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Cardiac Cachexia in Left Ventricular Assist Device Recipients and the Implications of Weight Gain Early After Implantation.

Amanda R VestLori Lyn PriceAnindita ChandaBenjamin A SweigartJoronia CheryMatthew LawrenceLauren ParslyGaurav GulatiMichael S KiernanJenica N UpshawAndre C CritsinelisGregory S CouperEdward Saltzman
Published in: Journal of the American Heart Association (2023)
Background Severe cardiac cachexia or malnutrition are commonly considered relative contraindications to left ventricular assist device (LVAD) implantation, but post-LVAD prognosis for patients with cachexia is uncertain. Methods and Results Intermacs (Interagency Registry for Mechanically Assisted Circulatory Support) 2006 to 2017 was queried for the preimplantation variable cachexia/malnutrition. Cox proportional hazards modeling examined the relationship between cachexia and LVAD outcomes. Of 20 332 primary LVAD recipients with available data, 516 (2.54%) were reported to have baseline cachexia and had higher risk baseline characteristics. Cachexia was associated with higher mortality during LVAD support (unadjusted hazard ratio [HR], 1.36 [95% CI, 1.18-1.56]; P <0.0001), persisting after adjustment for baseline characteristics (adjusted HR, 1.23 [95% CI, 1.0-1.42]; P =0.005). Mean weight change at 12 months was +3.9±9.4 kg. Across the cohort, weight gain ≥5% during the first 3 months of LVAD support was associated with lower mortality (unadjusted HR, 0.90 [95% CI, 0.84-0.98]; P =0.012; adjusted HR, 0.89 [95% CI, 0.82-0.97]; P =0.006). Conclusions The proportion of LVAD recipients recognized to have cachexia preimplantation was low at 2.5%. Recognized cachexia was independently associated with higher mortality during LVAD support. Early weight gain ≥5% was independently associated with lower mortality during subsequent LVAD support.
Keyphrases
  • left ventricular assist device
  • weight gain
  • body mass index
  • birth weight
  • cardiovascular events
  • weight loss
  • cardiovascular disease
  • gestational age
  • coronary artery disease
  • extracorporeal membrane oxygenation