Effects of continuous-flow versus pulsatile-flow left ventricular assist devices on myocardial unloading and remodeling

Tomoko S. Kato, Aalap Chokshi, Parvati Singh, Tuba Khawaja, Faisal Cheema, Hirokazu Akashi, Khurram Shahzad, Shinichi Iwata, Shunichi Homma, Hiroo Takayama, Yoshifumi Naka, Ulrich P. Jorde, Maryjane Farr, Donna M. Mancini, P. Christian Schulze

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Background: Continuous-flow left ventricular assist devices (LVAD) are increasingly used for patients with end-stage heart failure (HF). We analyzed the effects of ventricular decompression by continuous-flow versus pulsatile-flow LVADs on myocardial structure and function in this population. Methods and Results: Sixty-one patients who underwent LVAD implantation as bridge-to-transplant were analyzed (pulsatile-flow LVAD: group P, n = 31; continuous-flow LVAD: group C, n=30). Serial echocardiograms, serum levels of brain natriuretic peptide (BNP), and extracellular matrix biomarkers (ECM) were compared between the groups. Myocardial BNP and ECM gene expression were evaluated in a subset of 18 patients. Postoperative LV ejection fraction was greater (33.2± 12.6% versus 17.6±8.8%, P>0.0001) and the mitral E/E' was lower (9.9±2.6 versus 13.2±3.8, P=0.0002) in group P versus group C. Postoperative serum levels of BNP, metalloproteinases (MMP)-9, and tissue inhibitor of MMP (TIMP)-4 were significantly lower in group P compared with group C (BNP: 552.6±340.6 versus 965.4±805.7 pg/mL, P<0.01; MMP9:309.0±220.2 versus 475.2±336.9 ng/dL, P<0.05; TIMP4:1490.9±622.4 versus 2014.3±452.4 ng/dL, P<0.001). Myocardial gene expression of ECM markers and BNP decreased in both groups; however, expression of TIMP-4 decreased only in group P (P=0.024). Conclusions: Mechanical unloading of the failing myocardium using pulsatile devices is more effective as indicated by echocardiographic parameters of systolic and diastolic LV function as well as dynamics of BNP and ECM markers. Therefore, specific effects of pulsatile mechanical unloading on the failing myocardium may have important implications for device selection especially for the purpose of bridge-to-recovery in patients with advanced HF.

Original languageEnglish (US)
Pages (from-to)546-553
Number of pages8
JournalCirculation: Heart Failure
Volume4
Issue number5
DOIs
StatePublished - Sep 2011
Externally publishedYes

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Pulsatile Flow
Heart-Assist Devices
Brain Natriuretic Peptide
Extracellular Matrix
Biomarkers
Matrix Metalloproteinase Inhibitors
Myocardium
Heart Failure
Gene Expression
Equipment and Supplies
Matrix Metalloproteinase 9
Decompression
Serum
Transplants
Population

Keywords

  • Echocardiography
  • Heart assist device
  • Heart failure
  • Remodeling
  • Transplant

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Effects of continuous-flow versus pulsatile-flow left ventricular assist devices on myocardial unloading and remodeling. / Kato, Tomoko S.; Chokshi, Aalap; Singh, Parvati; Khawaja, Tuba; Cheema, Faisal; Akashi, Hirokazu; Shahzad, Khurram; Iwata, Shinichi; Homma, Shunichi; Takayama, Hiroo; Naka, Yoshifumi; Jorde, Ulrich P.; Farr, Maryjane; Mancini, Donna M.; Christian Schulze, P.

In: Circulation: Heart Failure, Vol. 4, No. 5, 09.2011, p. 546-553.

Research output: Contribution to journalArticle

Kato, TS, Chokshi, A, Singh, P, Khawaja, T, Cheema, F, Akashi, H, Shahzad, K, Iwata, S, Homma, S, Takayama, H, Naka, Y, Jorde, UP, Farr, M, Mancini, DM & Christian Schulze, P 2011, 'Effects of continuous-flow versus pulsatile-flow left ventricular assist devices on myocardial unloading and remodeling', Circulation: Heart Failure, vol. 4, no. 5, pp. 546-553. https://doi.org/10.1161/CIRCHEARTFAILURE.111.962142
Kato, Tomoko S. ; Chokshi, Aalap ; Singh, Parvati ; Khawaja, Tuba ; Cheema, Faisal ; Akashi, Hirokazu ; Shahzad, Khurram ; Iwata, Shinichi ; Homma, Shunichi ; Takayama, Hiroo ; Naka, Yoshifumi ; Jorde, Ulrich P. ; Farr, Maryjane ; Mancini, Donna M. ; Christian Schulze, P. / Effects of continuous-flow versus pulsatile-flow left ventricular assist devices on myocardial unloading and remodeling. In: Circulation: Heart Failure. 2011 ; Vol. 4, No. 5. pp. 546-553.
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AU - Kato, Tomoko S.

