Longitudinal Outcomes of Cardiogenic Shock Patients Undergoing Conventional Cardiac Surgery

Background: Cardiogenic shock is a known risk factor for early mortality following conventional cardiac surgery, however its impact on longitudinal outcomes is less established. This study evaluated longer-term outcomes of conventional cardiac surgery in patients with cardiogenic shock. Methods: This was a retrospective review of conventional cardiac operations performed in patients presenting with cardiogenic shock between 2010 and 2020. The primary outcome was survival, and secondary outcomes included postoperative complications, and rates of heart failure readmission. Multivariable Cox proportional hazards modeling was conducted to identify risk-adjusted predictors of mortality. Results: 604 patients were included, representing 4% of all cardiac cases. Median follow up was 4.3 (IQR 0.3-6.8) years. Aortic root repair/replacement (31.6%) was most commonly performed. 11.1% of patients required preoperative cardiopulmonary resuscitation. Bridging modalities included intravenous inotropes (35.4%), intra-aortic balloon pump (33.4%), Impella (0.5%), or venoarterial extracorporeal membrane oxygenation (3.3%). Operative mortality was 21.5%. Complications included reoperation (24.3%), stroke (15.9%) renal failure (19.2%), and prolonged ventilation (47.9%). Unadjusted 1- and 5-year survival were 71.7% and 62.1%. Risk-adjusted preoperative predictors for mortality included peripheral vascular disease (HR 1.75, 95% CI 1.23-2.49), dialysis dependency (HR 6.30, 95% CI 3.77–10.51) and increasing age (HR 1.02, 95% CI 1.02–1.04). Three patients eventually underwent ventricular assist device implantation and no patients underwent heart transplantation. Conclusions: Despite high initial rates of morbidity and mortality following conventional cardiac surgery in patients presenting with cardiogenic shock, 62% survive to 5 years and most do not require heart failure readmission or advanced heart failure surgical therapy.

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Abstract P169: Health Literacy and Outcomes in Heart Failure: a Prospective Community Study

Circulation ◽

10.1161/circ.135.suppl_1.p169 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Matteo Fabbri ◽

Kathleen Yost ◽

Lila Finney Rutten ◽

Sheila Manemann ◽

Susan Weston ◽

...

Keyword(s):

Heart Failure ◽

Health Literacy ◽

Proportional Hazards ◽

International Classification Of Diseases ◽

Cox Proportional Hazards ◽

Low Literacy ◽

Adequate Health Literacy ◽

Low Health Literacy ◽

Increased Risk

Background: Growing evidence documents the association between low health literacy and poorer health outcomes. However, less is known about the relationship between health literacy and outcomes among patients with heart failure (HF). We examined the association of health literacy with risk of hospitalization and mortality in patients with HF. Methods: Residents in an 11-county region in southeastern Minnesota with incident HF from 1/01/2013 to 3/31/2015 were identified using the International Classification of Diseases, Ninth Revision code 428 (n=3715) and prospectively surveyed to measure health literacy using established screening questions. A total of 1992 patients returned a survey (response rate 54%); 1779 patients with complete clinical data and adequate follow up were retained for analysis. Health literacy, measured as a composite on three 5-point scales, was categorized as adequate (≤ 10) or low (> 10). Cox proportional hazards regression and Andersen-Gill models were used to determine the association of health literacy with mortality and hospitalization. Results: Among 1779 patients (mean age 74, 53% male), 10% had low health literacy. After a mean follow-up of 8±4 months, 72 deaths and 600 hospitalizations occurred. Low health literacy was associated with increased mortality and hospitalizations (Figure). After adjusting for age, sex, comorbidity, education and marital status, the hazard ratio for death and hospitalization in patients with low health literacy was 2.84 (95% CI: 1.63, 4.96) and 1.43 (95% CI: 1.04, 1.96) respectively, compared to patients with adequate health literacy. Conclusions: Low health literacy is associated with increased risk of hospitalization and death among patients with HF. Health literacy is critical to the self-management demands of living with heart failure. Evaluation of health literacy in the clinical setting may guide inventions to target patients with low literacy.

