Mechanical unloading leads to echocardiographic, electrocardiographic, neurohormonal, and histologic recovery.
BACKGROUND
Mechanical unloading during left ventricular assist device (LVAD) support may lead to cardiac recovery. Predictors of recovery, however, have not been identified. We aimed to evaluate the time course and durability of echocardiographic, electrocardiographic (ECG), histologic, and neurohormonal changes that occur with LVAD support and to screen for non-invasive markers of cardiac recovery.


METHODS
LVAD patients underwent monthly testing, including echocardiographic, ECG, and serum B-type natriuretic peptide (BNP) measurement. Paired myocardial tissue samples from implant and explant were also analyzed.


RESULTS
Thirty-six LVAD patients were prospectively followed for an average of 101 +/- 99 days. Left ventricular ejection fraction (LVEF) and end-diastolic diameter (LVEDD) significantly improved at 30 days compared with pre-LVAD (19% +/- 6.6% vs 33% +/- 8.1%, 7.1 +/- 1.2 cm vs 4.9 +/- 1.0 cm, respectively; both p < 0.001), with no improvement thereafter. At 30 days, QRS duration and QTc interval were significantly decreased from pre-LVAD (both p < 0.05). There was a marked reduction in BNP, myocyte size, and collagen deposition with LVAD support (all p < 0.01). In screening for markers of recovery, the decrease in QTc was inversely related to LVEDD at 60 days. Changes in QRS and myocyte diameter also correlated with the improvement in LVEF at 30 days. No patients had sufficient recovery for device explantation.


CONCLUSIONS
We demonstrate echocardiographic, ECG, histologic, and neurohormonal improvement during LVAD support. Cardiac recovery peaked by 60 days, and there was a trend toward progressive improvement in QRS duration with ongoing support. We report the association of ECG changes with echocardiographic and histologic improvements. Future prospective studies may yield important markers of recovery.
Xydas
Steve
S
Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, NY 10032, USA. sx25@columbia.edu
Rosen
Rebecca S
RS
Ng
Chuck
C
Mercando
Michelle
M
Cohen
Jason
J
DiTullio
Marco
M
Magnano
Anthony
A
Marboe
Charles C
CC
Mancini
Donna M
DM
Naka
Yoshifumi
Y
Oz
Mehmet C
MC
Maybaum
Simon
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002306:Cardiac Volume; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011312:Pressure; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000601:surgery*
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain