PDE5i Use Linked to Post-LVAD Right Heart Failure Events

For left ventricular assist device (LVAD) recipients, those on phosphodiesterase-5 inhibitors (PDE5i) have a higher incidence of severe early right heart failure (RHF), according to a study published online June 11 in Circulation: Heart Failure.

Gaurav Gulati, M.D., from Tufts Medical Center in Boston, and colleagues analyzed 11,544 adult patients who received a continuous flow LVAD after 2012. A total of 1,199 patients who received preoperative PDE5i were propensity-matched to controls. The primary outcome was incidence of severe early RHF, which was a composite of death from RHF within 30 days or inotrope use beyond 14 days.

The researchers found that patients on PDE5i had higher pulmonary artery systolic pressure (53.4 versus 49.5 mm Hg) and pulmonary vascular resistance (2.6 versus 2.3 WU) compared with controls. The incidence of severe early RHF was higher among patients on PDE5i than among controls before propensity matching (29.4 versus 23.1 percent; unadjusted odds ratio, 1.32); after propensity matching, the correlation persisted (28.9 versus 23.7 percent; odds ratio, 1.31) and was driven by a higher incidence of prolonged inotropic support.

"We found no benefit of this therapy in patients receiving LVAD devices, including patients with pulmonary vascular disease or right ventricular dysfunction -- the very patients who might be expected to benefit most," a coauthor said in a statement. "Our findings should give pause to clinicians considering this therapy, and we would caution against routine use of these therapies prior to LVAD surgery."

Several authors disclosed financial ties to the pharmaceutical industry.

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