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P6355The behavior of atrial fibrillation in patients with heart failure hospitalization

European Heart Journal ◽

10.1093/eurheartj/ehz746.0951 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Fukunaga ◽

K Hirose ◽

A Isotani ◽

T Morinaga ◽

K Ando

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Significant Difference ◽

The Impact

Abstract Background Relationship between atrial fibrillation (AF) and heart failure (HF) is often compared with proverbial question of which came first, the chicken or the egg. Some patients showing AF at the HF admission result in restoration of sinus rhythm (SR) at discharge. It is not well elucidated that the restoration into SR during hospitalization can render the preventive effect for rehospitalization. Purpose To investigate the impact of restoration into SR during hospitalization for readmission rate of the HF patients showing AF. Methods We enrolled consecutive 640 HF patients hospitalized from January 2015 to December 2015. Patients data were retrospectively investigated from medical record. Patients showing atrial fibrillation on admission but unrecognized ever were defined as “incident AF”; patients with AF diagnosed before admission were defined as “prevalent AF”. Primary endpoint was a composite of death from cardiovascular disease or hospitalization for worsening heart failure. Secondary endpoints were death from cardiovascular disease, unplanned hospitalization related to heart failure, and any hospitalization. Results During mean follow up of 19 months, 139 patients (22%) were categorized as incident AF and 145 patients (23%) were categorized as prevalent AF. Among 239 patients showing AF on admission, 44 patients were discharged in SR (39 patients in incident AF and 5 patients in prevalent AF). Among incident AF patients, the primary composite end point occurred in significantly fewer in those who discharged in SR (19% vs. 42% at 1-year; 23% vs. 53% at 2-year follow-up, p=0.005). To compare the risk factors related to readmission due to HF with the cox proportional-hazards model, AF only during hospitalization [Hazard Ratio (HR)=0.37, p<0.01] and prevalent AF (HR=1.67, p=0.04) was significantly associated. There was no significant difference depending on LVEF. Conclusion Newly diagnosed AF with restoration to SR during hospitalization was a good marker to forecast future prognosis.

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“BAX602” in Preventing Surgical Adhesion after Extracorporeal Ventricular Assist Device Implantation for Refractory Congestive Heart Failure: Study Protocol for a Multicenter Randomized Clinical Trial

Cardiovascular Drugs and Therapy ◽

10.1007/s10557-020-06990-2 ◽

2020 ◽

Vol 34 (5) ◽

pp. 651-657

Author(s):

Satsuki Fukushima ◽

Koko Asakura ◽

Toshimitsu Hamasaki ◽

Kaori Onda ◽

Takuya Watanabe ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Cardiac Surgery ◽

Ventricular Assist Device ◽

Adhesion Prevention ◽

Open Label ◽

Assist Device ◽

Ventricular Assist ◽

Device Implantation ◽

Great Vessels

Abstract Background The high surgical risk in redo cardiac surgery is largely attributed to adhesions around the epicardium and the great vessels. BAX602 is an adhesion prevention reagent composed of two synthetic polyethylene glycols. Spraying BAX602 over the epicardium and the great vessels reportedly contributes to adhesion prevention after pediatric cardiac surgery. The present study aims to evaluate the safety and effectiveness of BAX602 spray in patients undergoing extracorporeal ventricular assist device implantation surgery to treat refractory congestive heart failure. Methods and Design This investigator-initiated, multicenter, pivotal, two-arm, open-label, randomized trial will include a total of 30 patients. The primary outcome measure is the severity of adhesions, which will be evaluated during re-sternotomy surgery performed 2–12 weeks after the primary extracorporeal ventricular assist device implantation surgery. The adhesion severity will be evaluated at five predefined sites using a four-grade adhesion evaluation score (0 = no adhesion; 1 = filmy and avascular adhesion; 2 = dense/vascular adhesion; 3 = cohesive adhesion). This measure will be summarized in two ways to evaluate the effect of BAX602: (1) the total score of the severity of adhesions at all five sites (ranging from 0 to 15), and (2) the total number of sites with dense/vascular or cohesive adhesions (ranging from 0 to 5). Ethics and Dissemination The study findings will be disseminated at regional, national, and international conferences and through peer-reviewed scientific journals. Trial Registration The trial was registered in the UMIN Clinical Trials Registry (UMIN-CTR: UMIN000038998) on 6 January 2020.

