Impact of Ischemic Heart Failure Etiology on Cardiac Recovery During Mechanical Unloading

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• 作者：James Wever-Pinzon ; MD^a ; Craig H. Selzman ; MD^a ; ^b ; Greg Stoddard ; MPH ; MBA^a ; Omar Wever-Pinzon ; MD^a ; Anna Catino ; MD^a ; Abdallah G. Kfoury ; MD^a ; Nikolaos A. Diakos ; MD^a ; ^b ; Bruce B. Reid ; MD^a ; Stephen McKellar ; MD^a ; ^b ; Michael Bonios ; MD ; PhD^a ; Antigone Koliopoulou ; MD^a ; Deborah Budge ; MD^b ; Aaron Kelkhoff ; MD^a ; Josef Stehlik ; MD^a ; James C. Fang ; MD^a ; Stavros G. Drakos ; MD ; PhD^a ; ^b ; ^{stavros.drakos@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：cardiac recovery ; ischemic cardiomyopathy ; left ventricular assist device ; mechanical unloading ; myocardial function ; myocardial structure
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：18 October 2016
• 年：2016
• 卷：68
• 期：16
• 页码：1741-1752
• 全文大小：857 K

文摘

Small-scale studies focused mainly on nonischemic cardiomyopathy (NICM) have shown that a subset of left ventricular assist device (LVAD) patients can achieve significant improvement of their native heart function, but the impact of ischemic cardiomyopathy (ICM) has not been specifically investigated. Many patients with acute myocardial infarction are discharged from their index hospitalization without heart failure (HF), only to return much later with overt HF syndrome, mainly caused by chronic remodeling of the noninfarcted region of the myocardium.

Objectives

This study sought to prospectively investigate the effect of ICM HF etiology on LVAD-associated improvement of cardiac structure and function using NICM as control.

Methods

Consecutive patients (n = 154) with documented chronic and dilated cardiomyopathy (ICM, n = 61; NICM, n = 93) requiring durable support with continuous-flow LVAD were prospectively evaluated with serial echocardiograms and right heart catheterizations.

Results

In patients supported with LVAD for at least 6 months, we found that 5% of subjects with ICM and 21% of subjects with NICM achieved left ventricular ejection fraction ≥40% (p = 0.034). LV end-diastolic and end-systolic volumes and diastolic function were significantly and similarly improved in patients with ICM and NICM.

Conclusions

LVAD-associated unloading for 6 months resulted in a substantial improvement in myocardial structure, and systolic and diastolic function in 1 in 20 ICM and 1 in 5 NICM patients. These specific incidence and timeline findings may provide guidance in clinical practice and research design for sequencing and prioritizing advanced HF and heart transplantation therapeutic options in patients with ICM and NICM.