Abstract 4361974: Safety Outcomes in Heart Failure Patients Undergoing Colonoscopy Screening for Cardiac Transplant Evaluation

Age-appropriate colon cancer screening is recommended for cardiac transplant evaluation. Patients with advanced cardiomyopathy may require inpatient evaluation and inotropes or mechanical circulatory support (MCS) for optimization. The peri- and postprocedural risks of colonoscopy amongst this population are not well defined. We hypothesized that patients requiring hemodynamic support during colonoscopy are at an increased risk for complications. We retrospectively analyzed adult patients at our center from 2018-2023 who underwent inpatient colonoscopy as part of a cardiac transplant evaluation. The primary outcome was any adverse event, including increased oxygen requirement (escalation to higher form of oxygen delivery), major (≥ 3 g/dL) or minor (<3 g/dL) bleeding, new arrhythmia or new hypotension requiring vasopressors for up to 48 hours post-procedure. We performed descriptive and multivariable regression analyses. Fifty-nine patients (mean age 59 years, 46 (78%) male) with advanced cardiomyopathy underwent inpatient colonoscopy for cardiac transplant evaluation. At the time of colonoscopy, 38 patients required hemodynamic support, 29 (49.2%) with inotrope infusions, 7 (11.9%) with MCS, and 2 (3.4%) with both. Thirty-nine (66.1%) were on systemic anticoagulation prior to colonoscopy, with 9 (15.3%) continuing periprocedurally. Patients on hemodynamic support had a lower baseline left ventricular ejection fraction. Baseline characteristics were otherwise well balanced between the two groups (Table 1). Following colonoscopy, adverse events occurred in 7 (11.9%) patients, including increased oxygen requirement in 1 (1.7%), minor bleeding in 4 (6.8%), and new arrhythmia in 2 (3.4%). There were no major bleeding events or postprocedural hypotension in any patients. MCS or inotrope use was not associated with adverse events (p=0.993), even after controlling for age, BMI, gender, baseline oxygen requirement, diabetes and anticoagulation (p=0.996). Malignancy was not found in any patient. In a single-center analysis of hospitalized adults undergoing a cardiac transplant evaluation, we found an 11.9% rate of adverse events driven by minor bleeding. There was no association between hemodynamic support with inotropes or MCS during colonoscopy and adverse events.