Effect of Neurohormonal Blockade Drug Therapy on Outcomes and Left Ventricular Function and Structure After Left
Avishay Grupper1, Yanjun M Zhao2, Pavol Sajgalik1
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Insights
Neurohormonal blockade drug therapy (NHBDT) improves cardiac remodeling and outcomes in patients with left ventricular assist devices (LVADs). NHBDT significantly reduces heart failure hospitalizations and mortality compared to LVAD support alone.
Area of Science:
- Cardiology
- Medical Devices
- Pharmacology
Background:
- Neurohormonal blockade drug therapy (NHBDT) is standard for heart failure (HF) management.
- Its role in patients with left ventricular assist devices (LVADs) is not well-defined.
Purpose of the Study:
- To evaluate the impact of NHBDT on cardiac remodeling and clinical outcomes in LVAD-supported patients.
Main Methods:
- Retrospective review of 64 continuous flow LVAD patients.
- Comparison between a no-NHBDT group (n=33) and an NHBDT group (n=31).
- Assessment of echocardiographic parameters, biomarkers, functional status, hospital readmissions, and mortality.
Main Results:
- NHBDT group showed increased ejection fraction, decreased LV end-diastolic diameter index and LV mass index, and reduced NTproBNP at 6 months.
- Significant improvements in NYHA functional class and 6-minute-walk distance were observed with NHBDT.
- NHBDT significantly reduced the combined endpoint of cardiovascular death or HF hospitalization, mainly due to a 12.1% absolute reduction in HF hospitalizations.
Conclusions:
- NHBDT in LVAD patients promotes significant reverse cardiac remodeling.
- NHBDT is associated with reduced morbidity and mortality in LVAD recipients compared to LVAD support alone.
Abstract:
Neurohormonal blockade drug therapy (NHBDT) is the cornerstone therapy in heart failure (HF) management for promoting reverse cardiac remodeling and improving outcomes. It's utility in left ventricular assist device (LVAD) supported patients remains undefined. Sixty-four patients who received continuous flow LVAD at our institution were retrospectively reviewed and divided into 2 groups: no-NHBDT group (n = 33) received LVAD support only and NHBDT group (n = 31) received concurrent NHBDT based on the clinical judgment of the attending physicians. Cardiac remodeling (echocardiographic parameters and biomarkers) and clinical outcome (functional status, HF-related hospital readmissions, and mortality) data were collected. A statistically significant increase in ejection fraction, decrease in LV end-diastolic diameter index and LV mass index, and a sustained reduction in N-terminal pro B-type natriuretic peptide (NTproBNP) were observed in the NHBDT group at 6 months after LVAD implant (p <0.05). NHBDT-treated patients experienced significantly greater improvement in New York Heart Association functional classification and 6-minute-walk distance throughout the study. The combined end point of cardiovascular death or HF hospitalization was significantly reduced in patients receiving NHBDT (p = 0.013) associated primarily with a 12.1% absolute reduction in HF-related hospitalizations (p = 0.046). In conclusion, NHBDT in LVAD-supported patients is associated with a significant reversal in adverse cardiac remodeling and a reduction in morbidity and mortality compared with LVAD support alone.
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