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Implantation of ventricular assist devices in hypertrophic cardiomyopathy with left ventricular systolic dysfunction

Nobuichiro Yagi1,2, Osamu Seguchi1, Hiroki Mochizuki1

  • 1Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita-shi, Osaka, 564-8565, Japan.

ESC Heart Failure
|October 28, 2021
PubMed

Insights

Patients with hypertrophic cardiomyopathy with left ventricular systolic dysfunction (HCM-LVSD) undergoing left ventricular assist device (LVAD) implantation had comparable outcomes to those with dilated cardiomyopathy (DCM), despite some differences in right ventricular function.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Devices

Background:

  • Outcomes for patients with hypertrophic cardiomyopathy and left ventricular systolic dysfunction (HCM-LVSD) after left ventricular assist device (LVAD) implantation are not well-defined.
  • Left ventricular assist devices (LVADs) are crucial for end-stage heart failure management.

Purpose of the Study:

  • To evaluate the clinical impact of LVAD implantation on HCM-LVSD patients.
  • To compare clinical outcomes, hemodynamics, and brain natriuretic peptide (BNP) levels between HCM-LVSD and dilated cardiomyopathy (DCM) patients post-LVAD.

Main Methods:

  • Retrospective, single-center observational study of 120 patients (24 HCM-LVSD, 96 DCM) who underwent LVAD implantation between 2011-2020.
  • Analysis of clinical outcomes, hemodynamic parameters (pulmonary artery pulsatility index, right ventricular stroke work index, cardiac index, right atrial pressure), and BNP levels pre- and post-LVAD.

Main Results:

  • HCM-LVSD patients had smaller left ventricles and thicker walls, with higher post-LVAD BNP levels compared to DCM.
  • Subclinical right ventricular dysfunction was suggested in HCM-LVSD patients (lower indices, higher right atrial pressure).
  • Post-implantation survival, cerebrovascular accidents, right ventricular failure, infections, arrhythmia, and aortic insufficiency were comparable between groups.

Conclusions:

  • Despite impaired right ventricular function and elevated BNP, HCM-LVSD patients achieve similar outcomes to DCM patients after LVAD implantation.
  • LVAD therapy is a viable option for selected HCM-LVSD patients with end-stage heart failure.
Abstract

Keywords:
Advanced heart failureDilated cardiomyopathyHCM-LVSDLeft ventricular assist device

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