Michael J Bonios1, Antigone Koliopoulou1, Omar Wever-Pinzon1, Iosif Taleb1, Josef Stehlik1, Weining Xu1, James Wever-Pinzon1, Anna Catino1, Abdallah G Kfoury1, Benjamin D Horne1, Jose Nativi-Nicolau1, Stamatis N Adamopoulos1, James C Fang1, Craig H Selzman1, Jeroen J Bax1, Stavros G Drakos2. 1. Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.). 2. Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.). stavros.drakos@hsc.utah.edu.
Abstract
BACKGROUND: Impaired qualitative and quantitative left ventricular (LV) rotational mechanics predict cardiac remodeling progression and prognosis after myocardial infarction. We investigated whether cardiac rotational mechanics can predict cardiac recovery in chronic advanced cardiomyopathy patients. METHODS AND RESULTS: Sixty-three patients with advanced and chronic dilated cardiomyopathy undergoing implantation of LV assist device (LVAD) were prospectively investigated using speckle tracking echocardiography. Acute heart failure patients were prospectively excluded. We evaluated LV rotational mechanics (apical and basal LV twist, LV torsion) and deformational mechanics (circumferential and longitudinal strain) before LVAD implantation. Cardiac recovery post-LVAD implantation was defined as (1) final resulting LV ejection fraction ≥40%, (2) relative LV ejection fraction increase ≥50%, (iii) relative LV end-systolic volume decrease ≥50% (all 3 required). Twelve patients fulfilled the criteria for cardiac recovery (Rec Group). The Rec Group had significantly less impaired pre-LVAD peak LV torsion compared with the Non-Rec Group. Notably, both groups had similarly reduced pre-LVAD LV ejection fraction. By receiver operating characteristic curve analysis, pre-LVAD peak LV torsion of 0.35 degrees/cm had a 92% sensitivity and a 73% specificity in predicting cardiac recovery. Peak LV torsion before LVAD implantation was found to be an independent predictor of cardiac recovery after LVAD implantation (odds ratio, 0.65 per 0.1 degrees/cm [0.49-0.87]; P=0.014). CONCLUSIONS: LV rotational mechanics seem to be useful in selecting patients prone to cardiac recovery after mechanical unloading induced by LVADs. Future studies should investigate the utility of these markers in predicting durable cardiac recovery after the explantation of the cardiac assist device.
BACKGROUND: Impaired qualitative and quantitative left ventricular (LV) rotational mechanics predict cardiac remodeling progression and prognosis after myocardial infarction. We investigated whether cardiac rotational mechanics can predict cardiac recovery in chronic advanced cardiomyopathypatients. METHODS AND RESULTS: Sixty-three patients with advanced and chronic dilated cardiomyopathy undergoing implantation of LV assist device (LVAD) were prospectively investigated using speckle tracking echocardiography. Acute heart failurepatients were prospectively excluded. We evaluated LV rotational mechanics (apical and basal LV twist, LV torsion) and deformational mechanics (circumferential and longitudinal strain) before LVAD implantation. Cardiac recovery post-LVAD implantation was defined as (1) final resulting LV ejection fraction ≥40%, (2) relative LV ejection fraction increase ≥50%, (iii) relative LV end-systolic volume decrease ≥50% (all 3 required). Twelve patients fulfilled the criteria for cardiac recovery (Rec Group). The Rec Group had significantly less impaired pre-LVAD peak LV torsion compared with the Non-Rec Group. Notably, both groups had similarly reduced pre-LVADLV ejection fraction. By receiver operating characteristic curve analysis, pre-LVAD peak LV torsion of 0.35 degrees/cm had a 92% sensitivity and a 73% specificity in predicting cardiac recovery. Peak LV torsion before LVAD implantation was found to be an independent predictor of cardiac recovery after LVAD implantation (odds ratio, 0.65 per 0.1 degrees/cm [0.49-0.87]; P=0.014). CONCLUSIONS: LV rotational mechanics seem to be useful in selecting patients prone to cardiac recovery after mechanical unloading induced by LVADs. Future studies should investigate the utility of these markers in predicting durable cardiac recovery after the explantation of the cardiac assist device.
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