Heart Failure Severity Stratification Beyond INTERMACS Profiles: A Step Toward Optimal Left Ventricular Assist Device...

Area of Science:

• Cardiology
• Radiology
• Geriatrics

Background:

• Left ventricular assist device (LVAD) implantation is a critical intervention for advanced heart failure.
• Identifying patient subgroups with differential disease severity is crucial for optimizing outcomes.
• Pectoralis muscle measures on preoperative imaging may reflect overall patient health and resilience.

Purpose of the Study:

• To determine if pectoralis muscle measures on pre-LVAD CT scans can stratify patients by disease severity within INTERMACS profiles.
• To investigate the association between pectoralis muscle characteristics and survival after LVAD implantation.

Main Methods:

• Retrospective analysis of 276 patients undergoing LVAD implantation.
• Quantification of pectoralis muscle mass and attenuation from preoperative CT scans.
• Kaplan-Meier and Cox regression analyses to compare mortality based on muscle groups within INTERMACS profiles.

Main Results:

• Patients in INTERMACS profiles 3 and 4 with higher pectoralis muscle mass (HIGH PEC group) demonstrated significantly better 1-year survival (85% vs. 68%).
• Being in the HIGH PEC group was associated with a 60% reduction in the hazard rate of death post-LVAD.
• Renal function deterioration before LVAD correlated with lower INTERMACS profiles and reduced pectoralis muscle attenuation, suggesting progressive sarcopenia.

Conclusions:

• Preoperative pectoralis muscle quantification via CT can identify subgroups of LVAD patients with differential survival.
• Higher pectoralis muscle measures in INTERMACS 3 and 4 patients predict superior outcomes on LVAD support.
• CT-quantified sarcopenia may aid in determining optimal timing for LVAD implantation.