Left Ventricular Remodeling and Myocardial Recovery on Mechanical Circulatory Support
Received 8 May 2009; received in revised form 8 October 2009; accepted 8 October 2009. published online 16 November 2009.
Abstract
Background
Myocardial recovery after ventricular assist devices (VAD) is rare but appears more common in nonischemic cardiomyopathies (NICM). We sought to evaluate left ventricular (LV) end diastolic diameter (LVEDD) for predicting recovery after VAD.
Methods and Results
NICM patients receiving long-term mechanical support between 1996 and 2008 were reviewed. Subjects were divided into 3 groups: mild, moderate, and severe dilation (Group A: LVEDD <6.0 cm [n = 22]; Group B: 6.0-7.0 cm [n = 32]; Group C: >7.0 cm [n = 48], respectively). Overall, recovery (successful explant without transplantation) occurred in 14 of 102 subjects (14%). Of these, 2 died and 2 required transplantation within 1 year. Recovery was more common in patients without LV dilation (Groups A/B/C = 32%/22%/0%, P < .001), as was sustained recovery (alive and transplant free 1 year after explant; A/B/C = 27%/10%/0%, P = .001). Of the recovery patients in Group A, 6/7 (86%) had sustained recovery versus 3/6 (50%) in Group B.
Conclusions
Recovery occurred in 32% of NICM patients without significant LV dilation at time of VAD, the majority of whom experienced significant sustained recovery. Recovery was not evident in those with severe LV dilation. Routine echocardiography at the time of implant may assist in targeting patients for recovery after VAD.
1Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA
2Departments of Medicine and Pediatrics, University of Pittsburgh, Pittsburgh, PA
3Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA
4Heart, Lung, Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, PA
5Artificial Heart Program, University of Pittsburgh, Pittsburgh, PA
Reprint requests: Marc A Simon, MD, MS, S-554 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA 15213. Tel: (412) 647-7168; Fax: (412) 647-0595.
Dr. Simon is supported by the NIH Roadmap Multidisciplinary Clinical Research Career Development Award (KL2 RR024154). Dr. McNamara is supported by NIH Award R01 HL75038, and K24 HL069912. Dr. Primack is supported by a grant from the National Cancer Institute (K07-CA114315) and a grant from the Maurice Falk Foundation. Dr. Gorcsan is supported in part by NIH award K24 HL04503 and R01 HL086918. Dr. Kormos is on the medical advisory boards of Thoratec Corporation & World Heart Corporation. No other authors report relationships with industry.
ABSTRACT