Framework to Classify Reverse Cardiac Remodeling With Mechanical Circulatory Support: The Utah-Inova Stages.

Aged Female Heart Failure / physiopathology Heart Ventricles / physiopathology Heart-Assist Devices Humans Male Middle Aged Myocardium / cytology Recovery of Function / physiology Stroke Volume / physiology Ventricular Function, Left / physiology Ventricular Remodeling / physiology
cardiomyopathy heart failure left ventricular remodeling myocardial recovery ventricular assist device

Journal

Circulation. Heart failure
ISSN: 1941-3297
Titre abrégé: Circ Heart Fail
Pays: United States
ID NLM: 101479941

Informations de publication

Date de publication:
05 2021
Historique:
pubmed: 6 5 2021
medline: 12 11 2021
entrez: 5 5 2021
Statut: ppublish

Résumé

Variable definitions and an incomplete understanding of the gradient of reverse cardiac remodeling following continuous flow left ventricular assist device (LVAD) implantation has limited the field of myocardial plasticity. We evaluated the continuum of LV remodeling by serial echocardiographic imaging to define 3 stages of reverse cardiac remodeling following LVAD. The study enrolled consecutive LVAD patients across 4 study sites. A blinded echocardiographer evaluated the degree of structural (LV internal dimension at end-diastole [LVIDd]) and functional (LV ejection fraction [LVEF]) change after LVAD. Patients experiencing an improvement in LVEF ≥40% and LVIDd ≤6.0 cm were termed responders, absolute change in LVEF of ≥5% and LVEF <40% were termed partial responders, and the remaining patients with no significant improvement in LVEF were termed nonresponders. Among 358 LVAD patients, 34 (10%) were responders, 112 (31%) partial responders, and the remaining 212 (59%) were nonresponders. The use of guideline-directed medical therapy for heart failure was higher in partial responders and responders. Structural changes (LVIDd) followed a different pattern with significant improvements even in patients who had minimal LVEF improvement. With mechanical unloading, the median reduction in LVIDd was -0.6 cm (interquartile range [IQR], -1.1 to -0.1 cm; nonresponders), -1.1 cm (IQR, -1.8 to -0.4 cm; partial responders), and -1.9 cm (IQR, -2.9 to -1.1 cm; responders). Similarly, the median change in LVEF was -2% (IQR, -6% to 1%), 9% (IQR, 6%-14%), and 27% (IQR, 23%-33%), respectively. Reverse cardiac remodeling associated with durable LVAD support is not an all-or-none phenomenon and manifests in a continuous spectrum. Defining 3 stages across this continuum can inform clinical management, facilitate the field of myocardial plasticity, and improve the design of future investigations.

Sections du résumé

BACKGROUND
Variable definitions and an incomplete understanding of the gradient of reverse cardiac remodeling following continuous flow left ventricular assist device (LVAD) implantation has limited the field of myocardial plasticity. We evaluated the continuum of LV remodeling by serial echocardiographic imaging to define 3 stages of reverse cardiac remodeling following LVAD.
METHODS
The study enrolled consecutive LVAD patients across 4 study sites. A blinded echocardiographer evaluated the degree of structural (LV internal dimension at end-diastole [LVIDd]) and functional (LV ejection fraction [LVEF]) change after LVAD. Patients experiencing an improvement in LVEF ≥40% and LVIDd ≤6.0 cm were termed responders, absolute change in LVEF of ≥5% and LVEF <40% were termed partial responders, and the remaining patients with no significant improvement in LVEF were termed nonresponders.
RESULTS
Among 358 LVAD patients, 34 (10%) were responders, 112 (31%) partial responders, and the remaining 212 (59%) were nonresponders. The use of guideline-directed medical therapy for heart failure was higher in partial responders and responders. Structural changes (LVIDd) followed a different pattern with significant improvements even in patients who had minimal LVEF improvement. With mechanical unloading, the median reduction in LVIDd was -0.6 cm (interquartile range [IQR], -1.1 to -0.1 cm; nonresponders), -1.1 cm (IQR, -1.8 to -0.4 cm; partial responders), and -1.9 cm (IQR, -2.9 to -1.1 cm; responders). Similarly, the median change in LVEF was -2% (IQR, -6% to 1%), 9% (IQR, 6%-14%), and 27% (IQR, 23%-33%), respectively.
CONCLUSIONS
Reverse cardiac remodeling associated with durable LVAD support is not an all-or-none phenomenon and manifests in a continuous spectrum. Defining 3 stages across this continuum can inform clinical management, facilitate the field of myocardial plasticity, and improve the design of future investigations.

