Amanda R Vest1, Peter J Kennel2, Dawn Maldonado2, James B Young2, Maria M Mountis2, Yoshifumi Naka2, Paolo C Colombo2, Donna M Mancini2, Randall C Starling2, P Christian Schulze2. 1. From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.). avest@tuftsmedicalcenter.org. 2. From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.).
Abstract
BACKGROUND: Advanced systolic heart failure is associated with myocardial and systemic metabolic abnormalities, including low levels of total cholesterol and low-density lipoprotein. Low cholesterol and low-density lipoprotein have been associated with greater mortality in heart failure. Implantation of a left ventricular assist device (LVAD) reverses some of the metabolic derangements of advanced heart failure. METHODS AND RESULTS: A cohort was retrospectively assembled from 2 high-volume implantation centers, totaling 295 continuous-flow LVAD recipients with ≥2 cholesterol values available. The cohort was predominantly bridge-to-transplantation (67%), with median age of 59 years and 49% ischemic heart failure cause. Total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels all significantly increased after LVAD implantation (median values from implantation to 3 months post implantation 125-150 mg/dL, 67-85 mg/dL, 32-42 mg/dL, and 97-126 mg/dL, respectively). On Cox proportional hazards modeling, patients achieving recovery of total cholesterol levels, defined as a median or greater change from pre implantation to 3 months post-LVAD implantation, had significantly better unadjusted survival (hazard ratio, 0.445; 95% confidence interval, 0.212-0.932) and adjusted survival (hazard ratio, 0.241; 95% confidence interval, 0.092-0.628) than those without cholesterol recovery after LVAD implantation. The continuous variable of total cholesterol at 3 months post implantation and the cholesterol increase from pre implantation to 3 months were also both significantly associated with survival during LVAD support. CONCLUSIONS: Initiation of continuous-flow LVAD support was associated with significant recovery of all 4 lipid variables. Patients with a greater increase in total cholesterol by 3 months post implantation had superior survival during LVAD support.
BACKGROUND: Advanced systolic heart failure is associated with myocardial and systemic metabolic abnormalities, including low levels of total cholesterol and low-density lipoprotein. Low cholesterol and low-density lipoprotein have been associated with greater mortality in heart failure. Implantation of a left ventricular assist device (LVAD) reverses some of the metabolic derangements of advanced heart failure. METHODS AND RESULTS: A cohort was retrospectively assembled from 2 high-volume implantation centers, totaling 295 continuous-flow LVAD recipients with ≥2 cholesterol values available. The cohort was predominantly bridge-to-transplantation (67%), with median age of 59 years and 49% ischemic heart failure cause. Total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels all significantly increased after LVAD implantation (median values from implantation to 3 months post implantation 125-150 mg/dL, 67-85 mg/dL, 32-42 mg/dL, and 97-126 mg/dL, respectively). On Cox proportional hazards modeling, patients achieving recovery of total cholesterol levels, defined as a median or greater change from pre implantation to 3 months post-LVAD implantation, had significantly better unadjusted survival (hazard ratio, 0.445; 95% confidence interval, 0.212-0.932) and adjusted survival (hazard ratio, 0.241; 95% confidence interval, 0.092-0.628) than those without cholesterol recovery after LVAD implantation. The continuous variable of total cholesterol at 3 months post implantation and the cholesterol increase from pre implantation to 3 months were also both significantly associated with survival during LVAD support. CONCLUSIONS: Initiation of continuous-flow LVAD support was associated with significant recovery of all 4 lipid variables. Patients with a greater increase in total cholesterol by 3 months post implantation had superior survival during LVAD support.
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