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Abstract MP34: The Association Between Periodontal Disease And Incident Heart Failure: The Atherosclerosis Risk In Communities Study

Circulation ◽

10.1161/circ.143.suppl_1.mp34 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Rebecca L Molinsky ◽

Faye L Norby ◽

Bing Yu ◽

Amil M Shah ◽

Pamela L Lutsey ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Periodontal Disease ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Atherosclerosis Risk In Communities ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Incident Heart Failure

Introduction: Periodontal disease, resulting from inflammatory host-response to dysbiotic subgingival microbiota, has been associated with incident hypertension, heart attack, stroke and diabetes. Limited data exist investigating the prospective relationship between periodontal disease and incident heart failure (HF) and HF subtypes. We hypothesize that periodontal disease is associated with increased risk for heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Methods: We studied 6,707 participants enrolled in the Atherosclerosis Risk in Communities Study who received a full-mouth clinical periodontal examination at visit 4 (1996-1998) and had longitudinal follow-up starting in 2005. Participants were classified as being periodontally healthy, having periodontal disease (based on the Periodontal Profile Classification (PPC)), or being edentulous. Hospitalization records were reviewed, and HF events were adjudicated and classified as HFpEF, HFrEF or HF of unknown ejection fraction (HFunknownEF) from 2005-2018. We used multivariable-adjusted Cox proportional hazards models to assess the association between periodontal disease or edentulism and incident HF. Results: Among participants 58% had periodontitis and 19% were edentulous. During a median follow-up time of 13 years, 1,178 cases of incident HF occurred (350 HFpEF, 319 HFrEF and 509 HFunknownEF). Periodontal disease and being edentulous were both associated with increased risk for both HFpEF and HFrEF (Table). Conclusion: Periodontal disease measured in mid-life was associated with both incident HFpEF and HFrEF. Adverse microbial exposures underlying periodontal disease might represent a modifiable risk factor for inflammation-induced heart failure pathophysiology.

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P6360Prognostic value of polypharmacy in patients with heart failure

European Heart Journal ◽

10.1093/eurheartj/ehz746.0956 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Fujita ◽

K Takabayashi ◽

K Iwatsu ◽

K Matsumura ◽

T Ikeda ◽

...

Keyword(s):

Heart Failure ◽

Hospital Readmission ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Medication Schedule ◽

Significant Difference ◽

Patients With Heart Failure ◽

Clinical Background ◽

The Impact

Abstract Background Polypharmacy creates an increased patient's burden by drug-drug interactions and poor adherence. However, there are very few studies available evaluating the association of polypharmacy with hospital readmission in patients with heart failure (HF). Purpose The aim of this study was to investigate the impact of polypharmacy on hospital readmission for HF. Methods We enrolled 1253 patients who were hospitalized with acute heart failure (AHF) or acute exacerbation of chronic heart failure in the Kitakawachi Clinical Background and Outcome of Heart Failure Registry (KICKOFF Registry) from April 2015 to July 2018 (age 78.1±11.5 years, male 51.4%). Our Registry is a prospective multicenter community-based cohort study of HF patients in Japan. The inclusion criteria for the registry was a diagnosis of HF during hospitalization according to the Framingham criteria, and there were no exclusion criteria. From data at discharge, we collected data on clinical characteristics, medication schedule, and social backgrounds. We defined polypharmacy as the use of seven or more medications. The primary end point was HF rehospitalization within 1 year after discharge. Cox proportional hazards regression analysis was used to describe the association between polypharmacy and 1-year HF rehospitalization, controlling for potential confounding factors. Results In this study, the prevalence of polypharmacy was 59.7% of all patients. Patients with polypharmacy were more likely to have comorbidities such as hypertension, dyslipidemia, diabetes, chronic kidney disease, coronary artery disease and dementia. They also had lower EF (50.9±0.64 vs 53.6±0.80, p<0.01), compared to patients without polypharmacy. There was no significant difference in age, gender and BMI, compared to patients without polypharmacy. During the follow-up period, a total of 278 patients (24.9%) were readmitted for HF. In Kaplan-Meier analyses, hospital readmission for HF during 1-year follow-up was significantly higher in patients with polypharmacy (p<0.01) (figure). After adjusting for gender, age, EF, and the other co-morbidities, polypharmacy was independently associated with higher risk of rehospitalization for HF (hazard ratio 1.28, 95% confidence interval, 1.07–1.52, p<0.01). Conclusion Polypharmacy is an independent predictor of hospital readmission for HF. Our study suggests the need for developing an effective strategy to choose the appropriate drugs in patients with HF. Acknowledgement/Funding Nakajima Steel Pipe

