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Impact of comorbid malignancy on clinical courses following left ventricular assist device implantation

To the Editor, The literature of the onco‐cardiology is receiving great concern given that comorbidities are overlapping between oncology and cardiology. Hong and colleagues observed that more than half of the patients with a history of malignancy were alive for two years following left ventricular assist device (LVAD) implantation. Several concerns have been raised. Incidences of post‐LVAD adverse events were approximately comparable between those with and without malignancy, whereas mortality was higher in the malignancy group. Post‐LVAD comorbidities including gastrointestinal bleeding often develop repeatedly. Comparison of event rates instead of incidence might more clarify the impact of malignancy on post‐LVAD outcomes. A comparison of causes of death would also elucidate the association between the malignancy and post‐LVAD outcomes. In addition to the incidence analyses, physiological assessments using echocardiography and right heart catheterization would further reveal the impact of malignancy. For example, chemotherapy‐ induced cardiomyopathy might be associated with post‐LVAD right ventricular failure due to diffuse myocardial impairment. As the authors suspected, inflammatory status and empirically higher international normalized ratio goals might be associated with a higher incidence of bleeding in the malignancy group. Data of biomarkers associating with the formation of arteriovenous malformation including angiotensin‐2 might approach their findings. Post‐LVAD therapeutic data including antiplatelet and anticoagulant would also useful to establish an optimal strategy for those with malignancy. FUNDING INFORMATION Teruhiko Imamura receives grant support from JSPS KAKENHI: JP20K17143.