Early intervention for lactate dehydrogenase elevation improves clinical outcomes in patients with the HeartMate II left ventricular assist device: Insights from the PREVENT study

Thenappan Thenappan, John M. Stulak, Richa Agarwal, Simon Maltais, Palak Shah, Peter Eckman, Sitaramesh Emani, Jason N. Katz, Igor Gregoric, Mary E. Keebler, Nir Uriel, Eric Adler, Joyce Chuang, David J. Farrar, Kartik S. Sundareswaran, Ranjit John

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4 Scopus citations

Abstract

Background Hemolysis, assessed by elevated serum lactate dehydrogenase (LDH), is strongly associated with HeartMate II pump thrombosis (PT). However, it is unknown whether early intervention for elevated LDH circumvents the risk of serious PT requiring pump exchange. We sought to evaluate the relationship between elevated LDH and clinical outcomes, the effectiveness of early medical intervention, and risk factors for elevated LDH. Methods We studied 268 patients in the prospective, multicenter PREVENT study who had 2 or more LDH measurements at ≥30 days post-implant. Elevated LDH was defined as LDH ≥2.5× upper limit of normal (ULN) for 2 consecutive measurements. Results Fourteen percent of patients had elevated LDH. Stroke-free survival at 6 months was lower in patients with elevated LDH vs patients with normal LDH (83 ± 6% vs 93 ± 2%, p = 0.035). Elevated LDH resolved without intervention in 19% of patients, with intensified medical therapy in 43% and required surgical intervention in 38%. For patients receiving only medical therapy, survival was 94 ± 6% at 6 months post-treatment. In this subgroup, resolution of symptoms with intensified medical therapy was sustained in 15 of 16 patients, with PT occurring in 1 patient at 171 days after initial treatment for elevated LDH (202 days post-implant). Early medical intervention at moderately elevated LDH (2.5× to 3.2× ULN), as compared with higher levels (>3.2× ULN), led to more sustained resolution of symptoms without subsequent PT or need for surgical intervention (91% vs 26% at 6 months post-treatment, p = 0.002). Conclusions Early medical intervention can successfully resolve moderate LDH elevations (2.5× to 3.2× ULN) with a low incidence of death or PT at 6 months post-treatment.

Original languageEnglish (US)
Pages (from-to)25-32
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume37
Issue number1
DOIs
StatePublished - Jan 1 2018

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Keywords

  • anticoagulation
  • cardiac transparent
  • cardiomyopathy
  • Heart failure
  • HeartMate II
  • hemolysis
  • pump thrombosis
  • serum lactate dehydrogenase
  • thrombosis

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Thenappan, T., Stulak, J. M., Agarwal, R., Maltais, S., Shah, P., Eckman, P., Emani, S., Katz, J. N., Gregoric, I., Keebler, M. E., Uriel, N., Adler, E., Chuang, J., Farrar, D. J., Sundareswaran, K. S., & John, R. (2018). Early intervention for lactate dehydrogenase elevation improves clinical outcomes in patients with the HeartMate II left ventricular assist device: Insights from the PREVENT study. Journal of Heart and Lung Transplantation, 37(1), 25-32. https://doi.org/10.1016/j.healun.2017.10.017