Open AccessNeurohormonal Blockade During Left Ventricular Assist Device Support
Author(s) -
Teruhiko Imamura,
Priya Mehta,
Ann Nguyen,
B. Chung,
Nikhil Narang,
Daniel Rodgers,
J. Raikhelkar,
Bryan Smith,
Tae Ho Song,
Takeyoshi Ota,
Valluvan Jeevanandam,
Gene Kim,
Gabriel Sayer,
Nir Uriel
Publication year - 2019
Publication title -
asaio journal
Language(s) - Uncategorized
Resource type - Journals
eISSN - 1538-943X
pISSN - 1058-2916
DOI - 10.1097/mat.0000000000001104
Subject(s) - medicine , heart failure , blockade , cardiology , randomized controlled trial , beta blocker , aldosterone , ventricular assist device , receptor
Neurohormonal blockade (NHB) is the mainstay of therapy for patients with systolic heart failure (HF). However, the efficacy in patients with left ventricular assist devices (LVADs) remains unknown. Of all, 114 LVAD patients (57 [48, 65] years old and 78% male) were enrolled and followed during the early period (6 months after index discharge), and 98 were followed during the late period (6-12 months following index discharge). Of them, 46% were on beta-blocker (BB), 49% on angiotensin-converting enzyme inhibitor (ACEi) and/or angiotensin II receptor blocker (ARB), and 51% on aldosterone antagonist at baseline. Prevalence of BB and ACEi/ARB use increased during the study period. During the early period, similar event rates were found irrespective of the NHB uses. During the late period, BB was associated with reduced HF readmission, and ACEi/ARB was associated with reduced HF readmission and gastrointestinal bleeding (p < 0.05 for all). In conclusion, BB and ACEi/ARB use during the late period was associated with a reduction in HF recurrence in LVAD patients. Further prospective randomized control trials are warranted to clarify the utility of NHB therapy in LVAD patients.