Cardiac improvement during mechanical circulatory support: a prospective multicenter study of the LVAD Working Group.
ABSTRACT Myocardial recovery after left ventricular assist device (LVAD) support has been reported. The LVAD Working Group Recovery Study was a prospective multicenter trial to assess the incidence of myocardial recovery in patients bridged to cardiac transplantation.
After LVAD implantation, patients were evaluated with the use of rest echocardiograms with partial LVAD support and cardiopulmonary exercise testing. Dobutamine echocardiography with hemodynamic measurements was performed in those patients with left ventricular ejection fraction >40% during resting studies. Histological analysis was performed on myocardial samples taken at LVAD implantation and explantation. Sixty-seven LVAD patients with heart failure participated in the study. After 30 days, significant improvement occurred in left ventricular ejection fraction (17+/-7% versus 34+/-12%; P<0.001) and reductions in left ventricular end-diastolic diameter (7.1+/-1.2 versus 5.1+/-1.1 cm; P<0.001) and left ventricular mass (320+/-113 versus 194+/-79 g; P<0.001) compared with before LVAD. Thirty-four percent of patients had left ventricular ejection fraction >40% with partial device support. Left ventricular ejection fraction decreased over time to pre-LVAD measurement by 120 days. Peak VO2 improved with mechanical support (13.7+/-4.2 versus 18.9+/-5.5 mL/kg per minute, 30 versus 120 days; P<0.001). Tissue analysis revealed significant reductions in myocyte size, collagen content, and cardiac tumor necrosis factor-alpha. Six subjects (9%) underwent LVAD explantation for recovery.
Cardiac function improves significantly after device implantation. Although cellular recovery and improvement in ventricular function are observed, the degree of clinical recovery is insufficient for device explantation in most patients with chronic heart failure.
Article: Increased levels of retinol binding protein 4 in patients with advanced heart failure correct after hemodynamic improvement through ventricular assist device placement.[show abstract] [hide abstract]
ABSTRACT: Background: Chronic heart failure is associated with higher risk for developing diabetes mellitus. Secretory products from adipocytes may contribute to the deterioration in glycemic control and increased insulin resistance (IR). Retinol binding protein 4 (RBP4) is an adipose tissue-derived protein with pro-diabetogenic effects. The aim of the present study was to investigate the relationship of RBP4 in patients with heart failure. Methods and Results: Serum levels of RBP4, insulin, and fasting glucose were assessed in 58 patients with severe heart failure at the time of left ventricular assist device (LVAD) implantation and in 44 patients at the time of explantation, as well as in 10 normal control subjects. Serum RBP4 levels were measured by specific enzyme-linked immunosorbent assay, and IR was assessed using the homeostatic model of IR (HOMA-IR). Fasting glucose, insulin and HOMA-IR were significantly higher in patients at the time of LVAD implantation compared to controls (all P<0.01). RBP-4 and HOMA-IR significantly decreased after LVAD implantation (21.7±8.8mg/dl to 16.0±3.8mg/dl, P<0.05; 4.2±2.7 to 2.5±2.0, P<0.01). Conclusions: Patients with advanced heart failure have increased levels of RBP4, and LVAD implantation reduces RBP4. These findings implicate RBP4 in the cascade of reversible metabolic derangements in advanced heart failure. (Circ J 2012; 76: 2148-2152).Circulation Journal 06/2012; 76(9):2148-52. · 3.77 Impact Factor
Article: Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion.[show abstract] [hide abstract]
ABSTRACT: We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies.Journal of Translational Medicine 01/2011; 9:12. · 3.41 Impact Factor
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ABSTRACT: Since the commencement of the artificial-heart program at the National Institutes of Health in 1964, many circulatory-support devices have been developed for short-term use in patients with end-stage heart failure. In the last decade, the interest on mechanical devices for ventricular assistance increased rapidly. As a result, significant advances in both the technology and clinical experience in the field of mechanical cardiac assist occurred over the last decade. In the current era, there is a wide variety of devices both available and in development. This article briefly reviews the evolving concepts and current systems on ventricular assist devices, as well as their role in today's clinical practice.Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 11/2008; 8 Suppl 2:117-30. · 0.44 Impact Factor