The Anemia Stress Index—Anemia, Transfusions, and Mortality in Patients with Continuous Flow Ventricular Assist Devices

Abstract

We aimed to identify a simple metric accounting for peri-procedural hemoglobin changes, independent of blood product transfusion strategies, and assess its correlation with outcomes in patients undergoing left ventricular assist device (LVAD) implantation We included consecutive patients undergoing LVAD implantation at a single center between 10/1/2008 and 6/1/2014. The anemia stress index (ASI), defined as the sum of number of packed red blood cells transfused and the hemoglobin changes after LVAD implantation, was calculated for each patient at 24 h, discharge, and 3 months after LVAD implantation. Our cohort included 166 patients (80.1% males, mean age 56.3 ± 15.6 years) followed up for a median of 12.3 months. Increases in ASI per unit were associated with a higher hazard for all-cause mortality and early RV failure. The associations between the ASI and all-cause mortality persisted after multivariable adjustment, irrespective of when it was calculated (adjusted HR of 1.11, 95% CI 1.03–1.20 per unit increase in ASI). Similarly, ASI at 24 h after implant was associated with early RV failure despite multivariable adjustment (OR 1.09, 95% CI 1.05–1.14). We present a novel metric, the ASI, that is correlated with an increased risk for all-cause mortality and early RV failure in LVAD recipients.

Computational evaluation of heart failure and continuous flow left ventricular assist device support in anaemia

“…Moreover, left and right ventricular unloading may remain suboptimal and cause functional mitral and tricuspid valve regurgitation, and right atrial pressure may decrease during CF‐LVAD support because of anaemia 19 . Also, suboptimal right ventricular unloading due to anaemia may cause right early ventricular dysfunction 20 . Increased reduction of haemoglobin over time also increases the risk of mortality in patients implanted with CF‐LVAD 21,22 …”

“…19 Also, suboptimal right ventricular unloading due to anaemia may cause right early ventricular dysfunction. 20 Increased reduction of haemoglobin over time also increases the risk of mortality in patients implanted with CF-LVAD. 21,22 A numerical model simulating clinical outcomes of anaemia in heart failure patients can help to evaluate possible CF-LVAD support strategies.…”