Guvenc Tolga Sinan, Güzelburc Ozge, Ekmekci Ahmet, Erdogan Sevinc Bayer, Guvenc Rengin Cetin, Velibey Yalcin, Tasdemir Muge, Agustos Semra, Orhan Gokcen, Aka Serap Aykut, Eren Mehmet
Siyami Ersek Cardiovascular and Thoracic Surgery Center, Research and Training Hospital, Department of Cardiology, Istanbul, Turkey.
Siyami Ersek Cardiovascular and Thoracic Surgery Center, Research and Training Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey.
Heart Lung Circ. 2017 Jul;26(7):702-708. doi: 10.1016/j.hlc.2016.10.011. Epub 2016 Nov 24.
Cardiac cachexia and low serum albumin levels are poor prognostic signs in advanced heart failure, while overweight patients or patients who gain weight after treatment have more favourable outcomes. Weight gain following LVAD implantation is common, while the dynamic changes in body mass or serum proteins have not been studied adequately. Our aim was to study short-term changes in serum albumin, total protein and body weight following LVAD implantation and to compare these changes with heart failure patients treated medically.
A total of 15 patients scheduled for LVAD implantation and 15 patients receiving medical treatment were prospectively enrolled. Anthropometric and laboratory data for the patients were obtained at baseline and at first and sixth months after LVAD implantation.
Anthropometric, demographic and clinical characteristics between two groups were similar at baseline. Both serum albumin (3.59±0.71 vs. 4.17±0.46g/dl, p=0.01) and total protein (6.45±0.80 vs. 7.12±0.35g/dl, p<0.01) levels were significantly lower in LVAD group at baseline. Both total protein and serum albumin levels increased significantly in LVAD group (final total protein 7.60±0.62g/dl and serum albumin 4.20±0.46g/dl; p<0.01 for both), while there was a nonsignificant small decrease in serum albumin in medical group. The change in serum albumin, but not total protein was significantly different between LVAD and medical groups at the sixth month. Body weight initially decreased in LVAD group at first month but was nonsignificantly higher compared to baseline and medical group at the sixth month. There was a moderate correlation between the percentage weight gain and percentage increase in serum albumin in LVAD group at six months (r=0.44).
In suitable patients with advanced heart failure, LVAD treatment can correct hypoalbuminaemia associated with heart failure within six months after implantation.
心脏恶病质和低血清白蛋白水平是晚期心力衰竭的不良预后指标，而超重患者或治疗后体重增加的患者预后更佳。左心室辅助装置（LVAD）植入后体重增加很常见，但体重或血清蛋白的动态变化尚未得到充分研究。我们的目的是研究LVAD植入后血清白蛋白、总蛋白和体重的短期变化，并将这些变化与接受药物治疗的心力衰竭患者进行比较。
前瞻性纳入了15例计划接受LVAD植入的患者和15例接受药物治疗的患者。在基线以及LVAD植入后的第一个月和第六个月获取患者的人体测量和实验室数据。
两组患者在基线时的人体测量、人口统计学和临床特征相似。LVAD组在基线时血清白蛋白（3.59±0.71 vs. 4.17±0.46g/dl，p=0.01）和总蛋白（6.45±0.80 vs. 7.12±0.35g/dl，p<0.01）水平均显著较低。LVAD组的总蛋白和血清白蛋白水平均显著升高（最终总蛋白为7.60±0.62g/dl，血清白蛋白为4.20±0.46g/dl；两者p均<0.01），而药物治疗组血清白蛋白有不显著的小幅下降。在第六个月时，LVAD组和药物治疗组之间血清白蛋白的变化有显著差异，但总蛋白无显著差异。LVAD组在第一个月体重最初下降，但在第六个月时与基线和药物治疗组相比无显著升高。在六个月时，LVAD组体重增加百分比与血清白蛋白增加百分比之间存在中度相关性（r=0.44）。
对于合适的晚期心力衰竭患者，LVAD治疗可在植入后六个月内纠正与心力衰竭相关的低白蛋白血症。
