BackgroundEarly right heart failure (RHF) occurs commonly in left ventricular assist device (LVAD) recipients, and increased right ventricular (RV) afterload may contribute. Selective pulmonary vasodilators, like phosphodiesterase-5 inhibitors (PDE5i), are used off-label to reduce RV afterload before LVAD implantation, but the association between preoperative PDE5i use and early RHF after LVAD is unknown.Methods and ResultsWe analyzed adult patients from the INTERMACS registry (Interagency Registry for Mechanically Assisted Circulatory Support) who received a continuous flow LVAD after 2012. Patients on PDE5i were propensity-matched 1:1 to controls. The primary outcome was the incidence of severe early RHF, defined as the composite of death from RHF within 30 days, need for RV assist device support within 30 days, or use of inotropes beyond 14 days. Of 11 544 continuous flow LVAD recipients, 1199 (10.4%) received preoperative PDE5i. Compared to controls, patients on PDE5i had higher pulmonary artery systolic pressure (53.4 mm Hg versus 49.5 mm Hg) and pulmonary vascular resistance (2.6 WU versus 2.3 WU; P<0.001 for both). Before propensity matching, the incidence of severe early RHF was higher among patients on PDE5i than in controls (29.4% versus 23.1%; unadjusted odds ratio (OR), 1.32; 95% CI, 1.17–1.50). This association persisted after propensity matching (PDE5i, 28.9% versus control 23.7%; OR, 1.31; 95% CI, 1.09–1.57), driven by a higher incidence of prolonged inotropic support. Similar results were observed across a wide range of subgroups stratified by markers of pulmonary vascular disease and RV dysfunction.ConclusionsPatients treated with preoperative PDE5i had markers of increased RV afterload and HF severity compared to unmatched controls. Even after propensity matching, patients receiving preimplant PDE5i therapy had higher rates of post-LVAD RHF.

中文翻译：

---

植入左室辅助装置后，植入前磷酸二酯酶-5抑制剂的使用与较高的严重早期右心衰竭发生率相关。

背景早期右心衰竭（RHF）通常发生在左心室辅助装置（LVAD）的接受者中，并且右心室（RV）后负荷增加可能是造成这种情况的原因。选择性磷酸化血管扩张剂（如磷酸二酯酶5抑制剂（PDE5i））在LVAD植入前用于标签外以减少RV后负荷，但术前PDE5i使用与LVAD后早期RHF之间的关联尚不清楚。登记（机械辅助循环支持机构间登记）于2012年后接受了持续性LVAD。PDE5i患者与对照组的比例为1：1。主要结局是严重的早期RHF发生率，定义为30天内因RHF死亡的综合情况，30天内需要RV辅助装置支持，或使用超过14天的正性肌力药。在11 544名连续流LVAD接受者中，有1199名（10.4％）接受了术前PDE5i治疗。与对照组相比，PDE5i患者的肺动脉收缩压更高（53.4 mm Hg对49.5 mm Hg）和肺血管阻力（2.6 WU对2.3 WU；两者均< P <0.001）。在倾向匹配之前，PDE5i患者中严重早期RHF的发生率高于对照组（29.4％比23.1％；未调整优势比（OR），1.32； 95％CI，1.17-1.50）。这种倾向在倾向性匹配后持续存在（PDE5i，28.9％，对照组为23.7％； OR，1.31； 95％CI，1.09–1.57），这是由于长期的正性肌力支持发生率更高。在由肺血管疾病和RV功能障碍标志物分层的广泛亚组中也观察到了相似的结果。结论术前PDE5i治疗的患者与无配对对照组相比，具有RV后负荷和HF严重程度增加的标志物。即使在倾向匹配后，接受植入前PDE5i治疗的患者的LVAD后RHF发生率也较高。