Early post-implant hemodynamics and outcomes after durable lvad support: limited prognostic value of resting cardiac index
S Liori, I Kyriakoulis, E Dranow, C Selzman, M Goodwin, J Stehlik, T Hanff, R Florido, S Carter, A Brann, E Tseliou, J Fang, S Drakos, C KapeliosAbstract
Background
Right-heart catheterization (RHC) is frequently performed after durable LVAD implantation to guide hemodynamic optimization. However, the prognostic relevance of resting cardiac index (CI) measured early after implant remains unclear.
Objectives
To examine whether resting CI assessed during early post-implant RHC is associated with long-term mortality following durable LVAD support.
Methods
We studied a single-center cohort of LVAD recipients undergoing their first routine RHC within 6 months of implantation. The primary outcome was all-cause mortality, with censoring at transplantation or last follow-up. Survival was compared according to CI (Fick) above versus below the cohort median (2.4 L/min/m²) using Kaplan–Meier analysis. Cox proportional hazards models were constructed with adjustment for age, sex, ischemic cardiomyopathy, and LVAD type. CI by both Fick and thermodilution methods was also evaluated as a continuous variable.
Results
The study included 178 patients (median age 57 [IQR 41–64] years; 79% male), with RHC performed at a median of 94 (IQR 64–126) days post-implant. Over a follow-up period of up to 5 years, 44 deaths occurred. Survival did not differ between patients with CI above versus below 2.4 L/min/m2 (log-rank p=0.33) (Figure A). In adjusted analyses, neither Fick-derived nor thermodilution-derived CI was independently associated with mortality (Figure B). Conversely, higher left- and right-sided filling pressures, including PCWP, PAD pressure, RA pressure, and PVR, demonstrated significant associations with mortality (Figure B).
Conclusion
In the early period following LVAD implantation, markers of congestion rather than resting cardiac index were associated with adverse outcomes. These findings suggest that post-implant risk stratification may benefit from greater emphasis on filling pressures, while the role of routine CI assessment warrants further investigation.For image description, please refer to the figure legend and surrounding text.