worse prognosis than hemodynamic NR. In multivariable analysis, age (OR: 1.20, p=0.062), BMI >30 (OR: 1.83, p=0.004), centrifugal device type (OR: 1.69, p=0.011), BUN (OR: 1.16, p=0.016), and presence of a CRT device (OR: 1.51, p=0.048) were associated with combined hemodynamic and functional NR. CONCLUSION: Up to 40% of patients with post-implant hemodynamics were non-responders to LVAD therapy in important HF domains. Pre-implant age, high BMI, device type, elevated BUN, and presence of CRT device were associated with hemodynamic and functional NR. Future research is warranted to understand whether LVAD non-responsiveness can be modified with device modification and/or medical therapy.

Duke Scholars

Author Adam David DeVore Medicine, Cardiology

Author Stuart Dean Russell Medicine, Cardiology

Author Chetan B. Patel Medicine, Cardiology

Author Richa Agarwal Medicine, Cardiology