Organ function and outcomes of 29 patients across five time points. Out of 29 patients with advanced heart failure undergoing mechanical circulatory support surgery, 17 had organ function improvement from preoperative day one to day eight, and 12 patients had no organ function improvement. Each purple line represents one one-year survivor, while each red line represents one one-year non-survivor.Graphic: Courtesy of Dr. Mario Deng
An experimental blood test developed at UCLA that uses gene activity data from immune cells was 93 percent accurate in predicting survival rates for people with advanced heart failure who had surgery to implant mechanical circulatory support devices, such as ventricular assist devices and temporary total artificial hearts.
People with advanced heart failure often also suffer from multi-organ dysfunction syndrome, which is associated with atypical white blood cell activity and can lead to death after a device is implanted. When patients and doctors are considering a mechanical assist device, current clinical methods used to predict treatment results have limitations: They do not perform well in very sick patients, and they do not use molecular information. That lack of precision in predicting treatment outcomes can complicate the shared decision-making process between patients and their doctors.
Mario Deng, MD, professor of medicine in the Division of Cardiology, is a co-developer of a Food and Drug Administration-approved molecular blood test that is used to diagnose organ rejection in heart transplant recipients. The technology employed in the new study builds on the methods used in developing the molecular blood test. The study involved 29 people with advanced heart failure who underwent mechanical circulatory support surgery at UCLA from 2012 to 2014. Researchers collected blood samples one day before surgery and took clinical data both before surgery and eight days afterward. The patients were classified into two groups depending on their level of organ function. Seventeen patients showed improvement and 12 did not. One year later, 88 percent of the people in the “improved” group were still alive, compared with 27 percent in the other group.
The researchers identified a set of 28 genes from the pre-surgery blood samples that predicted how well the patients’ organ function would recover shortly after surgery — and of those 28 genes, 12 helped predict whether or not organ function would improve after surgery and in forecasting if the patients would live at least a year after the surgery.
The researchers hope to study whether or not the test also can be used to accurately predict how people with advanced heart failure and declining organ function will fare after undergoing other types of heart surgery and catheter-based interventions. The test also could help patients and doctors make more informed decisions about treatment options; if it predicts a poor outcome, patients could choose to postpone surgery until their condition improves or could opt for another course of treatment. Ultimately, it could improve survival rates and the quality and cost-effectiveness of care.
“Association between Preoperative Peripheral Blood Mononuclear Cell Gene Expression Profiles, Early Postoperative Organ Function Recovery Potential and Long-term Survival in Advanced Heart Failure Patients Undergoing Mechanical Circulatory Support,” PloS One, December 13, 2017
