Pre-operative mortality risk assessment in patients with continuous-flow left ventricular assist devices

Application of the HeartMate II risk score

Sunu S. Thomas, Nadav Nahumi, Jason Han, Matthew Lippel, Paolo Colombo, Melana Yuzefpolskaya, Hiroo Takayama, Yoshifumi Naka, Nir Uriel, Ulrich P. Jorde

Research output: Contribution to journalArticle

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Abstract

Background Survival with left ventricular assist device (LVAD) therapy is dependent on appropriate patient selection. The HeartMate II risk score (HMRS) was recently derived and validated to predict 90-day mortality in clinical trial patients with continuous-flow LVADs. The aim of this study was to test HMRS validity in predicting survival at our institution. Methods We performed a retrospective analysis of patients implanted with HeartMate II (HMII; Thoratec, Pleasanton, CA) LVADs from March 31, 2004 to September 20, 2012 at the Columbia University Medical Center (CUMC). Patients were stratified according to HMRS profiles (HMRS Low < 1.58, 1.58 ≤HMRS Medium >2.48, HMRS High > 2.48) calculated using age, albumin, creatinine, international normalized ratio (INR) and center volume. Outcome was defined as survival at 90 days after device implantation. Results HeartMate II LVADs were implanted in 205 patients. Pre-operative data from 201 patients were categorized into HMRS Low (n = 101; 1.04 [0.64 to 1.31]), HMRS Medium (n = 73; 1.98 [1.78 to 2.25]) and HMRS High (n = 27, 3.07 [2.70 to 3.43]) (p < 0.0001). Kaplan-Meier survival estimates at 90 days (HMRS Low 91.0 ± 2.9%, HMRS Medium 91.7 ± 3.2%, HMRS High 88.7 ± 6.1%) and at 1 year (HMRS Low 85.5 ± 3.8%, HMRS Medium 79.3 ± 5.5%, HMRS High 82.4 ± 8.4%) after LVAD implantation were not statistically different (p = 0.43). Prediction of 90-day mortality by receiver operating characteristic was poor (AUC = 0.56). Conclusion HMRS stratification poorly discriminates 90-day mortality after HMII LVAD implantation at our institution. Its generalizability as a universal prognostic score may be limited.

Original languageEnglish (US)
Pages (from-to)675-681
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume33
Issue number7
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Heart-Assist Devices
Mortality
Survival
International Normalized Ratio
Kaplan-Meier Estimate
ROC Curve
Patient Selection

Keywords

  • continuous-flow left ventricular assist device
  • heart failure
  • mechanical circulatory support
  • mortality
  • prognosis
  • risk score

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery
  • Medicine(all)

Cite this

Pre-operative mortality risk assessment in patients with continuous-flow left ventricular assist devices : Application of the HeartMate II risk score. / Thomas, Sunu S.; Nahumi, Nadav; Han, Jason; Lippel, Matthew; Colombo, Paolo; Yuzefpolskaya, Melana; Takayama, Hiroo; Naka, Yoshifumi; Uriel, Nir; Jorde, Ulrich P.

In: Journal of Heart and Lung Transplantation, Vol. 33, No. 7, 2014, p. 675-681.

Research output: Contribution to journalArticle

Thomas, Sunu S. ; Nahumi, Nadav ; Han, Jason ; Lippel, Matthew ; Colombo, Paolo ; Yuzefpolskaya, Melana ; Takayama, Hiroo ; Naka, Yoshifumi ; Uriel, Nir ; Jorde, Ulrich P. / Pre-operative mortality risk assessment in patients with continuous-flow left ventricular assist devices : Application of the HeartMate II risk score. In: Journal of Heart and Lung Transplantation. 2014 ; Vol. 33, No. 7. pp. 675-681.
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abstract = "Background Survival with left ventricular assist device (LVAD) therapy is dependent on appropriate patient selection. The HeartMate II risk score (HMRS) was recently derived and validated to predict 90-day mortality in clinical trial patients with continuous-flow LVADs. The aim of this study was to test HMRS validity in predicting survival at our institution. Methods We performed a retrospective analysis of patients implanted with HeartMate II (HMII; Thoratec, Pleasanton, CA) LVADs from March 31, 2004 to September 20, 2012 at the Columbia University Medical Center (CUMC). Patients were stratified according to HMRS profiles (HMRS Low < 1.58, 1.58 ≤HMRS Medium >2.48, HMRS High > 2.48) calculated using age, albumin, creatinine, international normalized ratio (INR) and center volume. Outcome was defined as survival at 90 days after device implantation. Results HeartMate II LVADs were implanted in 205 patients. Pre-operative data from 201 patients were categorized into HMRS Low (n = 101; 1.04 [0.64 to 1.31]), HMRS Medium (n = 73; 1.98 [1.78 to 2.25]) and HMRS High (n = 27, 3.07 [2.70 to 3.43]) (p < 0.0001). Kaplan-Meier survival estimates at 90 days (HMRS Low 91.0 ± 2.9{\%}, HMRS Medium 91.7 ± 3.2{\%}, HMRS High 88.7 ± 6.1{\%}) and at 1 year (HMRS Low 85.5 ± 3.8{\%}, HMRS Medium 79.3 ± 5.5{\%}, HMRS High 82.4 ± 8.4{\%}) after LVAD implantation were not statistically different (p = 0.43). Prediction of 90-day mortality by receiver operating characteristic was poor (AUC = 0.56). Conclusion HMRS stratification poorly discriminates 90-day mortality after HMII LVAD implantation at our institution. Its generalizability as a universal prognostic score may be limited.",
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author = "Thomas, {Sunu S.} and Nadav Nahumi and Jason Han and Matthew Lippel and Paolo Colombo and Melana Yuzefpolskaya and Hiroo Takayama and Yoshifumi Naka and Nir Uriel and Jorde, {Ulrich P.}",
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T1 - Pre-operative mortality risk assessment in patients with continuous-flow left ventricular assist devices

