Heartlogic Heart Failure Index As Covid Index: Predicting Severity Of Covid-19 In Patients With Advanced Heart Failure
HFSA ePoster Library. Panta U. 09/10/21; 343486; 251
Utsab Panta
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Abstract
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Introduction: The Model for End-Stage Liver Disease (MELD) risk score has been linked with poor outcomes for patients undergoing left ventricular assist device (LVAD) placement. However, many patients are on anticoagulation before LVAD and thus the MELD-XI (eXcluding International Normalized Ratio) has been proposed as an alternate score. Prior studies have reviewed MELD-XI performance in patients with mainly HeartMate II (HM2) and HeartWare HVAD devices. We systematically evaluated the impact of MELD-XI on outcomes following LVAD in a modern cohort including HeartMate3 (HM3) devices.
Hypothesis: An elevated MELD -XI will have a higher risk of adverse perioperative events and lower 24-month survival.
Methods: At a single center, 177 patients received LVAD therapy between June 2011 and October 2018. Patients were classified into either low MELD-XI (<17, n=83) or high MELD-XI (≥ 17, n=33) based on preoperative levels. A cut off of 17 was chosen based on previously established values. 61 patients were excluded due to missing data.
Baseline characteristics and post-operative adverse events were compared using Fishers exact and Wilcoxon rank sum tests. Pearson correlation coefficient was used to assess for linear correlation between pre-operative MELD-XI and perioperative transfusion requirements. Kaplan-Meir plot and log-rank statistics were used for survival analysis. Unadjusted and adjusted Cox models were used to examine the association of high MELD-XI and 24-month all-cause mortality.
Results: Both cohorts consisted of predominately Caucasian males with an average age of 62 who had LVAD implanted as a destination therapy (68%). Of the LVAD types, HM2 was the most commonly implanted (61%), followed by HM3 (28%) and HVAD (11%).
Red blood cell transfusion in the first 24 hours and 30 days post LVAD implantation did not reveal a strong relationship (r=0.23, p=0.01) and (r=0.11, p=0.23). Post-operative bleeding was no different between groups (20.5 vs 37.5%, p=0.06). However, a higher MELD-XI was associated with other post-operative adverse events including renal failure (7.2 vs 37.5%, p<0.001), stroke (6.1 vs 18.7%, p=0.04), need for tracheostomy (10.8 vs 31.2%, p=0.008) and hepatic dysfunction (4.8 vs 34.4%, p=0.02).
24-month survival was equal across groups (p=0.08). Risk adjusted Cox proportional hazard ratios for 24-month mortality for a MELD-XI ≥ 17 was 1.53 (0.92 - 2.53, p=0.10).
Conclusions: A preoperative MELD-XI score of >17 identifies LVAD candidates, including those planned to receiving HM3, with a higher risk of mortality and other postoperative adverse events but not necessarily bleeding.
Hypothesis: An elevated MELD -XI will have a higher risk of adverse perioperative events and lower 24-month survival.
Methods: At a single center, 177 patients received LVAD therapy between June 2011 and October 2018. Patients were classified into either low MELD-XI (<17, n=83) or high MELD-XI (≥ 17, n=33) based on preoperative levels. A cut off of 17 was chosen based on previously established values. 61 patients were excluded due to missing data.
Baseline characteristics and post-operative adverse events were compared using Fishers exact and Wilcoxon rank sum tests. Pearson correlation coefficient was used to assess for linear correlation between pre-operative MELD-XI and perioperative transfusion requirements. Kaplan-Meir plot and log-rank statistics were used for survival analysis. Unadjusted and adjusted Cox models were used to examine the association of high MELD-XI and 24-month all-cause mortality.
Results: Both cohorts consisted of predominately Caucasian males with an average age of 62 who had LVAD implanted as a destination therapy (68%). Of the LVAD types, HM2 was the most commonly implanted (61%), followed by HM3 (28%) and HVAD (11%).
Red blood cell transfusion in the first 24 hours and 30 days post LVAD implantation did not reveal a strong relationship (r=0.23, p=0.01) and (r=0.11, p=0.23). Post-operative bleeding was no different between groups (20.5 vs 37.5%, p=0.06). However, a higher MELD-XI was associated with other post-operative adverse events including renal failure (7.2 vs 37.5%, p<0.001), stroke (6.1 vs 18.7%, p=0.04), need for tracheostomy (10.8 vs 31.2%, p=0.008) and hepatic dysfunction (4.8 vs 34.4%, p=0.02).
24-month survival was equal across groups (p=0.08). Risk adjusted Cox proportional hazard ratios for 24-month mortality for a MELD-XI ≥ 17 was 1.53 (0.92 - 2.53, p=0.10).
