title: Impact of Ischemic Heart Failure Etiology on Cardiac Recovery During Mechanical Unloading.
abstract: Small-scale studies focused mainly on nonischemic cardiomyopathy (NICM) have shown that a subset of left ventricular assist device (LVAD) patients can achieve significant improvement of their native heart function, but the impact of ischemic cardiomyopathy (ICM) has not been specifically investigated. Many patients with acute myocardial infarction are discharged from their index hospitalization without heart failure (HF), only to return much later with overt HF syndrome, mainly caused by chronic remodeling of the noninfarcted region of the myocardium.
  
  
  
  This study sought to prospectively investigate the effect of ICM HF etiology on LVAD-associated improvement of cardiac structure and function using NICM as control.
  
  
  
  Consecutive patients (n = 154) with documented chronic and dilated cardiomyopathy (ICM, n = 61; NICM, n = 93) requiring durable support with continuous-flow LVAD were prospectively evaluated with serial echocardiograms and right heart catheterizations.
  
  
  
  In patients supported with LVAD for at least 6 months, we found that 5% of subjects with ICM and 21% of subjects with NICM achieved left ventricular ejection fraction ≥40% (p = 0.034). LV end-diastolic and end-systolic volumes and diastolic function were significantly and similarly improved in patients with ICM and NICM.
  
  
  
  LVAD-associated unloading for 6 months resulted in a substantial improvement in myocardial structure, and systolic and diastolic function in 1 in 20 ICM and 1 in 5 NICM patients. These specific incidence and timeline findings may provide guidance in clinical practice and research design for sequencing and prioritizing advanced HF and heart transplantation therapeutic options in patients with ICM and NICM.
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: James
authors.initials: J
authors.lastname: Wever-Pinzon
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; University of Utah Molecular Medicine Program, Salt Lake City, Utah.
authors.forename: Craig H
authors.initials: CH
authors.lastname: Selzman
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Greg
authors.initials: G
authors.lastname: Stoddard
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Omar
authors.initials: O
authors.lastname: Wever-Pinzon
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Anna
authors.initials: A
authors.lastname: Catino
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; University of Utah Molecular Medicine Program, Salt Lake City, Utah.
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Diakos
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Reid
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; University of Utah Molecular Medicine Program, Salt Lake City, Utah.
authors.forename: Stephen
authors.initials: S
authors.lastname: McKellar
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Michael
authors.initials: M
authors.lastname: Bonios
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Antigone
authors.initials: A
authors.lastname: Koliopoulou
authors.affiliation: University of Utah Molecular Medicine Program, Salt Lake City, Utah.
authors.forename: Deborah
authors.initials: D
authors.lastname: Budge
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Aaron
authors.initials: A
authors.lastname: Kelkhoff
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.affiliation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; University of Utah Molecular Medicine Program, Salt Lake City, Utah. Electronic address: stavros.drakos@hsc.utah.edu.
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Drakos
mesh_terms: D005260:Female; D006321:Heart / Q000033:anatomy & histology / Q000502:physiology; D006333:Heart Failure / Q000209:etiology* / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000150:complications*; D011446:Prospective Studies; D020127:Recovery of Function
keywords: cardiac recovery; ischemic cardiomyopathy; left ventricular assist device; mechanical unloading; myocardial function; myocardial structure