Glucagon-Like Peptide-1 Receptor Agonists in Patients With Durable Left Ventricular Assist Devices

Background: GLP-1 RAs improve cardiometabolic outcomes in obese, diabetic, and heart failure patients. Data on the safety and efficacy of GLP-1 RA in advanced heart failure with durable LVAD is limited.

Objectives: To assess the safety and efficacy of GLP-1 RA in durable LVAD patients.

Methods: We conducted a single-center retrospective analysis of patients on durable LVAD support treated with GLP-1 RA. Outcomes included cardiometabolic efficacy and LVAD and GLP-1 RA related adverse events up to 1 year post GLP-1 RA initiation.

Results: Forty LVAD patients were treated with GLP-1 RA therapy between 2018 and 2023. At 1 year follow-up, the patient's weight was significantly reduced (116 (98-134) vs. 110 (91-129) kg, p-value < 0.001), HBA1C was improved (6.4 (5.8-8.1) vs. 5.7 (5.3-6.1), p-value 0.003), and NT-proBNP levels were significantly reduced (810 (594-1413) vs. 732 (354-1155) pg/mL, p-value 0.04). GLP-1 RA therapy was not associated with cannula position change (cannula coronal angle of 29.7° (15.0-42.0) vs. 23.1° (12.8-42.3), p-value 0.683), and LVADs complication rate was relatively low (12.5% of the patients had hemocompatibility adverse events, 15% had driveline infection, 12% had HF hospitalization, and 2.5% (1 patient) died due to HeartMate2 malfunction). There was no interruption of drug administration due to adverse events.

Conclusion: Durable LVAD patients treated with GLP-1 RA had improved cardiometabolic profiles and low major adverse events. GLP-1 RA therapy holds promise as a potential adjunctive treatment strategy in LVAD recipients, offering improved cardiometabolic profile, hemodynamics, and potential future transplant candidacy.