title: Low blood pressure, low serum cholesterol and anemia predict early necessity of ventricular assist device implantation in patients with advanced heart failure at the time of referral from non-ventricular assist device institutes.
abstract: BACKGROUND
  The timing of ventricular assist device (VAD) implantation is always a matter of debate, especially when a patient is referred from a non-VAD institute. We focused on objective noninvasive parameters at the time of admission to a VAD implant center and analyzed the factors predicting the necessity of early VAD. METHODS AND RESULTS: We retrospectively analyzed advanced heart failure (HF) patients referred since January 2011, including patients less than 65 years old. They all had a history of hospitalization for HF management in non-VAD institutes within 1 month before referral. We excluded patients transferred with mechanical circulatory support. We enrolled 46 patients (40 males, 39.8±13.4 years old). Among them, 26 patients had a VAD implanted or died within 120 days. By multivariable logistic analysis using admission parameters, systolic blood pressure (BP) <93 mmHg [odds ratio (OR) 13.335], hemoglobin <12.7 g/dl (OR 12.175) and serum total cholesterol <144 mg/dl (OR 8.096) were significant predictors of early VAD requirement. We constructed a scoring system according to the ORs, and the area under the receiver-operating characteristic curve was 0.913.
  
  
  CONCLUSIONS
  Low BP, low serum cholesterol and anemia on admission predict early VAD in advanced HF patients who have been treated in non-VAD institutes. Such patients should be promptly referred to a VAD implant center.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo.
authors.forename: Takeo
authors.initials: T
authors.lastname: Fujino
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Imamura
authors.forename: Hironori
authors.initials: H
authors.lastname: Muraoka
authors.forename: Shun
authors.initials: S
authors.lastname: Minatsuki
authors.forename: Toshiro
authors.initials: T
authors.lastname: Inaba
authors.forename: Hisataka
authors.initials: H
authors.lastname: Maki
authors.forename: Osamu
authors.initials: O
authors.lastname: Kinoshita
authors.forename: Kan
authors.initials: K
authors.lastname: Nawata
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yao
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology*; D000886:Anthropometry; D019540:Area Under Curve; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002784:Cholesterol / Q000097:blood*; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000600:supply & distribution; D006801:Humans; D007022:Hypotension / Q000453:epidemiology*; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012372:ROC Curve; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D002317:Cardiovascular Agents; D002784:Cholesterol