Identifiants

DOI: 10.1161/CIRCHEARTFAILURE.120.007991 PMID: 33947201 PMC: PMC8137588
pubmed: 33947201
doi: 10.1161/CIRCHEARTFAILURE.120.007991
pmc: PMC8137588
mid: NIHMS1677992
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e007991

Subventions

Organisme : NHLBI NIH HHS
ID : R01 HL135121
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL150322
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL143179
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL132067
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL007576
Pays : United States

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Auteurs

Palak Shah (P)

Heart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.

Mitchell Psotka (M)

Heart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.

Iosif Taleb (I)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah School of Medicine, Salt Lake City (I.T., O.W.-P., M.Y., C.P.K., C.H.S., S.G.D.).

Rami Alharethi (R)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).

Mortada A Shams (MA)

Heart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.
Division of Cardiology (M.A.S.), George Washington University, Washington, DC.

Omar Wever-Pinzon (O)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah School of Medicine, Salt Lake City (I.T., O.W.-P., M.Y., C.P.K., C.H.S., S.G.D.).

Michael Yin (M)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah School of Medicine, Salt Lake City (I.T., O.W.-P., M.Y., C.P.K., C.H.S., S.G.D.).

Federica Latta (F)

Heart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.
Department of Cardiology, University of Brescia, Italy (F.L.).

Josef Stehlik (J)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).

James C Fang (JC)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).

Guoqing Diao (G)

Department of Biostatistics and Bioinformatics (G.D.), George Washington University, Washington, DC.

Ramesh Singh (R)

Cardiac Surgery (R.S.), Inova Heart and Vascular Institute, Falls Church, Virginia.

Naila Ijaz (N)

Heart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.

Christos P Kyriakopoulos (CP)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah School of Medicine, Salt Lake City (I.T., O.W.-P., M.Y., C.P.K., C.H.S., S.G.D.).

Wei Zhu (W)

Heart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.

Christopher W May (CW)

Heart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.

Lauren B Cooper (LB)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).

Shashank S Desai (SS)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).

Craig H Selzman (CH)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah School of Medicine, Salt Lake City (I.T., O.W.-P., M.Y., C.P.K., C.H.S., S.G.D.).

Abdallah G Kfoury (AG)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).

Stavros G Drakos (SG)

Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah School of Medicine, Salt Lake City (I.T., O.W.-P., M.Y., C.P.K., C.H.S., S.G.D.).

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Framework to Classify Reverse Cardiac...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Défaillance cardiaque › Framework to Classify Reverse Cardiac...
questionsmedicales.fr › Système cardiovasculaire › Coeur › Ventricules cardiaques › Framework to Classify Reverse Cardiac...
questionsmedicales.fr › Équipement et fournitures › Équipement chirurgical › Organes artificiels › Coeur artificiel › Dispositifs d'assistance circulatoire › Framework to Classify Reverse Cardiac...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Framework to Classify Reverse Cardiac...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Framework to Classify Reverse Cardiac...
questionsmedicales.fr › Tissus › Muscles › Muscle strié › Myocarde › Framework to Classify Reverse Cardiac...
questionsmedicales.fr › Phénomènes biologiques › Récupération fonctionnelle › Framework to Classify Reverse Cardiac...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Hémodynamique › Débit cardiaque › Débit systolique › Framework to Classify Reverse Cardiac...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Fonction ventriculaire › Fonction ventriculaire gauche › Framework to Classify Reverse Cardiac...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Fonction ventriculaire › Remodelage ventriculaire › Framework to Classify Reverse Cardiac...