Journal of Cardiac Failure
Volume 16, Issue 3 , Pages 218-224 , March 2010

Right Ventricular Dysfunction During Intensive Pharmacologic Unloading Persists After Mechanical Unloading

  • Maryse Palardy, MD

      Affiliations

    • Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Anju Nohria, MD

      Affiliations

    • Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Jose Rivero, MD

      Affiliations

    • Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Neal Lakdawala, MD

      Affiliations

    • Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Patricia Campbell, MD

      Affiliations

    • Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Mahoto Kato, MD

      Affiliations

    • Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Leslie M. Griffin, NP

      Affiliations

    • Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Colleen M. Smith, NP

      Affiliations

    • Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Gregory S. Couper, MD

      Affiliations

    • Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Lynne W. Stevenson, MD

      Affiliations

    • Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
  • ,
  • Michael M. Givertz, MD

      Affiliations

    • Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
    • Corresponding Author InformationReprint requests: Michael M. Givertz, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Tel: 617-732-7367; Fax: 617-264-5265.

Received 25 June 2009 ,Revised 13 October 2009 ,Accepted 4 November 2009.

References 

  1. Stevenson LW, Miller LW, Desvigne-Nickens P, Ascheim DD, Parides MK, Renlund DG, et al. Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy: a subset analysis from REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure). Circulation. 2004;110:975–981
  2. Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, et al. Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med. 2001;345:1435–1443
  3. Bank AJ, Mir SH, Nguyen DQ, Bolman RM, Shumway SJ, Miller LW, et al. Effects of left ventricular assist devices on outcomes in patients undergoing heart transplantation. Ann Thorac Surg. 2000;69:1369–1374
  4. Di Salvo TG, Mathier M, Semigran MJ, Dec GW. Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol. 1995;25:1143–1153
  5. de Groote P, Millaire A, Foucher-Hossein C, Nugue O, Marchandise X, Ducloux G, et al. Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol. 1998;32:948–954
  6. Dini FL, Conti U, Fontanive P, Andreini D, Banti S, Braccini L, et al. Right ventricular dysfunction is a major predictor of outcome in patients with moderate to severe mitral regurgitation and left ventricular dysfunction. Am Heart J. 2007;154:172–179
  7. Field ME, Solomon SD, Lewis EF, Kramer DB, Baughman KL, Stevenson LW, et al. Right ventricular dysfunction and adverse outcome in patients with advanced heart failure. J Card Fail. 2006;12:616–620
  8. Kormos RL, Gasior TA, Kawai A, Pham SM, Murali S, Hattler BG, et al. Transplant candidate's clinical status rather than right ventricular function defines need for univentricular versus biventricular support. J Thorac Cardiovasc Surg. 1996;111:773–782
  9. Matthews JC, Koelling TM, Pagani FD, Aaronson KD. The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates. J Am Coll Cardiol. 2008;51:2163–2172
  10. Ochiai Y, McCarthy PM, Smedira NG, Banbury MK, Navia JL, Feng J, et al. Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients. Circulation. 2002;106:I198–I202
  11. Zimpfer D, Zrunek P, Roethy W, Czerny M, Schima H, Huber L, et al. Left ventricular assist devices decrease fixed pulmonary hypertension in cardiac transplant candidates. J Thorac Cardiovasc Surg. 2007;133:689–695
  12. Salzberg SP, Lachat ML, von HK, Zund G, Turina MI. Normalization of high pulmonary vascular resistance with LVAD support in heart transplantation candidates. Eur J Cardiothorac Surg. 2005;27:222–225
  13. Baslaim G, Bashore J, Al-Malki F, Jamjoom A. Can the outcome of pediatric extracorporeal membrane oxygenation after cardiac surgery be predicted?. Ann Thorac Cardiovasc Surg. 2006;12:21–27
  14. Potapov EV, Hennig F, Wagner FD, Volk HD, Sodian R, Hausmann H, et al. Natriuretic peptides and E-selectin as predictors of acute deterioration in patients with inotrope-dependent heart failure. Eur J Cardiothorac Surg. 2005;27:899–905
  15. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–1463
  16. Farrar DJ, Compton PG, Dajee H, Fonger JD, Hill JD. Right heart function during left heart assist and the effects of volume loading in a canine preparation. Circulation. 1984;70:708–716
