Background:Left ventricular assist device (LVAD) therapy improves the hemodynamics of advanced heart failure patients. However, it is unknown whether hemodynamic optimization improves clinical outcomes. The aim of this study was to investigate whether hemodynamic optimization reduces hospital readmission rate in LVAD patients.Methods and Results:LVAD patients undergoing an invasive hemodynamic ramp test were prospectively enrolled and followed for 1 year. LVAD speed was optimized using a ramp test, targeting the following goals: central venous pressure <12 mm Hg, pulmonary capillary wedge pressure <18 mm Hg, and cardiac index >2.2 L/(min·m²). The frequency and cause of hospital readmissions were compared between patients who achieved (optimized group) or did not achieve (nonoptimized group) these goals. Eighty-eight outpatients (median 61 years old, 53 male) underwent ramp testing 236 days after LVAD implantation, and 54 (61%) had optimized hemodynamics after LVAD speed adjustment. One-year survival after the ramp study was comparable in both groups (89% versus 88%). The total hospital readmission rate was lower in the optimized group compared with the nonoptimized group (1.15 versus 2.86 events/y, P<0.001). This result was predominantly because of a reduction in the heart failure readmission rate in the optimized group (0.08 versus 0.71 events/y, P=0.016).Conclusions:LVAD patients, in whom hemodynamics were optimized, had a significantly lower rate of hospital readmissions, primarily because of fewer heart failure admissions. These findings highlight the importance of achieving hemodynamic optimization in LVAD patients.

中文翻译：

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左心室辅助装置支持期间的最佳血流动力学与降低的再入院率相关

背景：左心室辅助装置（LVAD）治疗可改善晚期心力衰竭患者的血液动力学。然而，尚不清楚血液动力学优化是否能改善临床结果。这项研究的目的是研究血液动力学优化是否会降低LVAD患者的住院率。方法和结果：前瞻性招募了接受有创血液动力学斜率测试的LVAD患者，并对其进行了为期1年的随访。LVAD速度使用斜坡测试进行了优化，其目标是：中心静脉压力<12 mm Hg，肺毛细血管楔压<18 mm Hg和心脏指数> 2.2 L /（min·m ²）。比较了达到（优化组）或未达到（未优化组）这些目标的患者的再次住院的频率和原因。LVAD植入后236天，有88名门诊患者（中值61岁，男性53岁）进行了斜波测试，LVAD速度调整后有54位患者（61％）具有最佳的血流动力学。两组的斜率研究后一年生存率相当（分别为89％和88％）。优化组的总住院率比未优化组低（1.15 vs 2.86事件/年，P <0.001）。该结果主要是由于优化组的心力衰竭再入院率降低（0.08对0.71个事件/年，P= 0.016）。结论：血液动力学得到优化的LVAD患者住院率明显降低，这主要是由于心衰入院人数减少。这些发现凸显了在LVAD患者中实现血液动力学优化的重要性。