Veli K Topkara1, A Reshad Garan2, Barry Fine2, Amandine F Godier-Furnémont2, Alexander Breskin2, Barbara Cagliostro2, Melana Yuzefpolskaya2, Koji Takeda2, Hiroo Takayama2, Donna M Mancini2, Yoshifumi Naka2, Paolo C Colombo2. 1. From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York. vt2113@cumc.columbia.edu. 2. From the Division of Cardiology, Department of Medicine (V.K.T., A.R.G., B.F., A.F.G.G.-F., A.B., M.Y., D.M.M., P.C.C.) and Division of Cardiothoracic Surgery, Department of Surgery (B.C., K.T., H.T., Y.N.), Columbia University Medical Center-New York Presbyterian, New York.
Abstract
BACKGROUND: Time course and predictors of myocardial recovery on contemporary left ventricular assist device support are poorly defined because of limited number of recovery patients at any implanting center. This study sought to investigate myocardial recovery using multicenter data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). METHODS AND RESULTS: Thirteen thousand four hundred fifty-four adult patients were studied. Device explant rates for myocardial recovery were 0.9% at 1-year, 1.9% at 2-year, and 3.1% at 3-year follow-up. Independent predictors of device explantation for recovery were age <50 years (odds ratio [OR] 2.5), nonischemic etiology (OR 5.4), time since initial diagnosis <2 years (OR 3.4), suboptimal heart failure therapy before implant (OR 2.2), left ventricular end-diastolic diameter <6.5 cm (OR 1.7), pulmonary systolic artery pressure <50 mm Hg (OR 2.0), blood urea nitrogen <30 mg/dL (OR 3.3), and axial-flow device (OR 7.6). Patients with myocarditis (7.7%), postpartum cardiomyopathy (4.4%), and adriamycin-induced cardiomyopathy (4.1%) had highest rates of device explantation for recovery. Use of neurohormonal blockers on left ventricular assist device support was significantly higher in patients who were explanted for recovery. Importantly, 9% of all left ventricular assist device patients who were not explanted for recovery have demonstrated substantial improvement in left ventricular ejection fraction (partial recovery) and had remarkable overlap in clinical characteristic profile compared with patients who were explanted for recovery (complete recovery). Complete and partial recovery rates have declined in parallel with recent changes observed in device indications and technology. CONCLUSIONS: Myocardial recovery is a spectrum of improvement rather than a binary clinical end point. One in every 10 left ventricular assist device patients demonstrates partial or complete myocardial recovery and should be targeted for functional assessment and optimization.
BACKGROUND: Time course and predictors of myocardial recovery on contemporary left ventricular assist device support are poorly defined because of limited number of recovery patients at any implanting center. This study sought to investigate myocardial recovery using multicenter data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). METHODS AND RESULTS: Thirteen thousand four hundred fifty-four adult patients were studied. Device explant rates for myocardial recovery were 0.9% at 1-year, 1.9% at 2-year, and 3.1% at 3-year follow-up. Independent predictors of device explantation for recovery were age <50 years (odds ratio [OR] 2.5), nonischemic etiology (OR 5.4), time since initial diagnosis <2 years (OR 3.4), suboptimal heart failure therapy before implant (OR 2.2), left ventricular end-diastolic diameter <6.5 cm (OR 1.7), pulmonary systolic artery pressure <50 mm Hg (OR 2.0), blood ureanitrogen <30 mg/dL (OR 3.3), and axial-flow device (OR 7.6). Patients with myocarditis (7.7%), postpartum cardiomyopathy (4.4%), and adriamycin-induced cardiomyopathy (4.1%) had highest rates of device explantation for recovery. Use of neurohormonal blockers on left ventricular assist device support was significantly higher in patients who were explanted for recovery. Importantly, 9% of all left ventricular assist device patients who were not explanted for recovery have demonstrated substantial improvement in left ventricular ejection fraction (partial recovery) and had remarkable overlap in clinical characteristic profile compared with patients who were explanted for recovery (complete recovery). Complete and partial recovery rates have declined in parallel with recent changes observed in device indications and technology. CONCLUSIONS: Myocardial recovery is a spectrum of improvement rather than a binary clinical end point. One in every 10 left ventricular assist device patients demonstrates partial or complete myocardial recovery and should be targeted for functional assessment and optimization.