T2 - Application of the HeartMate II risk score

AU - Thomas, Sunu S.

AU - Nahumi, Nadav

AU - Han, Jason

AU - Lippel, Matthew

AU - Colombo, Paolo

AU - Yuzefpolskaya, Melana

AU - Takayama, Hiroo

AU - Naka, Yoshifumi

AU - Uriel, Nir

AU - Jorde, Ulrich P.

PY - 2014

Y1 - 2014

N2 - Background Survival with left ventricular assist device (LVAD) therapy is dependent on appropriate patient selection. The HeartMate II risk score (HMRS) was recently derived and validated to predict 90-day mortality in clinical trial patients with continuous-flow LVADs. The aim of this study was to test HMRS validity in predicting survival at our institution. Methods We performed a retrospective analysis of patients implanted with HeartMate II (HMII; Thoratec, Pleasanton, CA) LVADs from March 31, 2004 to September 20, 2012 at the Columbia University Medical Center (CUMC). Patients were stratified according to HMRS profiles (HMRS Low < 1.58, 1.58 ≤HMRS Medium >2.48, HMRS High > 2.48) calculated using age, albumin, creatinine, international normalized ratio (INR) and center volume. Outcome was defined as survival at 90 days after device implantation. Results HeartMate II LVADs were implanted in 205 patients. Pre-operative data from 201 patients were categorized into HMRS Low (n = 101; 1.04 [0.64 to 1.31]), HMRS Medium (n = 73; 1.98 [1.78 to 2.25]) and HMRS High (n = 27, 3.07 [2.70 to 3.43]) (p < 0.0001). Kaplan-Meier survival estimates at 90 days (HMRS Low 91.0 ± 2.9%, HMRS Medium 91.7 ± 3.2%, HMRS High 88.7 ± 6.1%) and at 1 year (HMRS Low 85.5 ± 3.8%, HMRS Medium 79.3 ± 5.5%, HMRS High 82.4 ± 8.4%) after LVAD implantation were not statistically different (p = 0.43). Prediction of 90-day mortality by receiver operating characteristic was poor (AUC = 0.56). Conclusion HMRS stratification poorly discriminates 90-day mortality after HMII LVAD implantation at our institution. Its generalizability as a universal prognostic score may be limited.

AB - Background Survival with left ventricular assist device (LVAD) therapy is dependent on appropriate patient selection. The HeartMate II risk score (HMRS) was recently derived and validated to predict 90-day mortality in clinical trial patients with continuous-flow LVADs. The aim of this study was to test HMRS validity in predicting survival at our institution. Methods We performed a retrospective analysis of patients implanted with HeartMate II (HMII; Thoratec, Pleasanton, CA) LVADs from March 31, 2004 to September 20, 2012 at the Columbia University Medical Center (CUMC). Patients were stratified according to HMRS profiles (HMRS Low < 1.58, 1.58 ≤HMRS Medium >2.48, HMRS High > 2.48) calculated using age, albumin, creatinine, international normalized ratio (INR) and center volume. Outcome was defined as survival at 90 days after device implantation. Results HeartMate II LVADs were implanted in 205 patients. Pre-operative data from 201 patients were categorized into HMRS Low (n = 101; 1.04 [0.64 to 1.31]), HMRS Medium (n = 73; 1.98 [1.78 to 2.25]) and HMRS High (n = 27, 3.07 [2.70 to 3.43]) (p < 0.0001). Kaplan-Meier survival estimates at 90 days (HMRS Low 91.0 ± 2.9%, HMRS Medium 91.7 ± 3.2%, HMRS High 88.7 ± 6.1%) and at 1 year (HMRS Low 85.5 ± 3.8%, HMRS Medium 79.3 ± 5.5%, HMRS High 82.4 ± 8.4%) after LVAD implantation were not statistically different (p = 0.43). Prediction of 90-day mortality by receiver operating characteristic was poor (AUC = 0.56). Conclusion HMRS stratification poorly discriminates 90-day mortality after HMII LVAD implantation at our institution. Its generalizability as a universal prognostic score may be limited.

KW - continuous-flow left ventricular assist device

KW - heart failure

KW - mechanical circulatory support

KW - mortality

KW - prognosis

KW - risk score

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