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Published on: August 16, 2021
Pericardial Adipose Tissue Volume and Left Ventricular Assist Device-Associated Outcomes
Vishal N Rao1, Mary Jo Obeid2, Francesca Rigiroli3
1Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
Insights
Pericardial adipose tissue (PAT) in patients with end-stage heart failure (HF) does not predict worse outcomes after left ventricular assist device (LVAD) implantation. Further research is needed on regional adiposity versus obesity in LVAD recipients.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Pericardial adipose tissue (PAT) is linked to adverse cardiovascular events.
- The role of PAT in patients with end-stage heart failure (HF) undergoing left ventricular assist device (LVAD) implantation is unknown.
- This study investigates the association between PAT and LVAD-associated outcomes.
Purpose of the Study:
- To determine if pericardial adipose tissue (PAT) volume impacts outcomes in patients receiving a left ventricular assist device (LVAD).
- To analyze the relationship between pre-operative PAT and adverse events in end-stage heart failure patients.
Main Methods:
- Retrospective analysis of 77 patients undergoing HeartMate 3 LVAD implantation.
- Computed tomography (CT) scans were used to measure pericardial adipose tissue (PAT) volumes.
- Patients were categorized into above-median (≥219 cm³ ) and below-median (<219 cm³) PAT groups.
Main Results:
- Patients with above-median PAT had higher rates of atrial fibrillation, chronic kidney disease, and ischemic cardiomyopathy.
- No significant difference in 2-year composite outcomes (mortality, redo-LVAD, transplantation) between PAT groups (35.9% vs 32.2%).
- Similar 2-year composite incidence of HF hospitalizations, GI bleeding, infections, and stroke between PAT groups (61.5% vs 60.5%).
Conclusions:
- Pericardial adipose tissue (PAT) is not associated with worse 2-year outcomes in end-stage heart failure patients treated with LVAD.
- The clinical significance of regional adiposity versus general obesity in LVAD recipients requires further investigation.
Background:
Pericardial adipose tissue (PAT) is associated with adverse cardiovascular outcomes in those with and without established heart failure (HF). However, it is not known whether PAT is associated with adverse outcomes in patients with end-stage HF undergoing left ventricular assist device (LVAD) implantation. This study aimed to evaluate the associations between PAT and LVAD-associated outcomes.
Methods And Results:
We retrospectively measured computed tomography-derived PAT volumes in 77 consecutive adults who had available chest CT imaging prior to HeartMate 3 LVAD surgery between October 2015 and March 2019 at Duke University Hospital. Study groups were divided into above-median (≥219 cm3) and below-median (<219 cm3) PAT volume. Those with above-median PAT had a higher proportion of atrial fibrillation, chronic kidney disease and ischemic cardiomyopathy. Groups with above-median vs below-median PAT had similar Kaplan-Meier incidence rates over 2 years for (1) composite all-cause mortality, redo-LVAD surgery and cardiac transplantation (35.9 vs 32.2%; log-rank P = 0.65) and (2) composite incident hospitalizations for HF, gastrointestinal bleeding, LVAD-related infection, and stroke (61.5 vs 60.5%; log-rank P = 0.67).
Conclusions:
In patients with end-stage HF undergoing LVAD therapy, PAT is not associated with worse 2-year LVAD-related outcomes. The significance of regional adiposity vs obesity in LVAD patients warrants further investigation.
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