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Abstract 131: Cognitive Impairment Predicts Mortality in Patients with Heart Failure

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.131 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Howard Lan ◽

Lee Ann Hawkins ◽

Helme Silvet

Keyword(s):

Heart Failure ◽

Cognitive Impairment ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Mortality Data ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Study Population

Introduction: In our previously published study, we evaluated a Veteran cohort of 250 outpatients with heart failure (HF) and found 58% (144 of 250) incidence of previously undiagnosed cognitive impairment (CI). Previous studies have suggested that HF patients with CI have worse clinical outcomes including higher mortality but this has not been studied in the Veteran population. Methods: Current study was designed to prospectively follow this cohort of 250 patients. Cognitive function was previously evaluated in all patients at baseline using the St. Luis University Mental Status (SLUMS) exam. The primary outcome for this follow-up study was all-cause mortality. Data analysis including Cox regression analysis and Kaplan-Meier curves were generated using SPSS. Results: The study population was predominantly Caucasian (72%, 179 of 250) and male (99%, 247 of 250) with mean age of 69 ± 10 years. Mean follow up was 31 ± 11 months. During follow up, 26% (64 of 250) of patients died. Univariate and multivariate Cox proportional hazards regression analyses were performed and shown in Table 1. Using the SLUMS score, subjects were stratified into three groups: no CI (42%, 106 of 250), mild CI (42%, 104 of 250), and severe CI (16%, 40 of 250). Kaplan-Meier survival curves were generated to compare the three CI groups in Figure 1. Conclusion: Current study demonstrates that CI is an independent risk factor for mortality in outpatient HF patients. This is an important finding because CI is commonly unrecognized in this vulnerable population. Routine CI screening could help to identify those who are at greater risk for worse outcomes. Future studies are needed to derive possible interventions to improve outcomes in these patients.

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Risk-Based Intensive Blood Pressure Lowering and Prevention of Heart Failure: A SPRINT Post Hoc Analysis

Hypertension ◽

10.1161/hypertensionaha.121.18315 ◽

2021 ◽

Author(s):

Rebecca J. Molsberry ◽

Leah Rethy ◽

Michael C. Wang ◽

Rupal C. Mehta ◽

Donald M. Lloyd-Jones ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Adverse Events ◽

