TY - JOUR
T1 - Presence and impact of anemia in patients supported with left ventricular assist devices
AU - Tie, Hongtao
AU - Li, Tong
AU - Huang, Bi
AU - Mariani, Silvia
AU - Li, Tian
AU - van Bussel, Bas C.T.
AU - Wu, Qingchen
AU - Pei, Jianqiu
AU - Welp, Henryk
AU - Martens, Sabrina
AU - Li, Zhenhan
AU - Shi, Rui
AU - Zhu, Jing
AU - Luo, Suxin
AU - Lichtenberg, Artur
AU - Aubin, Hug
AU - Boeken, Udo
AU - Lorusso, Roberto
AU - Dan, Chen
N1 - Funding Information:
This work was supported by the National Natural Science Foundation of China (No. 81700602 ), the First-class Discipline Construction Project of First Clinical College, Chongqing Medical University (No. CYYY-BSHPYXM-2022-08 ), the Natural Science Foundation of Chongqing , China (No. CSTB2022NSCQ-MSX0840 ), the CQMU Program for Youth Innovation in Future Medicine ( W0153 ), the First Affiliated Hospital of CQMU Young Outstanding Scientific and Technological Talents Program ( ZYRC2022-04 ), and the Senior Medical Talents Program of Chongqing for Young and Middle-aged ( 2023-56 ).
Publisher Copyright:
© 2023 International Society for the Heart and Lung Transplantation
PY - 2023/9
Y1 - 2023/9
N2 - Background: Data on anemia and its effects on patients supported with continuous-flow left ventricular assist devices (LVADs) are lacking. Objectives: This study sought to describe the presence of anemia over time and investigate its association with mortality, quality of life, exercise capacity, and adverse events in LVAD patients. Methods: Adults receiving durable LVADs between 2008 and 2017 were identified from the INTERMACS database. The full cohort was stratified according to anemia severity (no anemia, mild, and moderate-severe). Results: The analysis of 19,509 patients (females: 21.2%, age: 56.9 ± 12.9 years) showed that moderate-severe anemia affected 45.2% of patients at baseline, 33.5% of them at 6 months, and 32.3% in the fourth year after implantation. The presence of normal hemoglobin was 24.4% before surgery, 32.5% at 6 months, and 36.6% at 4 years after implantation. Multivariable linear mixed-effect regression revealed that the average hemoglobin over time was significantly lower (ß, -0.233, 95% confidence interval (CI): -0.282 to -0.185), and the reduction of hemoglobin over time was bigger (ß, -0.032 95% CI: -0.035 to -0.028) for LVAD nonsurvivors compared with LVAD survivors. Adjusted Cox regression showed that the severity of preimplant anemia was associated with higher mortality (HR, mild: 1.19; 95% CI: 1.05-1.35 and moderate-severe: 1.44; 95% CI: 1.28-1.62), with similar results in competing risk regression. Anemia progression during follow-up was associated with decreased Kansas City Cardiomyopathy Questionnaire scores and shorter 6-minute walk distances. Conclusions: In patients supported with LVADs, anemia is a frequent comorbidity, and deterioration over time is associated with poor prognosis.
AB - Background: Data on anemia and its effects on patients supported with continuous-flow left ventricular assist devices (LVADs) are lacking. Objectives: This study sought to describe the presence of anemia over time and investigate its association with mortality, quality of life, exercise capacity, and adverse events in LVAD patients. Methods: Adults receiving durable LVADs between 2008 and 2017 were identified from the INTERMACS database. The full cohort was stratified according to anemia severity (no anemia, mild, and moderate-severe). Results: The analysis of 19,509 patients (females: 21.2%, age: 56.9 ± 12.9 years) showed that moderate-severe anemia affected 45.2% of patients at baseline, 33.5% of them at 6 months, and 32.3% in the fourth year after implantation. The presence of normal hemoglobin was 24.4% before surgery, 32.5% at 6 months, and 36.6% at 4 years after implantation. Multivariable linear mixed-effect regression revealed that the average hemoglobin over time was significantly lower (ß, -0.233, 95% confidence interval (CI): -0.282 to -0.185), and the reduction of hemoglobin over time was bigger (ß, -0.032 95% CI: -0.035 to -0.028) for LVAD nonsurvivors compared with LVAD survivors. Adjusted Cox regression showed that the severity of preimplant anemia was associated with higher mortality (HR, mild: 1.19; 95% CI: 1.05-1.35 and moderate-severe: 1.44; 95% CI: 1.28-1.62), with similar results in competing risk regression. Anemia progression during follow-up was associated with decreased Kansas City Cardiomyopathy Questionnaire scores and shorter 6-minute walk distances. Conclusions: In patients supported with LVADs, anemia is a frequent comorbidity, and deterioration over time is associated with poor prognosis.
KW - anemia
KW - INTERMACS registry
KW - left ventricular assist device
U2 - 10.1016/j.healun.2023.04.013
DO - 10.1016/j.healun.2023.04.013
M3 - Article
C2 - 37127070
SN - 1053-2498
VL - 42
SP - 1261
EP - 1274
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 9
ER -