AU - Chokshi, Aalap

AU - Singh, Parvati

AU - Khawaja, Tuba

AU - Cheema, Faisal

AU - Akashi, Hirokazu

AU - Shahzad, Khurram

AU - Iwata, Shinichi

AU - Homma, Shunichi

AU - Takayama, Hiroo

AU - Naka, Yoshifumi

AU - Jorde, Ulrich P.

AU - Farr, Maryjane

AU - Mancini, Donna M.

AU - Christian Schulze, P.

PY - 2011/9

Y1 - 2011/9

N2 - Background: Continuous-flow left ventricular assist devices (LVAD) are increasingly used for patients with end-stage heart failure (HF). We analyzed the effects of ventricular decompression by continuous-flow versus pulsatile-flow LVADs on myocardial structure and function in this population. Methods and Results: Sixty-one patients who underwent LVAD implantation as bridge-to-transplant were analyzed (pulsatile-flow LVAD: group P, n = 31; continuous-flow LVAD: group C, n=30). Serial echocardiograms, serum levels of brain natriuretic peptide (BNP), and extracellular matrix biomarkers (ECM) were compared between the groups. Myocardial BNP and ECM gene expression were evaluated in a subset of 18 patients. Postoperative LV ejection fraction was greater (33.2± 12.6% versus 17.6±8.8%, P>0.0001) and the mitral E/E' was lower (9.9±2.6 versus 13.2±3.8, P=0.0002) in group P versus group C. Postoperative serum levels of BNP, metalloproteinases (MMP)-9, and tissue inhibitor of MMP (TIMP)-4 were significantly lower in group P compared with group C (BNP: 552.6±340.6 versus 965.4±805.7 pg/mL, P<0.01; MMP9:309.0±220.2 versus 475.2±336.9 ng/dL, P<0.05; TIMP4:1490.9±622.4 versus 2014.3±452.4 ng/dL, P<0.001). Myocardial gene expression of ECM markers and BNP decreased in both groups; however, expression of TIMP-4 decreased only in group P (P=0.024). Conclusions: Mechanical unloading of the failing myocardium using pulsatile devices is more effective as indicated by echocardiographic parameters of systolic and diastolic LV function as well as dynamics of BNP and ECM markers. Therefore, specific effects of pulsatile mechanical unloading on the failing myocardium may have important implications for device selection especially for the purpose of bridge-to-recovery in patients with advanced HF.

AB - Background: Continuous-flow left ventricular assist devices (LVAD) are increasingly used for patients with end-stage heart failure (HF). We analyzed the effects of ventricular decompression by continuous-flow versus pulsatile-flow LVADs on myocardial structure and function in this population. Methods and Results: Sixty-one patients who underwent LVAD implantation as bridge-to-transplant were analyzed (pulsatile-flow LVAD: group P, n = 31; continuous-flow LVAD: group C, n=30). Serial echocardiograms, serum levels of brain natriuretic peptide (BNP), and extracellular matrix biomarkers (ECM) were compared between the groups. Myocardial BNP and ECM gene expression were evaluated in a subset of 18 patients. Postoperative LV ejection fraction was greater (33.2± 12.6% versus 17.6±8.8%, P>0.0001) and the mitral E/E' was lower (9.9±2.6 versus 13.2±3.8, P=0.0002) in group P versus group C. Postoperative serum levels of BNP, metalloproteinases (MMP)-9, and tissue inhibitor of MMP (TIMP)-4 were significantly lower in group P compared with group C (BNP: 552.6±340.6 versus 965.4±805.7 pg/mL, P<0.01; MMP9:309.0±220.2 versus 475.2±336.9 ng/dL, P<0.05; TIMP4:1490.9±622.4 versus 2014.3±452.4 ng/dL, P<0.001). Myocardial gene expression of ECM markers and BNP decreased in both groups; however, expression of TIMP-4 decreased only in group P (P=0.024). Conclusions: Mechanical unloading of the failing myocardium using pulsatile devices is more effective as indicated by echocardiographic parameters of systolic and diastolic LV function as well as dynamics of BNP and ECM markers. Therefore, specific effects of pulsatile mechanical unloading on the failing myocardium may have important implications for device selection especially for the purpose of bridge-to-recovery in patients with advanced HF.

KW - