Effects of Beta Blockers and ACE Inhibitors after Left Ventricular Assist Device Implantation

Purpose: While Beta blockers(BB) and Angiotensin system blockers(ACEinh/ARB) are important components in advanced heart failure therapy, their use after left ventricular assist device (LVAD) implantation remains controversial. Concern has been raised about possible adverse effects of BB on right ventricular(RV) function while tolerance and efficacy/outcome data for ACEinh are lacking. This study aimed to characterize the use of medical therapy post-LVAD implantation and to evaluate its safety and efficacy. Methods: Demographic, clinical and echocardiographic variables of patients implanted with a continuous-flow LVAD between 2012 and 2015 at a single center were retrospectively reviewed. Mortality and heart failure(CHF) hospitalizations were followed from 6-18 months’ post-implant. Results: Of a total of 98 patients, the mean age was 57 years, 81% were men and 61% had ischemic disease. While the use of diuretics decreased considerably post LVAD, over 50% continued to require diuretics. At 6th month post-implantation, 73% of patients were on BB, and these patients had significantly lower proBNP at 6 and 12 months follow up. Despite significant prevalence of RV dysfunction in the cohort (\u3e75% at 6 months), there was no significant difference in CHF hospitalizations based on BB use (14% vs 15%) and instead a trend towards less deaths in those on BB (6% vs 15%). ACEinh/ARB use was likewise common at 6 month (61%) and these patients had lower proBNP at 6 and 12 months, lower right atrial(RA) pressures (9 vs 12 mmHg, p=0.03), and a significantly lower mortality—a finding which remained on multivariate analysis. Conclusion: The use of ACEinh/ARB appeared to be associated with subsequent improved survival, lower proBNP and RA pressures. The use of BB post-LVAD appears safe and was associated with a lower proBNP, even in a patient population with a significant prevalence of RV dysfunction

A-081:The utility of ankle-brachial index (ABI) in risk stratifying patients undergoing evaluation for coronary artery disease (CAD)

BACKGROUND: Despite its efficacy at identifying patients with CAD, stress tests still have a high incidence of inconclusive results. PAD is associated with CAD and poor outcomes. Abnormal ABI results are associated with an elevated CV risk. Research in the utility of ABI test- ing to further risk stratify patients undergoing stress tests is limited. In such patients who have undergone coronary angiograms, we studied the relationship of ABIs with the severity of CAD, as measured by the SYNTAX score, and whether an abnormal ABI can further risk stratify indeterminate stress echocardiograms. METHODS: Patients who underwent an ABI and stress echocardiogra- phy followed by a coronary angiogram between January 2010 and De- cember 2014 at Loyola University were reviewed. Among these patients, only those with diagnostic studies performed within a six year timespan were included. A retrospective analysis was conducted. Analysis included demographics, stress test parameters, ABIs and SYNTAX scores. The Student’s t-test and Fischer exact test were used with signifi- cance at p RESULTS: A total of 199 patients were studied (41% females, mean age 63). Group A (95 patients) included patients with abnormal and bor- derline ABIs (ABI ¼ 1.00 and \u3c 1.30). Baseline characteristics were sim- ilar between groups A and B, except for higher incidence of smoking and diabetes in group A. SYNTAX score was significantly higher in Group A (mean 24.3 þ/5.3) vs B (mean 11.1 þ/4.2), p CONCLUSION: PAD, as demonstrated by ABIs, is associated with an increased severity and complexity of CAD, as demonstrated by the SYNTAX score. ABIs, when combined with a stress echocardiogram, can help further risk stratify patients being evaluated for CAD. Additional study of the association of PAD with CAD to help guide di- agnosis and management of CV disease is warranted

Management of pulmonary mucormycosis after orthotopic heart transplant: A case series

Invasive pulmonary mucormycosis is a potentially fatal infection that can occur in immunosuppressed patients such as those who have undergone orthotopic heart transplant (OHT). High-dose intravenous antifungal agents, including amphotericin B, are generally accepted as the first-line medical treatment, with prompt surgical resection of lesions if feasible. The body of evidence guiding treatment decisions, however, is sparse, particularly regarding adjustment of immunosuppression during acute infection and long-term recovery. We present 2 cases of patients with pulmonary mucormycosis occurring within the first 6 months after OHT, both of whom successfully recovered after appropriate medical and surgical treatment, and we highlight differences in immunosuppression management strategies for this life-threatening condition