Maurer Mathew S, Horn Evelyn, Reyentovich Alex, Dickson Victoria Vaughan, Pinney Sean, Goldwater Deena, Goldstein Nathan E, Jimenez Omar, Teruya Sergio, Goldsmith Jeff, Helmke Stephen, Yuzefpolskaya Melana, Reeves Gordon R
Clinical Cardiovascular Research Laboratory for the Elderly, Columbia University Medical Center, Allen Hospital of New York Presbyterian, New York, New York.
Weill Medical College of Cornell University, New York, New York.
J Am Geriatr Soc. 2017 Nov;65(11):2383-2390. doi: 10.1111/jgs.15124. Epub 2017 Sep 21.
BACKGROUND/OBJECTIVES: Frailty, characterized by low physiological reserves, is strongly associated with vulnerability to adverse outcomes. Features of frailty overlap with those of advanced heart failure, making a distinction between them difficult. We sought to determine whether implantation of a left ventricular assist device (LVAD) would decrease frailty.
Prospective, cohort study.
Five academic medical centers.
Frail individuals (N = 29; mean age 70.6 ± 5.5, 72.4% male).
Frailty, defined as having 3 or more of the Fried frailty criteria, was assessed before LVAD implantation and 1, 3, and 6 months after implantation. Other domains assessed included quality of life, using the Kansas City Cardiomyopathy Questionnaire; mood, using the Patient Health Questionnaire; and cognitive function, using the Trail-Making Test Part B.
After 6 months, three subjects had died, and one had undergone a heart transplant; of 19 subjects with serial frailty measures, the average number of frailty criteria decreased from 3.9 ± 0.9 at baseline to 2.8 ± 1.4 at 6 months (P = .003). Improvements were observed after 3 to 6 months of LVAD support, although 10 (52.6%) participants still had 3 or more Fried criteria, and all subjects had at least one at 6 months. Changes in frailty were associated with improvement in QOL but not with changes in mood or cognition. Higher estimated glomerular filtration rate at baseline was independently associated with a decrease in frailty.
Frailty decreased in approximately half of older adults with advanced heart failure after 6 months of LVAD support. Strategies to enhance frailty reversal in this population are worthy of additional study.
背景/目的：衰弱以生理储备低下为特征，与不良后果易感性密切相关。衰弱的特征与晚期心力衰竭的特征重叠，难以区分二者。我们旨在确定植入左心室辅助装置（LVAD）是否会减轻衰弱。
前瞻性队列研究。
五个学术医疗中心。
衰弱个体（N = 29；平均年龄70.6±5.5岁，72.4%为男性）。
在植入LVAD前以及植入后1、3和6个月评估衰弱情况，衰弱定义为符合3项或更多Fried衰弱标准。评估的其他领域包括生活质量（使用堪萨斯城心肌病问卷）、情绪（使用患者健康问卷）以及认知功能（使用连线测验B部分）。
6个月后，3名受试者死亡，1名接受了心脏移植；在19名有连续衰弱测量值的受试者中，衰弱标准的平均数量从基线时的3.9±0.9降至6个月时的2.8±1.4（P = 0.003）。在LVAD支持3至6个月后观察到有改善，尽管10名（52.6%）参与者仍有3项或更多Fried标准，且所有受试者在6个月时至少有一项标准。衰弱的变化与生活质量的改善相关，但与情绪或认知的变化无关。基线时较高的估计肾小球滤过率与衰弱的减轻独立相关。
在LVAD支持6个月后，约一半晚期心力衰竭的老年人衰弱情况有所减轻。增强该人群衰弱逆转的策略值得进一步研究。
