Diffusion Lung Capacity (DLCO) Correlates with Pre-Implant Pulmonary Hypertension and Predicts Outcome in Patients with HF Implanted with a LVAD

Purpose DLCO reduction is commonly observed in HF and is associated with a worse outcome. Correlations between DLCO and PH are unclear and published data are conflicting; moreover, it has been shown that even after normalization of pulmonary pressures driven by the LVAD, a DLCO impairment may persist or worsen, maybe reflecting the persistence of pulmonary vascular remodeling. In this study we investigated correlations between pre-implant DLCO, hemodynamics and post-implant outcome in patients with advanced HF implanted with a LVAD. Methods We retrospectively analyzed pre-implant clinical data and post-implant outcome of 42 patients implanted with a LVAD at our institution in whom a DLCO measurement was performed before surgery. Results Out of 42 patients (71% males, mean age 53 y), 35 (83%) had post-capillary PH, including 17 (40%) with combined post and pre-capillary PH (CpcPH; defined in1). At baseline, median DLCO was 59% (range 21-100%) and it inversely correlated with PVR (p 0.037) and DPG (p 0.042).Early after surgery, more than mild right HF (RHF) occurred in 12 patients, 4 of which died; neither RHF severity nor intensive care unit length of stay were associated with DLCO. Compared to baseline, the LVAD resulted in a significant reduction in LV dimension (Dd 61 vs 69 mm, p Conclusion We showed a significant improvement in hemodynamics after LVAD implantation. Reduced DLCO is associated with CpcPH suggesting that impaired DLCO may be a marker of pulmonary vascular remodeling. 1Galie N et al Eur Heart J 2015; doi:10.1093/eurheartj/ehv317