Pre-operative mortality risk assessment in patients with continuous-flow left ventricular assist devices: Application of the HeartMate II risk score

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Pre-operative mortality risk assessment in patients with continuous-flow left ventricular assist devices: Application of the HeartMate II risk score Sunu S. Thomas, MD, MSc, Nadav Nahumi, BA, Jason Han, BA, Matthew Lippel, BA, Paolo Colombo, MD, Melana Yuzefpolskaya, MD, Hiroo Takayama, MD, PhD, Yoshifumi Naka, MD, PhD, Nir Uriel, MD, Ulrich P. Jorde, MD The Journal of Heart and Lung Transplantation Volume 33, Issue 7, Pages 675-681 (July 2014) DOI: 10.1016/j.healun.2014.02.011 Copyright © 2014 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 1 Patient stratification according to HMRS profile and CF-LVAD strategy. CF-LVAD, continuous-flow left ventricular assist device; BTT, bridge to transplantation; DT, destination therapy (*p < 0.05). The Journal of Heart and Lung Transplantation 2014 33, 675-681DOI: (10.1016/j.healun.2014.02.011) Copyright © 2014 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 2 HMII CF-LVAD survival curve. Kaplan–Meier survival analysis estimating respective 90-day and 1-year survival rates of 91.1 ± 2.0%, and 83.2 ± 2.9%. Data reported as median ± SE. The Journal of Heart and Lung Transplantation 2014 33, 675-681DOI: (10.1016/j.healun.2014.02.011) Copyright © 2014 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 3 HMII CF-LVAD survival curve according to device strategy. Kaplan–Meier survival analysis demonstrating similar estimated survival in BTT and DT patients at 90 days (92.2 ± 2.2% vs 88.0 ± 4.6%) and 1 year (84.7 ± 3.4% vs 79.7 ± 5.7%) (p = 0.31). The Journal of Heart and Lung Transplantation 2014 33, 675-681DOI: (10.1016/j.healun.2014.02.011) Copyright © 2014 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 4 Pre-operative HMRS stratification yields similar 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 1 year (HMRS Low 85.5 ± 3.8%, HMRS Medium 79.3 ± 5.5%, HMRS High 82.4 ± 8.4%) after LVAD implantation (p = 0.43). HMRS, HeartMate II risk score; LVAD, left ventricular assist device. Data reported as percent with standard error. The Journal of Heart and Lung Transplantation 2014 33, 675-681DOI: (10.1016/j.healun.2014.02.011) Copyright © 2014 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 5 Kaplan–Meier survival estimates at 90 days in BTT CF-LVAD patients stratified according to HMRS profile. Pre-operative HMRS stratification yields similar Kaplan–Meier survival estimates for BTT at 90 days (HMRS Low 91.8 ± 3.0%, HMRS Medium 93.6 ± 3.6%, HMRS High 87.8 ± 8.1%) and 1 year (HMRS Low 84.9 ± 4.3; HMRS Medium 79.6 ± 8.2%; HMRS High 87.8 ± 8.1%) (p = 0.998). BTT, bridge to transplant; HMRS, HeartMate II risk score; CF-LVAD, continuous-flow left ventricular assist device. Data reported as percent with standard error. The Journal of Heart and Lung Transplantation 2014 33, 675-681DOI: (10.1016/j.healun.2014.02.011) Copyright © 2014 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 6 Kaplan–Meier survival estimates for DT CF-LVAD patients stratified according to HMRS risk were not different at 90 days (HMRS Low 86.7 ± 8.8%, HMRS Medium 88.5 ± 6.3%, HMRS High 88.9 ± 10.5%) and at 1 year (HMRS Low 86.7 ± 8.8%, HMRS Medium 76.6 ± 8.4%, HMRS High 77.8 ± 13.9%; p = 0.219). DT, destination therapy; HMRS, HeartMate II Risk Score; CF-LVAD, continuous-flow left ventricular assist device. Data reported as percent with standard error. The Journal of Heart and Lung Transplantation 2014 33, 675-681DOI: (10.1016/j.healun.2014.02.011) Copyright © 2014 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 7 Receiver operating characteristic curve of pre-operative HMRS stratification demonstrating poor 90-day mortality discrimination after LVAD implantation (AUC = 0.56). HMRS, HeartMate II risk score; LVAD, left ventricular assist device. The Journal of Heart and Lung Transplantation 2014 33, 675-681DOI: (10.1016/j.healun.2014.02.011) Copyright © 2014 International Society for Heart and Lung Transplantation Terms and Conditions