(335) Left Ventricular Assist Device Therapy in “Cold and Dry” Patients

PurposePatients who suffer from end-stage HF and have low PCWP are referred to as “cold and dry” patients and are an understudied minority, where the benefit derived from LVAD therapy is unclear. We therefore conducted a retrospective analysis to evaluate functional outcomes and quality of life after LVAD in patients with low versus high PCWP on pre-LVAD hemodynamics.MethodsAdults receiving LVADs between 2006 and 2017 were identified from the INTERMACS database. Outcomes include assessment of functional status with 6-minute walk test (6MWT) distance and quality of life measures, with KCCQ and EuroQol questionnaire scores pre- and post-LVAD, stratified by pre-LVAD PCWP. Median follow up was 379±43 days.ResultsStudy sample comprised 13774 patients with complete clinical profiles who received LVAD from 2006 to 2017. Mean age was 56±13, 10743 (78%) were male, and the mean PCWP prior to LVAD implantation was 25±9.1 mmHg. The patients were stratified into quartiles by PCWP with pressure ranges of 0-19, 19-25, 25-31, and 31-48 mmHg, respectively. For patients in the lowest PCWP quartile, mean age was 58±13, 2530 (75%) were males, LVEDD was 6.7±1 cm, and mean PCWP was 14±4 mmHg (Table 1). When compared to the three upper quartiles, patients in the lowest PCWP quartile showed less improvement in quality of life questionnaire scores, including EuroQol (+0.12 vs +0.18, p=0.001) and KCCQ (+25 vs +31, p=0.0001), and functional capacity with 6MWT distance (+185 feet vs +350 feet, p=0.03) after LVAD (Figure 1).ConclusionIn patients with end-stage HF and low PCWP, LVADs are associated with less improvement in functional capacity and quality of life when compared to patients with high PCWP. Patients who suffer from end-stage HF and have low PCWP are referred to as “cold and dry” patients and are an understudied minority, where the benefit derived from LVAD therapy is unclear. We therefore conducted a retrospective analysis to evaluate functional outcomes and quality of life after LVAD in patients with low versus high PCWP on pre-LVAD hemodynamics. Adults receiving LVADs between 2006 and 2017 were identified from the INTERMACS database. Outcomes include assessment of functional status with 6-minute walk test (6MWT) distance and quality of life measures, with KCCQ and EuroQol questionnaire scores pre- and post-LVAD, stratified by pre-LVAD PCWP. Median follow up was 379±43 days. Study sample comprised 13774 patients with complete clinical profiles who received LVAD from 2006 to 2017. Mean age was 56±13, 10743 (78%) were male, and the mean PCWP prior to LVAD implantation was 25±9.1 mmHg. The patients were stratified into quartiles by PCWP with pressure ranges of 0-19, 19-25, 25-31, and 31-48 mmHg, respectively. For patients in the lowest PCWP quartile, mean age was 58±13, 2530 (75%) were males, LVEDD was 6.7±1 cm, and mean PCWP was 14±4 mmHg (Table 1). When compared to the three upper quartiles, patients in the lowest PCWP quartile showed less improvement in quality of life questionnaire scores, including EuroQol (+0.12 vs +0.18, p=0.001) and KCCQ (+25 vs +31, p=0.0001), and functional capacity with 6MWT distance (+185 feet vs +350 feet, p=0.03) after LVAD (Figure 1). In patients with end-stage HF and low PCWP, LVADs are associated with less improvement in functional capacity and quality of life when compared to patients with high PCWP.