Abstract:
BACKGROUND: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.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Wever-Pinzon J,Selzman CH,Stoddard G,Wever-Pinzon O,Catino A,Kfoury AG,Diakos NA,Reid BB,McKellar S,Bonios M,Koliopoulou A,Budge D,Kelkhoff A,Stehlik J,Fang JC,Drakos SGdoi
10.1016/j.jacc.2016.07.756subject
Has Abstractpub_date
2016-10-18 00:00:00pages
1741-1752issue
16eissn
0735-1097issn
1558-3597pii
S0735-1097(16)34925-7journal_volume
68pub_type
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