  17. Farrar DJ, Compton PG, Hershon JJ, Foner JD, Hill JD. Right ventricular pressure-dimension relationship during left ventricular assistance in dogs. Trans Am Soc Artif Intern Organs. 1984;30:121–123
  18. Farrar DJ, Chow E, Compton PG, Foppiano L, Woodard J, Hill JD. Effects of acute right ventricular ischemia on ventricular interactions during prosthetic left ventricular support. J Thorac Cardiovasc Surg. 1991;102:588–595
  19. Chow E, Farrar DJ. Right heart function during prosthetic left ventricular assistance in a porcine model of congestive heart failure. J Thorac Cardiovasc Surg. 1992;104:569–578
  20. Santamore WP, Gray LA. Left ventricular contributions to right ventricular systolic function during LVAD support. Ann Thorac Surg. 1996;61:350–356
  21. Maeder MT, Leet A, Ross A, Esmore D, Kaye DM. Changes in right ventricular function during continuous-low left ventricular assist device support. J Heart Lung Transplant. 2009;28:360–366
  22. Edmunds LH. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 1998;66:S12–S16
  23. Pegg TJ, Selvanayagam JB, Karamitsos TD, Arnold RJ, Francis JM, Neubauer S, et al. Effects of off-pump versus on-pump coronary artery bypass grafting on early and late right ventricular function. Circulation. 2008;117:2202–2210
  24. Stein KL, Breisblatt W, Wolfe C, Gasior T, Hardesty R. Depression and recovery of right ventricular function after cardiopulmonary bypass. Crit Care Med. 1990;18:1197–1200
  25. McCarthy PM, Savage RM, Fraser CD, Vargo R, James KB, Goormastic M, et al. Hemodynamic and physiologic changes during support with an implantable left ventricular assist device. J Thorac Cardiovasc Surg. 1995;109:409–417
  26. Ghio S, Gavazzi A, Campana C, Inserra C, Klersy C, Sebastiani R, et al. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol. 2001;37:183–188
  27. Hershon JJ, Farrar DJ, Compton PG, Hill JD. Right ventricular dimensions with transesophageal echocardiography during an operating room model of left heart assist. Trans Am Soc Artif Intern Organs. 1984;30:129–132
  28. Farrar DJ, Compton PG, Hershon JJ, Hill JD. Right ventricular function in an operating room model of mechanical left ventricular assistance and its effects in patients with depressed left ventricular function. Circulation. 1985;72:1279–1285
  29. Farrar DJ, Compton PG, Hershon JJ, Fonger JD, Hill JD. Right heart interaction with the mechanically assisted left heart. World J Surg. 1985;9:89–102
  30. Hoffman D, Sisto D, Frater RW, Nikolic SD. Left-to-right ventricular interaction with a noncontracting right ventricle. J Thorac Cardiovasc Surg. 1994;107:1496–1502
  31. James KB, McCarthy PM, Thomas JD, Vargo R, Hobbs RE, Sapp S, et al. Effect of the implantable left ventricular assist device on neuroendocrine activation in heart failure. Circulation. 1995;92:II191–II195
  32. Torre-Amione G, Stetson SJ, Youker KA, Durand JB, Radovancevic B, Delgado RM, et al. Decreased expression of tumor necrosis factor-alpha in failing human myocardium after mechanical circulatory support: a potential mechanism for cardiac recovery. Circulation. 1999;100:1189–1193
  33. Vatta M, Stetson SJ, Perez-Verdia A, Entman ML, Noon GP, Torre-Amione G, et al. Molecular remodelling of dystrophin in patients with end-stage cardiomyopathies and reversal in patients on assistance-device therapy. Lancet. 2002;359:936–941
  34. Vatta M, Stetson SJ, Jimenez S, Entman ML, Noon GP, Bowles NE, et al. Molecular normalization of dystrophin in the failing left and right ventricle of patients treated with either pulsatile or continuous flow-type ventricular assist devices. J Am Coll Cardiol. 2004;43:811–817
  35. Barbone A, Holmes JW, Heerdt PM, The' AH, Naka Y, Joshi N, et al. Comparison of right and left ventricular responses to left ventricular assist device support in patients with severe heart failure: a primary role of mechanical unloading underlying reverse remodeling. Circulation. 2001;104:670–675
  36. Klotz S, Naka Y, Oz MC, Burkhoff D. Biventricular assist device-induced right ventricular reverse structural and functional remodeling. J Heart Lung Transplant. 2005;24:1195–1201
  37. Klotz S, Jan Danser AH, Burkhoff D. Impact of left ventricular assist device (LVAD) support on the cardiac reverse remodeling process. Prog Biophys Mol Biol. 2008;97:479–496

 Dr. Palardy's research was supported by a fellowship grant from the Heart Failure Society of America.

PII: S1071-9164(09)01175-0

doi: 10.1016/j.cardfail.2009.11.002

Journal of Cardiac Failure
Volume 16, Issue 3 , Pages 218-224 , March 2010