Premium
Hypomagnesemia after heart transplantation or left ventricular assist device implant for end‐stage heart failure
Author(s) -
Racca Vittorio,
Scaglione Anna,
De Maria Renata,
Panzarino Claudia,
Santangelo Maria Antonia,
Cipriani Manlio
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13902
Subject(s) - medicine , hypomagnesemia , heart failure , calcineurin , heart transplantation , ventricular assist device , cardiology , diabetes mellitus , immunosuppression , prednisone , transplantation , magnesium , endocrinology , materials science , metallurgy
Background Patients with advanced heart failure undergoing heart transplant (HTx) or left ventricular assist device (LVAD) implant are at high risk of magnesium deficiency, that may favor development of diabetes. We aimed to comparatively assess prevalence and correlates of hypomagnesemia during cardiac rehabilitation between 51 HTx and 46 LVAD recipients. Methods and Results We measured serum magnesium and correlated it to clinical and laboratory findings upon admission (T 1 ) and at discharge (T2) from cardiac rehabilitation. Among LVAD, magnesium levels increased from admission to discharge. Among HTx, magnesium concentrations were below normal in 33% and 47% at T 1 and T 2 , respectively, and decreased from admission to discharge. HTx on tacrolimus showed greater decreases in magnesium and increases in glucose levels than those on cyclosporine. Magnesium levels were inversely associated with >15 mg/dL increased glucose concentrations between T 2 and T 1 (HR 0.373, 95% CI 0.154‐0.903, P = .029) after adjustment for pre‐existing diabetes, insulin resistance markers, calcineurin inhibitors (cyclosporine/tacrolimus), prednisone doses, and magnesium supplementation. Conclusion Hypomagnesemia is rare in LVAD recipients, but common within 1 month from HTx, worsens during rehabilitation, despite immunosuppression tapering and magnesium supplements, and is independently associated to increasing glucose levels. Studies evaluating whether correcting hypomagnesemia improves outcome are warranted.