Neurohormonal blockade drug therapy (NHBDT) is the cornerstone therapy in heart failure
(HF) management for promoting reverse cardiac remodeling and improving outcomes. It's
utility in left ventricular assist device (LVAD) supported patients remains undefined.
Sixty-four patients who received continuous flow LVAD at our institution were retrospectively
reviewed and divided into 2 groups: no-NHBDT group (n = 33) received LVAD support
only and NHBDT group (n = 31) received concurrent NHBDT based on the clinical judgment
of the attending physicians. Cardiac remodeling (echocardiographic parameters and
biomarkers) and clinical outcome (functional status, HF-related hospital readmissions,
and mortality) data were collected. A statistically significant increase in ejection
fraction, decrease in LV end-diastolic diameter index and LV mass index, and a sustained
reduction in N-terminal pro B-type natriuretic peptide (NTproBNP) were observed in
the NHBDT group at 6 months after LVAD implant (p <0.05). NHBDT-treated patients experienced
significantly greater improvement in New York Heart Association functional classification
and 6-minute-walk distance throughout the study. The combined end point of cardiovascular
death or HF hospitalization was significantly reduced in patients receiving NHBDT
(p = 0.013) associated primarily with a 12.1% absolute reduction in HF-related hospitalizations
(p = 0.046). In conclusion, NHBDT in LVAD-supported patients is associated with a
significant reversal in adverse cardiac remodeling and a reduction in morbidity and
mortality compared with LVAD support alone.
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Article info
Publication history
Published online: March 17, 2016
Accepted:
March 8,
2016
Received in revised form:
March 8,
2016
Received:
January 18,
2016
Footnotes
See page 1769 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
