The purpose of this study was to determine which patients on a cardiac transplant list requir a ventricular assist device.
	In a preliminary study, 26 patients with decompensated Class 4 chronic heart failure were studied. Blood levels for sodium, hemoglobin, cytokines, neurohormones, and hemodynamics were tested. During short-term follow-up of 40 days, 12 patients had implantation of a ventricular assist device, 4 died, and 5 were alive and receiving medical therapy only while waiting for a transplant. Five patients had transplant.
	Survival curves were constructed by comparing the rate of death and the implantation of a ventricular assist device in patients with values of a variable above or below the average value. There was a significantly greater risk of death or need for a ventricular assist device in patients with higher levels of tumor necrosis factor-alpha, lower levels of serum sodium and hemoglobin, higher heart rates, and higher plasma norepinephrine levels. Only serum sodium independently predicted those patients who died or who required left ventricular assist device.
	CONCLUSION: Many variables, particularly serum sodium, need to be considered when evaluating which patients on the transplant list require early ventricular assist device or urgent transplant. This study merits confirmation in a larger patient population.

Title: Predicting short-term outcome in severely ill heart failure patients: implications regarding listing for urgent cardiac transplantation and patient selection for temporary ventricular assist device support
Authors: MacGowan GA, Kormos RL, McNamara DM, Alvarez RJ, Rosenblum WD, Pham S, Feldman AM, Murali S - Division of Cardiology, University of Pittsburgh Medical Center, Pennsylvania 15213, USA
From: J Card Fail 1998 Sep;4(3):169-75
PMID: 9754587, UI: 98425558