Proportional Hazards ◽

The United States ◽

Cox Proportional Hazards ◽

Risk Category ◽

Serious Adverse Events ◽

Intensive Blood Pressure

The SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated that intensive blood pressure (BP) lowering (target<120 mm Hg) was more effective in preventing heart failure (HF) compared with standard BP goals (target<140 mm Hg). However, intensive BP lowering also led to an increase in serious adverse events. We aimed to identify a subset of the clinical trial population who might derive the greatest benefit from intensive BP lowering for prevention of HF using a previously validated HF risk prediction model. SPRINT participants without prevalent cardiovascular disease were stratified into HF risk tertiles based on predicted HF risk. We performed Kaplan-Meier Survival analysis and multivariable Cox proportional hazards models to test the effect of intensive versus standard BP lowering on incident HF in each tertile of predicted HF risk. A total of 6911 individuals were included and 77 incident HF events occurred over a median follow-up time of 3.3 (interquartile range, 2.9–3.8) years. A reduction in risk of HF was observed among those randomized to intensive BP lowering in each risk tertile but was significant only in the highest HF risk category (risk tertile 1: hazard ratio, 0.86 [95% CI, 0.29–2.56]; risk tertile 2: 0.54 [0.23–1.30]; risk tertile 3: 0.46 [0.24–0.88]). Serious adverse events were frequent in all groups. While the short follow-up may lead to an underestimation of benefit in the lower predicted risk groups, prioritizing intensive BP lowering in those at highest predicted HF risk may help to reduce the high burden of HF in the United States.

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Predicting Heart Failure Events in Patients with Coronary Heart Disease and Impaired Glucose Tolerance: Insights from the Acarbose Cardiovascular Evaluation (ACE) Trial

10.21203/rs.3.rs-40817/v1 ◽

2020 ◽

Author(s):

Malgorzata Wamil ◽

John J. V. McMurray ◽

Charles A.B. Scott ◽

Ruth L. Coleman ◽

Yihong Sun ◽

...

Keyword(s):

Heart Failure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Plasma Creatinine ◽

Cardiovascular Evaluation

Abstract BACKGROUND Heart failure is a fatal complication of type 2 diabetes but little is known about its incidence in patients with impaired glucose tolerance (IGT). We used Acarbose Cardiovascular Evaluation (ACE) trial data to identify predictors of hospitalisation for heart failure (hHF) or cardiovascular (CV) death in patients with coronary heart disease (CHD) and IGT randomized to acarbose 50mg TID or placebo. METHODS Independent hHF or hHF/CV death risk factors were determined using Cox proportional hazards models, with participants censored at first hHF event, CV death, or end of follow-up. Baseline variables evaluated included age, sex, body mass index, smoking, plasma creatinine, prior CV events, fasting and 2-hour post-load glucose, and HbA1c. Those with nominal univariate associations (P<0.1) were entered into a multivariate model, with P<0.05 required for retention. Recurrent hHF events were analysed using the Andersen-Gill model, a generalisation of the Cox proportional hazards model, and logistic regression was used for death following hHF. RESULTS During median 5 years follow-up, hHF/CV death occurred in 393 (6.0%) ACE participants (triggered by 138 hHF events and 255 CV deaths). Significant hHF/CV death multivariate predictors were higher age and plasma creatinine, as well as prior heart failure (HF), myocardial infarction (MI), atrial fibrillation (AF) and stroke. Acarbose, compared with placebo, did not reduce hHF/CV death (hazard ratio [HR] 0.89, 95% CI 0.64–1.24, P=0.48) or hHF (HR 0.90, 95% CI 0.74–1.10, P=0.32). Forty of the 138 participants who experienced hHF had ³2 admissions, and 58 died. No significant effect of acarbose, compared with placebo, was seen for recurrent hHF (HR 1.19, 95% CI 0.92-1.55, p=0.19), or for all-cause mortality (odds ratio 1.49, 95% CI 0.75-2.95, p=0.25).CONCLUSIONS Patients with CHD and IGT at greater risk of hHF/CV death were older with higher plasma creatinine, and had prior HF, MI, AF or stroke. Addition of acarbose to optimized CV therapy did not reduce the risk of hHF/CV death or hHF. Clinical Trial Registration: ClinicalTrials.gov, number NCT00829660, and the International Standard Randomised Controlled Trial Number registry, number ISRCTN91899513.

