Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Circ J. 2013;77(1):96-104. doi: 10.1253/circj.cj-12-0686. Epub 2012 Sep 11.
It is often difficult to predict reversibility of liver or renal function after left ventricular assist device (LVAD) implantation in patients with stage D heart failure.
Data were obtained for 69 patients who had received a LVAD (18 continuous-flow, 51 pulsatile). Persistent hepatic or renal dysfunction was defined as levels of total bilirubin (TB) or creatinine (Cre) >1.5mg/dl at 6 months after LVAD implantation. TB score or Cre score was calculated: 0.15 × age+1.1 × (preoperative TB) or 0.2 × age+3.6 × (preoperative Cre), in which coefficients were determined on the basis of odds ratios for persistent hepatic or renal dysfunction, respectively. Receiver-operating characteristics analyses showed good predictabilities for persistent end-organ dysfunction (area under curve: 0.794 for TB score and 0.839 for Cre score). High-risk strata of TB score (>11.0 points) or Cre score (>14.1 points) were associated with persistently higher levels of TB or Cre (TB, 1.32 ± 0.51; Cre, 1.23 ± 0.41 mg/dl; both P<0.001 vs. low-risk strata).
Reversibility of end-organ function with LVAD implantation can be well predicted by our new risk scoring system that consists of the preoperative TB or Cre level adjusted by the patient's age. The scoring system would be beneficial, especially in considering the indication of a bridge to candidacy.
心力衰竭患者在植入左心室辅助装置（LVAD）后，肝脏或肾脏功能的恢复情况常常难以预测。
本研究纳入了 69 例接受 LVAD（18 例连续流，51 例搏动流）治疗的患者。LVAD 植入后 6 个月时总胆红素（TB）或肌酐（Cre）水平仍>1.5mg/dl 定义为持续存在肝肾功能障碍。TB 评分或 Cre 评分的计算方法为：0.15×年龄+1.1×（术前 TB）或 0.2×年龄+3.6×（术前 Cre），其中系数是根据持续肝肾功能障碍的比值比确定的。受试者工作特征曲线分析显示，TB 评分（曲线下面积：0.794）和 Cre 评分（曲线下面积：0.839）对持续终末器官功能障碍均具有良好的预测能力。TB 评分（>11.0 分）或 Cre 评分（>14.1 分）的高危分层与 TB 或 Cre 水平持续升高相关（TB：1.32±0.51；Cre：1.23±0.41mg/dl；均 P<0.001 比低危分层）。
通过我们新的风险评分系统，可以很好地预测 LVAD 植入后终末器官功能的恢复情况，该系统由术前 TB 或 Cre 水平和患者年龄调整组成。该评分系统将是有益的，尤其是在考虑候选资格桥接的适应证时。
