Left Ventricular Assist Device Therapy in Cold and Dry Patients

BACKGROUND: Patients with end-stage heart failure and low pulmonary capillary wedge pressure are referred to as cold and dry and represent an understudied minority in whom the benefit of left ventricular assist device (LVAD) therapy is unclear. METHODS: Adults receiving LVADs between 2006 and 2017 in the Interagency Registry for Mechanically Assisted Circulatory Support database were classified as cold and wet (pulmonary capillary wedge pressure >15 mm Hg) and cold and dry (pulmonary capillary wedge pressure ≤15 mm Hg) based on pre-LVAD hemodynamics obtained via right heart catheterization. The primary outcome was 1-year survival. Secondary outcomes were rehospitalizations, change in 6-minute walk test distance, change in Kansas City Cardiomyopathy Questionnaire, and change in EuroQol questionnaire scores 1 year after LVAD. RESULTS: Our study included 10 310 patients with complete clinical, echocardiographic, and functional capacity profiles. The median follow-up was 364 days (interquartile range, 326–381 days). Overall, the mean pulmonary capillary wedge pressure before LVAD implantation was 25±9 mm Hg. Cold and dry patients comprised 15% of the cohort and were more frequently female, had smaller mean body size, smaller mean left ventricular size, and better mean baseline renal function. Compared with cold and wet patients, cold and dry patients also had better baseline functional capacity and quality of life and experienced milder improvements after LVAD: EuroQol (+0.11 versus +0.17; P =0.001), Kansas City Cardiomyopathy Questionnaire (+26 versus +31; P =0.031), and 6-minute walk test distance (+194 feet versus +340 feet; P =0.026). There was no statistically significant difference between the rate of hospitalizations ( P =0.76), adverse events, and mortality (log-rank P =0.81) at 1 year between the 2 groups. CONCLUSIONS: In cold and dry patients with end-stage heart failure, LVADs are associated with milder but significant improvements in functional capacity and quality of life with a similar incidence of adverse events and survival at 1 year.