Calcium-Channel Blockers (Amlodipine) Therapy Is Associated with Improved Survival in Patients after Continuous-Flow Left Ventricular Assist Devices

Objectives: Amlodipine, an oral dihydropyridine calcium-channel blocker (CCB), has multiple effects. It reduces transient myocardial ischemia and pulmonary-artery pressure, and lowers pulmonary vascular as well as systemic vascular resistance. However, whether amlodipine therapy affects the long-term survival of patients after the implantation of continuous-flow left ventricular assist devices (CF-LVAD) remains unclear.

Methods: Between 2009 and 2020, a total of 123 patients who received LVADs (HeartMate II, HeartMate III and HeartWare) as bridge to transplantation, bridge to recovery, bridge to decision, or destination therapy were successfully discharged home. All participants were under medical treatment. Pharmacotherapy was supplemented by CCBs in one group. Others did not take CCBs during LVAD support. The outcome was overall survival after LVAD implantation.

Result: A total of 123 patients underwent LVAD implantation with HeartMate II (n = 28), HeartMate III (n = 23), and HeartWare (n = 72). Of those, 56 belonged to the CCB group and 67 to the no CCB group. Both groups were well matched except that patients without CCB use were older (50 vs. 57, p = 0.01). Median follow-up was 1541 (740–2,302) days, and the survival at 1, 2, 3, 5, and 7 years was 94.4, 82.6, 73.1, 62.8, and 45.9% versus 87.2, 68.6, 50.6, 29.9, and 23.3% in the CCB and no CCB groups, respectively (log-rank p = 0.008). In multivariate Cox regression analysis, CCB use was consistently associated with significant improved survival (hazard ratio: 0.51; 95% confidence interval: 0.28–0.91; p = 0.023).

Conclusion: In patients after LVAD implantation, CCB use is recommended and associated with a significantly better long-term survival.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021