Prognostic Implications of Changes in Albumin Following Left Ventricular Assist Device Implantation in Patients With Severe Heart Failure

Dipika J. Gopal, Thomas C. Hanff, Jeremy A. Mazurek, Wilson E. Grandin, Jessica Howard, Rhondalyn Forde-McLean, Joyce Wald, Kathie King, Michael A. Acker, Lee R. Goldberg, Mariell Jessup, Pavan Atluri, Kenneth B. Margulies, Eduardo J. Rame, Edo Y. Birati

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Mechanical assist devices have emerged as an established therapeutic option for patients with end-stage heart failure. Because preimplant hypoalbuminemia is a known risk factor for adverse outcomes, we hypothesized that change in albumin may be a prognostic indicator in patients with continuous-flow left ventricular assist devices (cfLVADs). This is a retrospective single-center study of patients who underwent cfLVAD implantation (HeartMate II and HeartWare HVAD) at an academic center from 2008 to 2014. After excluding those who died, were transplanted, or hospitalized during the first 3 months post-implant, albumin values were obtained and stratified by an increase or a decrease from pre-implant to 3 months post-implant on 171 (81% male, mean age 57 ± 16 years) patients (139 for the survival analysis and 90 for the hospitalization analysis). Decrease in albumin from pre-implant to 3 months after implant correlated with increased mortality (hazard ratio 2.93, confidence interval 1.57 to 5.44, p <0.01) and reduced time to next hospitalization (hazard ratio 1.70, confidence interval 1.03 to 2.81, p = 0.04). The Kaplan-Meier survival curve estimated a 49.43% 2-year survival rate in those whose albumin decreased versus 83.62% in those whose albumin increased over 3 months (p <0.01). Improved outcomes were seen in patients whose albumin normalized versus patients whose albumin remained normal over 3 months. In conclusion, our study is the first to demonstrate the importance of change in albumin from pre- to postimplant on the prognosis of cfLVAD patients. Future studies are needed to determine whether therapeutic intervention to improve albumin post-implant will prevent hospitalizations and improve outcomes.

Original languageEnglish
Pages (from-to)2003-2007
Number of pages5
JournalAmerican Journal of Cardiology
Volume120
Issue number11
DOIs
StatePublished - 1 Dec 2017
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017 Elsevier Inc.

Funding

Edo Y. Birati, MD, receives fellowship and research support from HeartWare Ltd. Lee R. Goldberg, MD, is a consultant for Medtronic and Respircardia Ltd. Kenneth B. Margulies, MD, receives research grant support from Juventis Therapeutics, Celladon Corporation, Thoratec Corporation, and Merck and Co, Inc., and is a consultant for Janssen, Merck, Pfizer, Ridgetop Research, AstraZeneca, and NovoNordisk. Eduardo J. Rame, MD, receives research grant support from Thoratec Corporation and HeartWare Ltd.

FundersFunder number
HeartWare Ltd
Juventis Therapeutics
AstraZeneca
Merck
Thoratec Corporation
Celladon Corporation
Novo Nordisk

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