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Sleep Timing May Predict Congestive Heart Failure: A Community‐Based Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.120.018385 ◽

2021 ◽

Vol 10 (6) ◽

Author(s):

Bin Yan ◽

Ruohan Li ◽

Jiamei Li ◽

Xuting Jin ◽

Fan Gao ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Cohort Study ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Health Study ◽

Sleep Timing ◽

Cox Proportional Hazards Models ◽

Increased Risk

Background Previous studies have suggested that sleep timing is associated with cardiovascular risk factors. However, there is no evidence on the relationship between sleep timing and congestive heart failure (CHF). We aimed to examine this relationship in this study. Methods and Results We recruited 4765 participants (2207 men; mean age, 63.6±11.0 years) from the SHHS (Sleep Heart Health Study) database in this multicenter prospective cohort study. Follow‐up was conducted until the first CHF diagnosis between baseline and the final censoring date. Sleep timing (bedtimes and wake‐up times on weekdays and weekends) was based on a self‐reported questionnaire. Cox proportional hazard models were constructed to investigate the association between sleep timing and CHF. During the mean follow‐up period of 11 years, 519 cases of CHF (10.9%) were reported. The multivariable Cox proportional hazards models revealed that participants with weekday bedtimes >12:00 am (hazard ratio [HR], 1.56; 95% CI, 1.15–2.11; P =0.004) and from 11:01 pm to 12:00 am (HR, 1.25; 95% CI, 1.00–1.56; P =0.047) had an increased risk of CHF compared with those with bedtimes from 10:01 pm to 11:00 pm . After stratified analysis, the association was intensified in participants with a self‐reported sleep duration of 6 to 8 hours. Furthermore, wake‐up times >8:00 am on weekdays (HR, 1.53; 95% CI, 1.07–2.17; P =0.018) were associated with a higher risk of incident CHF than wake‐up times ≤6:00 am . Conclusions Delayed bedtimes (>11:00 pm ) and wake‐up times (>8:00 am ) on weekdays were associated with an increased risk of CHF.

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Abstract 17033: Comparative Effectiveness of Pulmonary Vascular Resistance, Capacitance, and Resistance-Capacitance Time in the ESCAPE Trial

Circulation ◽

10.1161/circ.138.suppl_1.17033 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Nora Tolbert ◽

Kenneth Bilchick ◽

Alex Parker ◽

James Bergin ◽

Sula Mazimba

Keyword(s):

Heart Failure ◽

Pulmonary Vascular Resistance ◽

Vascular Resistance ◽

Proportional Hazards ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Escape Trial ◽

The Impact

Introduction: Right ventricular (RV) function portends adverse outcomes in heart failure (HF). Markers of RV load include pulmonary vascular resistance (PVR), pulmonary capacitance (PC), and the Resistance-Capacitance Time (RCT), a product of PVR and PC. The impact of changes in these indices during hemodynamic optimization is unknown. Hypothesis: PVR, PC and RCT after therapy and changes in these indices during therapy would be differentially associated with outcomes in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization (PAC) Effectiveness (ESCAPE) trial. Methods: Using Cox proportional hazards regression and Kaplan Meier survival analysis, we analyzed associations of PVR, PC, and RCT indices with the outcomes of death, transplantation, and left ventricular assist device (DTxLVAD) and a combined rehospitalization outcome (DTxLVADH) during 6 months follow-up. Results: Among 138 patients (age 56.9 ± 13.6 years, 30.4% female), PVR at the end of therapy was associated with increased DTxLVAD (HR 1.28 per 1 W.U. increase; 95% CI 1.11-1.47; P=0.0007), and final PC was associated with a decreased DTxLVAD (HR 0.60 per unit PC increase; 95% CI 0.41-0.87; P=0.0007). The final RCT was not associated with DTxLVAD (HR 0.70; CI 0.48-1.03; P=0.07). Changes in PVR during therapy (median -0.38 W.U.; IQR -1.57 to 0.62 W.U.) were associated with increased rehospitalization (DTxLVADH) during follow-up (HR 1.13; 95% CI 1.02-1.25; P=0.02). In a binary analysis, patients with an increase in PVR > 0.1 W.U. during therapy had a trend for more DTxLVADH events (log-rank P=0.058; Figure). Changes in PVR and PC during therapy were not associated with survival. Conclusions: Final PVR and PAC measurements but not changes in these parameters during therapy were associated with survival, although changes in PVR during therapy were associated with rehospitalization. More studies are needed to understand the utility of RV load parameters in HF therapy.

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