title: Preoperative beta-blocker treatment is a key for deciding left ventricular assist device implantation strategy as a bridge to recovery.
abstract: To date, there have been few reports demonstrating preoperative predictors for left ventricular reverse remodeling (LVRR) after LV assist device (LVAD) implantation, especially among patients with dilated cardiomyopathy (DCM). We retrospectively analyzed 60 patients with stage D heart failure due to DCM who had received LVAD treatment [pulsatile flow (PF) type, 26; continuous flow type, 34]. Data were evaluated at 6 months or just before explantation of the LVAD. We defined "LV reverse remodeling" (LVRR) by the achievement of an LV ejection fraction (LVEF) of ≥ 35 % after 6 months of LVAD support or explantation of LVAD within 6 months. LVRR occurred in 16 of our patients (26.7 %). Uni/multivariate logistic regression analyses for LVRR demonstrated that of the preoperative variables evaluated, PF LVAD usage and insufficient preoperative β-blocker treatment were independent predictors for LVRR. Patients who accomplished LVRR had a better clinical course, including lower levels of aortic valve insufficiency and lower levels of plasma B-type natriuretic peptide. Of the six patients (10.0 %) in whom LVADs were eventually explanted, all had an LVEF of ≥ 35 % before explantation or at 6 months. Based on these results, we conclude that DCM patients with insufficient preoperative β-blocker treatment have a chance to achieve LVRR under LVAD support as a bridge to recovery.
authors: Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, imamurate-int@h.u-tokyo.ac.jp.
authors: Teruhiko
authors: T
authors: Imamura
authors: Koichiro
authors: K
authors: Kinugawa
authors: Masaru
authors: M
authors: Hatano
authors: Takeo
authors: T
authors: Fujino
authors: Hironori
authors: H
authors: Muraoka
authors: Toshiro
authors: T
authors: Inaba
authors: Hisataka
authors: H
authors: Maki
authors: Yukie
authors: Y
authors: Kagami
authors: Miyoko
authors: M
authors: Endo
authors: Osamu
authors: O
authors: Kinoshita
authors: Kan
authors: K
authors: Nawata
authors: Shunei
authors: S
authors: Kyo
authors: Minoru
authors: M
authors: Ono
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011673:Pulsatile Flow; D012189:Retrospective Studies; D020257:Ventricular Remodeling; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists