| Abstract | Uređaj za mehaničku potporu lijevoj klijetci (LVAD, eng. Left Ventricular Assist Device) najčešće je korišten uređaj za potporu rada srca, a koristi se u bolesnika s uznapredovalim zatajivanjem srca. Bolesnici sa zatajivanjem srca etiološki su heterogena skupina te ju, prema izvještajima EUROMACS i INTERMACS registara, sačinjava 53 tj. 69,8% bolesnika s neishemijskom etiologijom zatajivanja srca. Cilj ovoga rada bio je prikazati predoperativne karakteristike populacije koja je primila LVAD kao terapiju za uznapredovalo zatajivanje srca u Klinici za bolesti srca i krvnih žila Kliničkog bolničkog centra Zagreb u periodu od 2017. do 2020. godine i prikazati razlike između skupine s ishemijskom etiologijom zatajivanja srca i neishemijskom etiologijom zatajivanja srca. Podaci o bolesnicima unošeni su iz Bolničkog informacijskog sustava (BIS) u PCHF-VAD registar sačinjen u REDcap platformi za sigurno pohranjivanje podataka te je provedena usporedba predoperacijskih parametara između dviju navedenih skupina. Bolesnici u skupini s ishemijskom etiologijom bili su stariji (58,3 ± 8,2 godina vs 49,7 ± 14,0 godina, p = 0,026), imali su viši sistolički tlak (111 ± 16 mmHg vs 101 ± 11 mmHg, p = 0,026), rjeđe su imali blok lijeve grane (9% vs 43%, p = 0,023), imali su niže koncentracije hemoglobina (117,9 ± 23,1 g/L vs 134,4 ± 23,3 g/L, p = 0,021) i eritrocita (4,00 ± 0,80 x1012/L vs 4,58 ± 0,81 x 1012/L, p = 0,023), ali i nižu koncentraciju bilirubina (15,0 [9,0, 23,8] μmol/L vs 31,0 [18,0, 61,0] μmol/L, p = 0,008). U ehokardiografskim mjerenjima imali su manji unutarnji promjer lijeve klijetke na kraju dijastole (66,2 ± 10 mm vs 77,5 ± 10,5 mm, p = 0,001), veću ejekcijsku frakciju (24,1 ± 7,3 % vs 19,8 ± 6,2 %, p = 0,04), ali i manji tlak u desnom atriju (9,2 ± 4,5 mmHg vs 17,4 ± 13,3 mmHg, p = 0,008). Bolesnici u skupini s ishemijskom etiologijom također su češće imali amiodaron u terapiji (45% vs 13%, p = 0,023). Podaci prikupljeni ovim istraživanjem ukazali su na klinički značajne razlike između primatelja LVAD uređaja, ovisno o prisutnosti ishemijske tj. neishemijske etiologije zatajivanja srca. Buduća istraživanja mogla bi biti usmjerena širenju na cijelu populaciju bolesnika u PCHF-VAD registru te uključivanju ishoda, poput preživljenja ili pojave opetovanog zatajivanja srca. |
| Abstract (english) | The Left Ventricular Assist Device (LVAD) is the most used device to support the heart's function in patients with advanced heart failure. Patients with heart failure are an etiologically heterogeneous group and, according to the reports of the EUROMACS and INTERMACS registers, 53 to 69.8% of this group have a non-ischemic etiology of heart failure. The aim of this work was to show the preoperative characteristics of the population that received an LVAD as therapy for advanced heart failure at the Department for Cardiovascular Diseases of the University Hospital Center Zagreb in the period from 2017 to 2020 and to show the differences between the group with ischemic etiology of heart failure and non-ischemic etiology of heart failure. Patient information was entered from the Hospital Information System into the PCHF-VAD registry based on REDcap, a secure web-based software platform designed for data capture, and an analysis of preoperative parameters between the two mentioned groups was performed. Patients in the group with ischemic etiology were older (58.3 ± 8.2 years vs 49.7 ± 14.0 years, p = 0.026), had higher systolic pressure (111 ± 16 mmHg vs 101 ± 11 mmHg, p = 0.026), a lower proportion of left bundle branch block (9% vs 43%, p = 0.023), lower concentrations of hemoglobin (117.9 ± 23.1 g/L vs 134.4 ± 23.3 g/L, p = 0.021) and erythrocytes (4.00 ± 0.80 x1012/L vs 4.58 ± 0.81 x 1012/L, p = 0.023), but also lower bilirubin concentration (15.0 [9.0, 23.8] μmol/L vs 31.0 [18.0, 61.0] μmol/L, p = 0.008). In echocardiographic measurements, they had a smaller internal diameter of the left ventricle at the end of diastole (66.2 ± 10 mm vs 77.5 ± 10.5 mm, p = 0.001), a higher ejection fraction (24.1 ± 7.3 % vs 19.8 ± 6.2 %, p = 0.04), but also a lower pressure in the right atrium (9.2 ± 4.5 mmHg vs 17.4 ± 13.3 mmHg, p = 0.008). Patients in the group with ischemic etiology also had amiodarone in their therapy more often (45% vs 13%, p = 0.023). Analysis of the data collected by this research has demonstrated clinically significant differences between LVAD recipients based on the presence of ischemic or non-ischemic etiology of heart failure. Further research could aim to encompass the whole PCHF-VAD register population and include outcomes like survival or repeated heart failure. |
