Abstract 12355: Blood Pressure Response to Exercise Predicts Successful Weaning from Left Ventricular Assist Device in Patients with End-stage Heart Failure

Abstract

Background: Left ventricular assist device (LVAD) is the most powerful but invasive therapy for patients with end-stage heart failure (HF). LVAD support has the potential to lead to cardiac recovery with significant LV unloading and reverse remodeling. Nevertheless, the incidence of LVAD weaning remains relatively low, partly because of lack of the reliable criteria for identifying candidates for successful weaning. Cardiopulmonary exercise testing (CPET) provides useful information to predict prognosis of patients with HF. However, peak VO2, the most reliable established prognostic predictor, may not be suitable for identifying such candidates because of long-term deconditioning. We hypothesized that systolic blood pressure (SBP) response to exercise would be more reliable for predicting successful weaning from LVAD.

Methods: We studied 107 consecutive patients with HF who received pulsatile LVAD implantation for a bridge to heart transplantation between 1998 and 2012 (mean follow up of 2.0 ± 1.2 years). Among them, 39 patients were considered as candidates for LVAD weaning and performed CPET; 9 were successfully weaned and received LVAD explantation, 21 received heart transplantation, and 9 died before transplantation. Clinical characteristics and exercise variables of CPET (performed during LVAD support) were examined and compared in the patients with successful weaning or failure.

Results: There was no significant difference in patients’ background characteristics, whereas peak exercise SBP and peak VO2 were significantly higher and VE/VCO2 slope was lower in the patients with successful weaning. Multivariable analysis indicated that peak SBP most strongly predicted successful weaning from LVAD (X2 5.3, p=0.02).

Conclusion: Preserved blood pressure response to exercise, suggestive of sufficient cardiovascular reserve, identifies the potential to facilitate cardiac recovery to tolerate weaning from LVAD in patients with end-stage HF.