Brief Report
Pericardial Adipose Tissue Volume and Left Ventricular Assist Device-Associated Outcomes

https://doi.org/10.1016/j.cardfail.2021.06.021Get rights and content

ABSTRACT

Background

Pericardial adipose tissue (PAT) is associated with adverse cardiovascular outcomes in those with and without established heart failure (HF). However, it is not known whether PAT is associated with adverse outcomes in patients with end-stage HF undergoing left ventricular assist device (LVAD) implantation. This study aimed to evaluate the associations between PAT and LVAD-associated outcomes.

Methods and Results

We retrospectively measured computed tomography-derived PAT volumes in 77 consecutive adults who had available chest CT imaging prior to HeartMate 3 LVAD surgery between October 2015 and March 2019 at Duke University Hospital. Study groups were divided into above-median (≥219 cm3) and below-median (<219 cm3) PAT volume. Those with above-median PAT had a higher proportion of atrial fibrillation, chronic kidney disease and ischemic cardiomyopathy. Groups with above-median vs below-median PAT had similar Kaplan-Meier incidence rates over 2 years for (1) composite all-cause mortality, redo-LVAD surgery and cardiac transplantation (35.9 vs 32.2%; log-rank P = 0.65) and (2) composite incident hospitalizations for HF, gastrointestinal bleeding, LVAD-related infection, and stroke (61.5 vs 60.5%; log-rank P = 0.67).

Conclusions

In patients with end-stage HF undergoing LVAD therapy, PAT is not associated with worse 2-year LVAD-related outcomes. The significance of regional adiposity vs obesity in LVAD patients warrants further investigation.

Section snippets

Methods

We included consecutive adults without pre-existing LVADs who underwent new HeartMate 3 (HM3) LVAD implantation between October 1, 2015, and March 31, 2019, at Duke University Hospital. Patients with available clinical CT scans for preoperative anatomic or respiratory assessments within 6 months prior to LVAD implantation were included for PAT measurements.

Results

Among 140 patients who underwent HM3 LVAD implantation, 77 (5%) had available clinical CT scans for PAT-volume measurements preLVAD (median 7 days). The mean follow-up time was 1.6 ± 0.7 years. Preoperative and periprocedural characteristics are displayed in Table 1. The mean age was 61.6 ± 11.9 years, 78% were male, and the mean BMI was 29.1 ± 6.8 kg/m2. Compared to patients with below-median PAT volume, patients with above-median PAT volume (≥219 cm3) were more likely to have atrial

Discussion

In this population with end-stage HF undergoing LVAD, PAT and BMI were highly discordant. Higher PAT was not associated with either composite all-cause mortality, redo-LVAD surgery and cardiac transplantation or with composite incident LVAD-related hospitalizations. Obesity, a well-established risk factor in patients undergoing LVAD surgery, was, similarly, not associated with adverse outcomes following LVAD in our study population.

PAT is increasingly recognized as a distinct clinical entity in

Disclosures

VNR is supported by a National Institutes of Health (NIH) Training Grant (NIH 5T32HL069749-17); FR receives research funding support from Bracco Diagnostics. RTG receives consulting fees for Bayer Pharma, Invivo, DxTx Medical, Bard; Russell serves on the DSMB for Abbott Laboratories and receives consulting fees for Medtronic; MF is supported by NHLBI K23HL151744 from the National Heart, Lung, and Blood Institute, the American Heart Association grant no. 20IPA35310955, Mario Family Award, Duke

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