Authors: Marc A Simon; Robert L Kormos; Srinivas Murali; Pradeep Nair; Michael Heffernan; John Gorcsan; Stephen Winowich; Dennis M McNamara Journal: Circulation Date: 2005-08-30 Impact factor: 29.690
Authors: Stefan Klotz; Alessandro Barbone; Steven Reiken; Jeffrey W Holmes; Yoshifumi Naka; Mehmet C Oz; Andrew R Marks; Daniel Burkhoff Journal: J Am Coll Cardiol Date: 2005-03-01 Impact factor: 24.094
Authors: O H Frazier; Andrew C W Baldwin; Zumrut T Demirozu; Ana Maria Segura; Ruben Hernandez; Heinrich Taegtmeyer; Hari Mallidi; William E Cohn Journal: J Heart Lung Transplant Date: 2014-09-28 Impact factor: 10.247
Authors: G Torre-Amione; S J Stetson; K A Youker; J B Durand; B Radovancevic; R M Delgado; O H Frazier; M L Entman; G P Noon Journal: Circulation Date: 1999-09-14 Impact factor: 29.690
Authors: Leslie W Miller; Francis D Pagani; Stuart D Russell; Ranjit John; Andrew J Boyle; Keith D Aaronson; John V Conte; Yoshifumi Naka; Donna Mancini; Reynolds M Delgado; Thomas E MacGillivray; David J Farrar; O H Frazier Journal: N Engl J Med Date: 2007-08-30 Impact factor: 91.245
Authors: Mark S Slaughter; Joseph G Rogers; Carmelo A Milano; Stuart D Russell; John V Conte; David Feldman; Benjamin Sun; Antone J Tatooles; Reynolds M Delgado; James W Long; Thomas C Wozniak; Waqas Ghumman; David J Farrar; O Howard Frazier Journal: N Engl J Med Date: 2009-11-17 Impact factor: 91.245
Authors: Sui Zhang; Xiaobing Liu; Tasneem Bawa-Khalfe; Long-Sheng Lu; Yi Lisa Lyu; Leroy F Liu; Edward T H Yeh Journal: Nat Med Date: 2012-10-28 Impact factor: 53.440
Authors: Stephen Pan; Baran Aksut; Omar E Wever-Pinzon; Shaline D Rao; Allison P Levin; Arthur R Garan; Justin A Fried; Koji Takeda; Takayama Hiroo; Melana Yuzefpolskaya; Nir Uriel; Ulrich P Jorde; Donna M Mancini; Yoshifumi Naka; Paolo C Colombo; Veli K Topkara Journal: J Heart Lung Transplant Date: 2015-09-01 Impact factor: 10.247
Authors: Veli K Topkara; Gabriel T Sayer; Kevin J Clerkin; Omar Wever-Pinzon; Koji Takeda; Hiroo Takayama; Craig H Selzman; Yoshifumi Naka; Daniel Burkhoff; Josef Stehlik; Maryjane A Farr; James C Fang; Nir Uriel; Stavros G Drakos Journal: J Am Coll Cardiol Date: 2022-03-08 Impact factor: 24.094
Authors: Palak Shah; Mitchell Psotka; Iosif Taleb; Rami Alharethi; Mortada A Shams; Omar Wever-Pinzon; Michael Yin; Federica Latta; Josef Stehlik; James C Fang; Guoqing Diao; Ramesh Singh; Naila Ijaz; Christos P Kyriakopoulos; Wei Zhu; Christopher W May; Lauren B Cooper; Shashank S Desai; Craig H Selzman; Abdallah G Kfoury; Stavros G Drakos Journal: Circ Heart Fail Date: 2021-05-05 Impact factor: 8.790
Authors: Ahmad A Cluntun; Rachit Badolia; Sandra Lettlova; K Mark Parnell; Thirupura S Shankar; Nikolaos A Diakos; Kristofor A Olson; Iosif Taleb; Sean M Tatum; Jordan A Berg; Corey N Cunningham; Tyler Van Ry; Alex J Bott; Aspasia Thodou Krokidi; Sarah Fogarty; Sophia Skedros; Wojciech I Swiatek; Xuejing Yu; Bai Luo; Shannon Merx; Sutip Navankasattusas; James E Cox; Gregory S Ducker; William L Holland; Stephen H McKellar; Jared Rutter; Stavros G Drakos Journal: Cell Metab Date: 2020-12-16 Impact factor: 27.287
Authors: Veli K Topkara; Pierre Elias; Rashmi Jain; Gabriel Sayer; Daniel Burkhoff; Nir Uriel Journal: Circ Heart Fail Date: 2021-12-24 Impact factor: 8.790
Authors: Eleanor F Gerhard; Lu Wang; Ramesh Singh; Stephan Schueler; Leonard D Genovese; Andrew Woods; Daniel Tang; Nicola Robinson Smith; Mitchell A Psotka; Sian Tovey; Shashank S Desai; Djordje G Jakovljevic; Guy A MacGowan; Palak Shah Journal: J Heart Lung Transplant Date: 2021-08-11 Impact factor: 10.247
Authors: Jeffrey J Saucerman; Philip M Tan; Kyle S Buchholz; Andrew D McCulloch; Jeffrey H Omens Journal: Nat Rev Cardiol Date: 2019-06 Impact factor: 32.419