Heart Failure; Patients with left-sided heart failure who get implant devices to improve the pumping of their hearts may be more likely to develop heart failure on the opposite side of their hearts if they are pre-treat with off-label selective vasodilator drugs, according to new research published in Circulation: Heart Failure, an American Heart Association journal.
Heart failure in patients
Between 10% and 40% of patients who undergo left-ventricular assist device (LVAD) implantation for left-side heart failure develop right-side heart failure a complication that spells worse outcomes. To head off the complication, physicians sometimes prescribe preemptive treatment with off-label selective vasodilator drugs called phosphodiesterase 5 inhibitors (PDE5i).
PDE5i drugs are currently approve for use to avoid right heart failure in patients; so with pulmonary arterial hypertension due to causes other than heart disease; which is a different patient group from the ones follow in this study. PDE5i drugs dilate the pulmonary artery the large vessel that carries blood away from the heart’s right side and into the lungs. A handful of small studies have shown a possible benefit to this off-label approach in some patients but affirmative data from large-scale studies have been lacking and the current study hopes to help close this gap.
An LVAD is a mechanical heart pump. It’s place inside a person’s chest, where it helps the heart pump; so oxygen-rich blood throughout the body. Unlike an artificial heart transplant; also LVADs do not replace the heart. LVADs help the heart do its job. The findings of the new study the largest analysis to date to assess; so the utility of this approach call the preemptive treatment with PDE5i drugs into question.
Pulmonary vascular disease
They found no benefit of this therapy in patients receiving LVAD devices; so including patients with pulmonary vascular disease or right ventricular dysfunction the very patients who might be expect to benefit most,” said study senior investigator Michael Kiernan, M.D., M.S., a cardiologist at Tufts Medical Center and assistant professor of medicine at Tufts University School of Medicine in Boston.
The results are base on analysis of 11,544 U.S. LVAD recipients who underwent implantation; so between 2012 and 2017. Of all device recipients, 1,199 (10%) receive pre-implantation treatment; so with PDE5i drugs which target the pulmonary artery to reduce the pressure in the heart’s right ventricle. Overall, 24% of all patients who got LVAD implants developed right side heart failure; but the group that got pre-implantation drugs did so at higher rates.
To minimize the possible effects of other factors that could bias the outcomes; so the researchers match 1,177 patients treated with PDE5i drugs to group of 1,177 patients who did not receive such preventive therapy; but were otherwise similar to the pre-treated group in terms of disease severity, age; also the presence of other diseases that could affect outcome and health status.
Compared with those who did not get drug therapy; so the group that received vasodilator drugs before LVAD implantation were 31% more likely to develop right side heart failure (29% for those treated, compared with 24% among those who did not receive pre-treatment). Additionally, the relative risk of bleeding within a week of LVAD surgery was 46% higher in patients; so receiving PDE5i therapy (12% of patients receiving therapy versus 8% of those not receiving this therapy), the analysis showed.