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 ≥ 40%. 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/m(2), p < 0.01, and 92 vs. 60 ml/m(2), p < 0.01, respectively). LV mass decreased as early as 30 days after LVAD unloading (114 vs. 95 g/m(2), 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.
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 ≥ 40%. 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/m(2), p < 0.01, and 92 vs. 60 ml/m(2), p < 0.01, respectively). LV mass decreased as early as 30 days after LVAD unloading (114 vs. 95 g/m(2), 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.
Authors: Roberto M Lang; Michelle Bierig; Richard B Devereux; Frank A Flachskampf; Elyse Foster; Patricia A Pellikka; Michael H Picard; Mary J Roman; James Seward; Jack S Shanewise; Scott D Solomon; Kirk T Spencer; Martin St John Sutton; William J Stewart Journal: J Am Soc Echocardiogr Date: 2005-12 Impact factor: 5.251
Authors: Michael Dandel; Yuguo Weng; Henryk Siniawski; Evgenij Potapov; Thomas Krabatsch; Hans B Lehmkuhl; Thorsten Drews; Christoph Knosalla; Roland Hetzer Journal: Circulation Date: 2012-09-11 Impact factor: 29.690
Authors: David J Farrar; William R Holman; Lawrence R McBride; Robert L Kormos; Timothy B Icenogle; Paul J Hendry; Charles H Moore; Daniel Y Loisance; Aly El-Banayosy; Howard Frazier Journal: J Heart Lung Transplant Date: 2002-05 Impact factor: 10.247
Authors: Vinay Thohan; Sonny J Stetson; Sherif F Nagueh; Carlos Rivas-Gotz; Michael M Koerner; Javier A Lafuente; Matthias Loebe; George P Noon; Guillermo Torre-Amione Journal: J Heart Lung Transplant Date: 2005-05 Impact factor: 10.247
Authors: D M Mancini; A Beniaminovitz; H Levin; K Catanese; M Flannery; M DiTullio; S Savin; M E Cordisco; E Rose; M Oz Journal: Circulation Date: 1998-12-01 Impact factor: 29.690
Authors: Stefan Klotz; Mario C Deng; Joerg Stypmann; Juergen Roetker; Markus J Wilhelm; Dieter Hammel; Hans H Scheld; Christof Schmid Journal: Ann Thorac Surg Date: 2004-01 Impact factor: 4.330
Authors: Peter Razeghi; Saumya Sharma; Jun Ying; Yi-Ping Li; Stanislaw Stepkowski; Michael B Reid; Heinrich Taegtmeyer Journal: Circulation Date: 2003-11-10 Impact factor: 29.690
Authors: Deborah D Ascheim; Annetine C Gelijns; Daniel Goldstein; Lemuel A Moye; Nicholas Smedira; Sangjin Lee; Charles T Klodell; Anita Szady; Michael K Parides; Neal O Jeffries; Donna Skerrett; Doris A Taylor; J Eduardo Rame; Carmelo Milano; Joseph G Rogers; Janine Lynch; Todd Dewey; Eric Eichhorn; Benjamin Sun; David Feldman; Robert Simari; Patrick T O'Gara; Wendy C Taddei-Peters; Marissa A Miller; Yoshifumi Naka; Emilia Bagiella; Eric A Rose; Y Joseph Woo Journal: Circulation Date: 2014-03-28 Impact factor: 29.690
Authors: Rachit Badolia; Dinesh K A Ramadurai; E Dale Abel; Peter Ferrin; Iosif Taleb; Thirupura S Shankar; Aspasia Thodou Krokidi; Sutip Navankasattusas; Stephen H McKellar; Michael Yin; Abdallah G Kfoury; Omar Wever-Pinzon; James C Fang; Craig H Selzman; Dipayan Chaudhuri; Jared Rutter; Stavros G Drakos Journal: Circulation Date: 2020-04-30 Impact factor: 29.690
Authors: Michael J Bonios; Antigone Koliopoulou; Omar Wever-Pinzon; Iosif Taleb; Josef Stehlik; Weining Xu; James Wever-Pinzon; Anna Catino; Abdallah G Kfoury; Benjamin D Horne; Jose Nativi-Nicolau; Stamatis N Adamopoulos; James C Fang; Craig H Selzman; Jeroen J Bax; Stavros G Drakos Journal: Circ Cardiovasc Imaging Date: 2018-04 Impact factor: 7.792
Authors: Thomas Seidel; Sutip Navankasattusas; Azmi Ahmad; Nikolaos A Diakos; Weining David Xu; Martin Tristani-Firouzi; Michael J Bonios; Iosif Taleb; Dean Y Li; Craig H Selzman; Stavros G Drakos; Frank B Sachse Journal: Circulation Date: 2017-01-10 Impact factor: 29.690
Authors: Veli K Topkara; A Reshad Garan; Barry Fine; Amandine F Godier-Furnémont; Alexander Breskin; Barbara Cagliostro; Melana Yuzefpolskaya; Koji Takeda; Hiroo Takayama; Donna M Mancini; Yoshifumi Naka; Paolo C Colombo Journal: Circ Heart Fail Date: 2016-07 Impact factor: 8.790
Authors: Ana Maria Segura; Lamia Dris; Edward K Massin; Fred J Clubb; L Maximilian Buja; O H Frazier; Heinrich Taegtmeyer Journal: Tex Heart Inst J Date: 2014-08-01
Authors: Maria Chiara Todaro; Bijoy K Khandheria; Timothy E Paterick; Matt M Umland; Vinay Thohan Journal: Curr Cardiol Rep Date: 2014-04 Impact factor: 2.931
Authors: Zaid I Almarzooq; Anubodh S Varshney; Muthiah Vaduganathan; Manan Pareek; Garrick C Stewart; Jerry D Estep; Mandeep R Mehra Journal: JACC Cardiovasc Imaging Date: 2019-09-18