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. 2024 May 17;12(5):1114.
doi: 10.3390/biomedicines12051114.

The Impact of Frailty Components and Preoperative Mechanical Cardiac Support Changes with Time after Heart Transplantation

Rita Szentgróti  1 , Dmitry Khochanskiy  2 , Balázs Szécsi  1 , Flóra Németh  2 , András Szabó  3 , Kinga Koritsánszky  1 , Alexandra Vereb  1 , Zsuzsanna Cserép  1 , Balázs Sax  4 , Béla Merkely  4 , Andrea Székely  3   4   5
Affiliations

The Impact of Frailty Components and Preoperative Mechanical Cardiac Support Changes with Time after Heart Transplantation

Rita Szentgróti et al. Biomedicines. .

Abstract

Background: Frailty has been proven to be associated with mortality after orthotopic heart transplantation (OHT). The aim of our study was to determine the impact of frailty on mortality in the current era using pretransplant mechanical cardiac support (MCS).

Methods: We retrospectively calculated the frailty scores of 471 patients undergoing OHT in a single institution between January 2012 and August 2022. The outcome was all-cause mortality.

Results: The median survival time was 1987 days (IQR: 1487 days) for all patients. In total, 266 (56.5%) patients were categorized as nonfrail, 179 (38.0%) as prefrail, and 26 (5.5%) as frail. The survival rates were 0.73, 0.54, and 0.28 for nonfrail, prefrail, and frail patients, respectively. The frailty score was associated with mortality [HR: 1.34 (95% CI: 1.22-1.47, p < 0.001)]. Among the components of the frailty score, age above 50 years, creatinine ≥ 3.0 mg/dL or prior dialysis, and hospitalization before OHT were independently associated with mortality. Continuous-flow left ventricular assist devices (CF-LVAD) were associated with an increased risk for all-cause mortality [AHR: 1.80 (95% CI: 1.01-3.24, p = 0.047)].

Conclusions: The components of the frailty score were not equally associated with mortality. Frailty and pretransplant MCS should be included in the risk estimation.

Keywords: frailty; frailty screening tool; heart transplantation; mechanical cardiac support.

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Conflict of interest statement

Béla Merkely received institutional grants from Abbott, Astra Zeneca, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, CSL Behring, Daiichi Sankyo, DUKE Clinical Institut, Eli Lilly, Medtronic, Novartis, Terumo, and VIFOR Pharma. Béla Merkely is the national leader of Librexia Program, New Amsterdam trial, DAPA ACT HF-TIMI 68 trial, MIRACLE trial, FINEARTS-HF trial, REALIZE-K trial, SOS-AMI trial, DELIVER trial, GARDEN-TIMI 74 trial, ENDEAVOR trial, EMPACT-MI trial, and CARDINAL-HF trial. Béla Merkely received payment/honoraria from Abbott, Astra Zeneca, Biotronik, Boehringer Ingelheim, CSL Behring, Daiichi Sankyo, DUKE Clinical Institut, Medtronic, and Novartis. Béla Merkely is rector (academic leader) of Semmelweis University, Director and Chair of the Heart and Vascular Center of Semmelweis University. Andrea Székely received payment/honoraria from Baxter GmbH and General Electrics Heatlhcare Hungary. Rita Szentgróti, Dmitry Khochanskiy, Balázs Szécsi, Flóra Németh, András Szabó, Kinga Koritsánszky, Alexandra Vereb, Zsuzsanna Cserép, and Balázs Sax have no conflicts of interest to declare regarding this study.

Figures

Figure 1
Figure 1
Kaplan–Meier curve for frailty categories.
Figure 2
Figure 2
Cox proportional hazards model results for the components of the frailty screening tool for all-cause mortality, with and without the inclusion of mechanical cardiac support. C-index of the original model (Model I): 0.67, c-index of the model with the addition of mechanical cardiac support devices (Model MCS): 0.68. BIVAD: biventricular assist device; CF-LVAD: continuous-flow left ventricular device; ECMO: extracorporeal membrane oxygenation; LVAD: temporary left ventricular assist device; MCS: mechanical cardiac support; Temporary MCS: temporary mechanical cardiac support. The threshold of 0.05 was selected for significance, ** and *** show the level of significance (**: 0.05; ***: 0.01).
Figure 3
Figure 3
Plot of cross-validated unadjusted areas under the time-dependent receiver operating characteristic curves for top-performing frailty component predictions over mortality outcome.
Figure 4
Figure 4
Hazard plots of the multivariable time-dependent Cox hazard model on continuous and binarized variables. The threshold of 0.05 was selected for significance, *, ** and *** show the level of significance (*: 0.1; **: 0.05; ***: 0.01).
See this image and copyright information in PMC

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