Status 2 patients had poor prognosis without mechanical circulatory support.
BACKGROUND
Indication for mechanical circulatory support (MCS) has been a matter of debate in less sick status 2 patients.


RESULTS
Data were obtained from 183 consecutive patients assigned to stage D heart failure (HF) who were evaluated by the institutional review board of the University of Tokyo Hospital and then listed for heart transplantation as status 1 or 2 of the Japan Organ Transplant Network. Patients with status 2 (n=38) had a prognosis as poor as those dependent on inotropes (n=54) or MCS (n=91; P=0.615, log-rank test), and only 4 of them had eventual ventricular assist device (VAD) implantation (10.5%). Patients who eventually received VAD (n=92) had better 4-year survival than those without MCS among status 1 and 2 (P=0.030, log-rank test). On Cox regression analysis plasma B-type natriuretic peptide (BNP) >740pg/ml was the only significant predictor for 4-year survival among the status 2 group (P=0.014; hazard ratio, 8.267). Ten patients with status 2 died: 6 due to acute hemodynamic compromise and 4 due to ventricular fibrillation.


CONCLUSIONS
Prognosis in status 2 patients was as poor as that of those dependent on inotrope infusion or VAD, mostly because of out-of-hospital sudden death without MCS. Status 2 patients with considerably high plasma BNP may be good candidates for continuous flow VAD therapy.
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo.
Teruhiko
T
Imamura
Koichiro
K
Kinugawa
Masaru
M
Hatano
Takeo
T
Fujino
Toshiro
T
Inaba
Hisataka
H
Maki
Osamu
O
Kinoshita
Eisuke
E
Amiya
Kan
K
Nawata
Atsushi
A
Yao
Shunei
S
Kyo
Minoru
M
Ono
Issei
I
Komuro
D000328:Adult; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014693:Ventricular Fibrillation / Q000097:blood / Q000401:mortality* / Q000628:therapy*
D002316:Cardiotonic Agents