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

Background 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 (>75% 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.