Association of diuretic requirement and right heart failure post-LVAD implantation

Diuretic responsiveness is associated with heart failure disease progression. Among patients with advanced heart failure, we hypothesized that decreased diuretic responsiveness and higher diuretic requirement are correlates of progressive right ventricular dysfunction and may help to risk stratify patients undergoing left ventricular assist device (LVAD) evaluation.

We performed a single-center, retrospective analysis of 147 patients undergoing LVAD implantation between 2014 and 2018. The primary outcome was early right heart failure (RHF) or death during the index hospital stay. Patients were stratified by tertiles of preoperative 24-hour diuretic dose within 72 hours of surgery.

The incidence of early RHF was higher in the highest-dose group (66.0%) compared to the medium- (41.3%) and low-dose groups (23.5%) (p < 0.001). Each 40 mg increase in intravenous furosemide dose was associated with a 6% increase in the risk of RHF, after adjusting for other known risk factors. The median ICU length of stay was 2 days longer for patients in the highest compared to low-dose group (7 vs 5 days, p = 0.02). Mortality within 14 days post-op was numerically higher although not significantly different between the highest-dose group and the low-dose group (12.0% vs 5.9%, p = 0.55). Six-month survival across diuretic dose tertiles was also not statistically different (p = 0.40).

We concluded that higher preoperative diuretic dose is associated with risk of early RHF following LVAD surgery. These data furthermore support the role of progressive right ventricular dysfunction on the development of cardiorenal disease and diuretic resistance.