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Metabolic Dysfunction in Continuous‐Flow Left Ventricular Assist Devices Patients and Outcomes

BACKGROUND: Metabolic impairment is common in heart failure patients. Continuous‐flow left ventricular assist devices (CF‐LVADs) improve hemodynamics and outcomes in patients with advanced heart failure; however, the effect of CF‐LVADs on metabolic status is unknown. This study aims to evaluate the...

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Autores principales: Nguyen, Ann B., Imamura, Teruhiko, Besser, Stephanie, Rodgers, Daniel, Chung, Ben, Raikhelkar, Jayant, Kalantari, Sara, Smith, Bryan, Sarswat, Nitasha, LaBuhn, Colleen, Jeevanandam, Valluvan, Kim, Gene, Sayer, Gabriel, Uriel, Nir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915293/
https://www.ncbi.nlm.nih.gov/pubmed/31718441
http://dx.doi.org/10.1161/JAHA.119.013278
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author Nguyen, Ann B.
Imamura, Teruhiko
Besser, Stephanie
Rodgers, Daniel
Chung, Ben
Raikhelkar, Jayant
Kalantari, Sara
Smith, Bryan
Sarswat, Nitasha
LaBuhn, Colleen
Jeevanandam, Valluvan
Kim, Gene
Sayer, Gabriel
Uriel, Nir
author_facet Nguyen, Ann B.
Imamura, Teruhiko
Besser, Stephanie
Rodgers, Daniel
Chung, Ben
Raikhelkar, Jayant
Kalantari, Sara
Smith, Bryan
Sarswat, Nitasha
LaBuhn, Colleen
Jeevanandam, Valluvan
Kim, Gene
Sayer, Gabriel
Uriel, Nir
author_sort Nguyen, Ann B.
collection PubMed
description BACKGROUND: Metabolic impairment is common in heart failure patients. Continuous‐flow left ventricular assist devices (CF‐LVADs) improve hemodynamics and outcomes in patients with advanced heart failure; however, the effect of CF‐LVADs on metabolic status is unknown. This study aims to evaluate the changes in metabolic status following CF‐LVAD implantation and measure the correlation of metabolic status with outcomes. METHODS AND RESULTS: Prospective data on CF‐LVAD patients were obtained. Metabolic evaluation, including hemoglobin A1C, free and total testosterone, thyroid‐stimulating hormone (TSH), and free T4, was obtained before and at multiple time points following implantation. Patients with nonelevated thyroid‐stimulating hormone and normal hemoglobin A1C and testosterone levels were defined as having normal metabolic status. Baseline characteristics, hemodynamics, and outcomes were collected. One hundred six patients were studied, of which 56 had paired data at baseline and 1‐ to 3‐month follow‐up. Before implantation, 75% of patients had insulin resistance, 86% of men and 39% of women had low free testosterone, and 44% of patients had abnormal thyroid function. There was a significant improvement in hemoglobin A1C, free testosterone, and thyroid‐stimulating hormone following implantation (P<0.001 for all). Patients with normal hemoglobin A1C (<5.7%) following implantation had higher 1‐year survival free of heart failure readmissions (78% versus 23%; P<0.001). Patients with normal metabolic status following implantation also had higher 1‐year survival free of heart failure readmissions (92% versus 54%; P=0.04). CONCLUSIONS: Metabolic dysfunction is highly prevalent in advanced heart failure patients and improves after CF‐LVAD implantation. Normal metabolic status is associated with a significantly higher rate of 1‐year survival free of heart failure readmissions.
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spelling pubmed-69152932019-12-23 Metabolic Dysfunction in Continuous‐Flow Left Ventricular Assist Devices Patients and Outcomes Nguyen, Ann B. Imamura, Teruhiko Besser, Stephanie Rodgers, Daniel Chung, Ben Raikhelkar, Jayant Kalantari, Sara Smith, Bryan Sarswat, Nitasha LaBuhn, Colleen Jeevanandam, Valluvan Kim, Gene Sayer, Gabriel Uriel, Nir J Am Heart Assoc Original Research BACKGROUND: Metabolic impairment is common in heart failure patients. Continuous‐flow left ventricular assist devices (CF‐LVADs) improve hemodynamics and outcomes in patients with advanced heart failure; however, the effect of CF‐LVADs on metabolic status is unknown. This study aims to evaluate the changes in metabolic status following CF‐LVAD implantation and measure the correlation of metabolic status with outcomes. METHODS AND RESULTS: Prospective data on CF‐LVAD patients were obtained. Metabolic evaluation, including hemoglobin A1C, free and total testosterone, thyroid‐stimulating hormone (TSH), and free T4, was obtained before and at multiple time points following implantation. Patients with nonelevated thyroid‐stimulating hormone and normal hemoglobin A1C and testosterone levels were defined as having normal metabolic status. Baseline characteristics, hemodynamics, and outcomes were collected. One hundred six patients were studied, of which 56 had paired data at baseline and 1‐ to 3‐month follow‐up. Before implantation, 75% of patients had insulin resistance, 86% of men and 39% of women had low free testosterone, and 44% of patients had abnormal thyroid function. There was a significant improvement in hemoglobin A1C, free testosterone, and thyroid‐stimulating hormone following implantation (P<0.001 for all). Patients with normal hemoglobin A1C (<5.7%) following implantation had higher 1‐year survival free of heart failure readmissions (78% versus 23%; P<0.001). Patients with normal metabolic status following implantation also had higher 1‐year survival free of heart failure readmissions (92% versus 54%; P=0.04). CONCLUSIONS: Metabolic dysfunction is highly prevalent in advanced heart failure patients and improves after CF‐LVAD implantation. Normal metabolic status is associated with a significantly higher rate of 1‐year survival free of heart failure readmissions. John Wiley and Sons Inc. 2019-11-13 /pmc/articles/PMC6915293/ /pubmed/31718441 http://dx.doi.org/10.1161/JAHA.119.013278 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Nguyen, Ann B.
Imamura, Teruhiko
Besser, Stephanie
Rodgers, Daniel
Chung, Ben
Raikhelkar, Jayant
Kalantari, Sara
Smith, Bryan
Sarswat, Nitasha
LaBuhn, Colleen
Jeevanandam, Valluvan
Kim, Gene
Sayer, Gabriel
Uriel, Nir
Metabolic Dysfunction in Continuous‐Flow Left Ventricular Assist Devices Patients and Outcomes
title Metabolic Dysfunction in Continuous‐Flow Left Ventricular Assist Devices Patients and Outcomes
title_full Metabolic Dysfunction in Continuous‐Flow Left Ventricular Assist Devices Patients and Outcomes
title_fullStr Metabolic Dysfunction in Continuous‐Flow Left Ventricular Assist Devices Patients and Outcomes
title_full_unstemmed Metabolic Dysfunction in Continuous‐Flow Left Ventricular Assist Devices Patients and Outcomes
title_short Metabolic Dysfunction in Continuous‐Flow Left Ventricular Assist Devices Patients and Outcomes
title_sort metabolic dysfunction in continuous‐flow left ventricular assist devices patients and outcomes
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915293/
https://www.ncbi.nlm.nih.gov/pubmed/31718441
http://dx.doi.org/10.1161/JAHA.119.013278
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