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Framework to Classify Reverse Cardiac Remodeling With Mechanical Circulatory Support: The Utah-Inova Stages.
Shah, Palak; Psotka, Mitchell; Taleb, Iosif; Alharethi, Rami; Shams, Mortada A; Wever-Pinzon, Omar; Yin, Michael; Latta, Federica; Stehlik, Josef; Fang, James C; Diao, Guoqing; Singh, Ramesh; Ijaz, Naila; Kyriakopoulos, Christos P; Zhu, Wei; May, Christopher W; Cooper, Lauren B; Desai, Shashank S; Selzman, Craig H; Kfoury, Abdallah G; Drakos, Stavros G.
Afiliação
  • 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.
  • 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.
  • 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.).
  • Alharethi R; 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.).
  • Shams MA; 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.).
  • Wever-Pinzon O; 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.
  • Yin M; Division of Cardiology (M.A.S.), George Washington University, Washington, DC.
  • Latta F; 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.).
  • Stehlik J; 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.).
  • 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.).
  • Diao G; 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.).
  • Singh R; 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.
  • Ijaz N; Department of Cardiology, University of Brescia, Italy (F.L.).
  • 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.).
  • Zhu W; 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.).
  • May CW; Department of Biostatistics and Bioinformatics (G.D.), George Washington University, Washington, DC.
  • Cooper LB; Cardiac Surgery (R.S.), Inova Heart and Vascular Institute, Falls Church, Virginia.
  • Desai SS; 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.
  • 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.).
  • Kfoury AG; 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.).
  • Drakos SG; 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.
Circ Heart Fail ; 14(5): e007991, 2021 05.
Article em En | MEDLINE | ID: mdl-33947201
ABSTRACT

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.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Recuperação de Função Fisiológica / Remodelação Ventricular / Insuficiência Cardíaca / Ventrículos do Coração Idioma: En Ano de publicação: 2021 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Recuperação de Função Fisiológica / Remodelação Ventricular / Insuficiência Cardíaca / Ventrículos do Coração Idioma: En Ano de publicação: 2021 Tipo de documento: Article