Magnitude and Time Course of Changes Induced by Continuous-Flow Left Ventricular Assist Device Unloading in Chronic Heart Failure: Insights Into Cardiac Recovery

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• 作者：Stavros G. Drakos ; MD ; PhD^? ; ^&dagger ; ; ^{stavros.drakos@u2m2.utah.edu} ; Omar Wever-Pinzon ; MD^? ; Craig H. Selzman ; MD^? ; ^&dagger ; ; Edward M. Gilbert ; MD^? ; Rami Alharethi ; MD^? ; Bruce B. Reid ; MD^? ; Abdulfattah Saidi ; MD^? ; Nikolaos A. Diakos ; MD^&dagger ; ; Sandi Stoker ; RN^? ; Erin S. Davis ; RN ; BSN^? ; Matthew Movsesian ; MD^? ; Dean Y. Li ; MD ; PhD^&dagger ; ; ^{dean.li@u2m2.utah.edu} ; Josef Stehlik ; MD^? ; Abdallah G. Kfoury ; MD^? ; UCAR (Utah Cardiac Recovery Program) Investigators
• 关键词：cardiac recovery ; left ventricular assist device ; mechanical unloading ; myocardial function ; myocardial structure
• 刊名：Journal of the American College of Cardiology
• 出版年：2013
• 出版时间：14 May, 2013
• 年：2013
• 卷：61
• 期：19
• 页码：1985-1994
• 全文大小：858 K

文摘

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Objectives

This study sought to prospectively investigate the longitudinal effects of continuous-flow left ventricular assist device (LVAD) unloading on myocardial structure and systolic and diastolic function.

Background

The magnitude, timeline, and sustainability of changes induced by continuous-flow LVAD on the structure and function of the failing human heart are unknown.

Methods

Eighty consecutive patients with clinical characteristics consistent with chronic heart failure requiring implantation of a continuous-flow LVAD were prospectively enrolled. Serial echocardiograms (at 1, 2, 3, 4, 6, 9, and 12 months) and right heart catheterizations were performed after LVAD implant. Cardiac recovery was assessed on the basis of improvement in systolic and diastolic function indices on echocardiography that were sustained during LVAD turn-down studies.

Results

After 6 months of LVAD unloading, 34 % of patients had a relative LV ejection fraction increase above 50 % and 19 % of patients, both ischemic and nonischemic, achieved an LV ejection fraction ¡Ý40 % . LV systolic function improved as early as 30 days, the greatest degree of improvement was achieved by 6 months of mechanical unloading and persisted over the 1-year follow up. LV diastolic function parameters also improved as early as 30 days after LVAD unloading, and this improvement persisted over time. LV end-diastolic and end-systolic volumes decreased as early as 30 days after LVAD unloading (113 vs. 77 ml/m², p < 0.01, and 92 vs. 60 ml/m², p < 0.01, respectively). LV mass decreased as early as 30 days after LVAD unloading (114 vs. 95 g/m², p < 0.05) and continued to do so over the 1-year follow-up but did not reach values below the normal reference range, suggesting no atrophic remodeling after prolonged LVAD unloading.

Conclusions

Continuous-flow LVAD unloading induced in a subset of patients, both ischemic and nonischemic, early improvement in myocardial structure and systolic and diastolic function that was largely completed within 6 months, with no evidence of subsequent regression.