Conclusions: A preoperative MELD-XI score of >17 identifies LVAD candidates, including those planned to receiving HM3, with a higher risk of mortality and other postoperative adverse events but not necessarily bleeding.
Introduction: The Model for End-Stage Liver Disease (MELD) risk score has been linked with poor outcomes for patients undergoing left ventricular assist device (LVAD) placement. However, many patients are on anticoagulation before LVAD and thus the MELD-XI (eXcluding International Normalized Ratio) has been proposed as an alternate score. Prior studies have reviewed MELD-XI performance in patients with mainly HeartMate II (HM2) and HeartWare HVAD devices. We systematically evaluated the impact of MELD-XI on outcomes following LVAD in a modern cohort including HeartMate3 (HM3) devices.
Hypothesis: An elevated MELD -XI will have a higher risk of adverse perioperative events and lower 24-month survival.
Methods: At a single center, 177 patients received LVAD therapy between June 2011 and October 2018. Patients were classified into either low MELD-XI (<17, n=83) or high MELD-XI (≥ 17, n=33) based on preoperative levels. A cut off of 17 was chosen based on previously established values. 61 patients were excluded due to missing data.
Baseline characteristics and post-operative adverse events were compared using Fishers exact and Wilcoxon rank sum tests. Pearson correlation coefficient was used to assess for linear correlation between pre-operative MELD-XI and perioperative transfusion requirements. Kaplan-Meir plot and log-rank statistics were used for survival analysis. Unadjusted and adjusted Cox models were used to examine the association of high MELD-XI and 24-month all-cause mortality.
Results: Both cohorts consisted of predominately Caucasian males with an average age of 62 who had LVAD implanted as a destination therapy (68%). Of the LVAD types, HM2 was the most commonly implanted (61%), followed by HM3 (28%) and HVAD (11%).
Red blood cell transfusion in the first 24 hours and 30 days post LVAD implantation did not reveal a strong relationship (r=0.23, p=0.01) and (r=0.11, p=0.23). Post-operative bleeding was no different between groups (20.5 vs 37.5%, p=0.06). However, a higher MELD-XI was associated with other post-operative adverse events including renal failure (7.2 vs 37.5%, p<0.001), stroke (6.1 vs 18.7%, p=0.04), need for tracheostomy (10.8 vs 31.2%, p=0.008) and hepatic dysfunction (4.8 vs 34.4%, p=0.02).
24-month survival was equal across groups (p=0.08). Risk adjusted Cox proportional hazard ratios for 24-month mortality for a MELD-XI ≥ 17 was 1.53 (0.92 - 2.53, p=0.10).
Conclusions: A preoperative MELD-XI score of >17 identifies LVAD candidates, including those planned to receiving HM3, with a higher risk of mortality and other postoperative adverse events but not necessarily bleeding.
Hypothesis: An elevated MELD -XI will have a higher risk of adverse perioperative events and lower 24-month survival.
Methods: At a single center, 177 patients received LVAD therapy between June 2011 and October 2018. Patients were classified into either low MELD-XI (<17, n=83) or high MELD-XI (≥ 17, n=33) based on preoperative levels. A cut off of 17 was chosen based on previously established values. 61 patients were excluded due to missing data.
Baseline characteristics and post-operative adverse events were compared using Fishers exact and Wilcoxon rank sum tests. Pearson correlation coefficient was used to assess for linear correlation between pre-operative MELD-XI and perioperative transfusion requirements. Kaplan-Meir plot and log-rank statistics were used for survival analysis. Unadjusted and adjusted Cox models were used to examine the association of high MELD-XI and 24-month all-cause mortality.
Results: Both cohorts consisted of predominately Caucasian males with an average age of 62 who had LVAD implanted as a destination therapy (68%). Of the LVAD types, HM2 was the most commonly implanted (61%), followed by HM3 (28%) and HVAD (11%).
Red blood cell transfusion in the first 24 hours and 30 days post LVAD implantation did not reveal a strong relationship (r=0.23, p=0.01) and (r=0.11, p=0.23). Post-operative bleeding was no different between groups (20.5 vs 37.5%, p=0.06). However, a higher MELD-XI was associated with other post-operative adverse events including renal failure (7.2 vs 37.5%, p<0.001), stroke (6.1 vs 18.7%, p=0.04), need for tracheostomy (10.8 vs 31.2%, p=0.008) and hepatic dysfunction (4.8 vs 34.4%, p=0.02).
24-month survival was equal across groups (p=0.08). Risk adjusted Cox proportional hazard ratios for 24-month mortality for a MELD-XI ≥ 17 was 1.53 (0.92 - 2.53, p=0.10).
Conclusions: A preoperative MELD-XI score of >17 identifies LVAD candidates, including those planned to receiving HM3, with a higher risk of mortality and other postoperative adverse events but not necessarily bleeding.
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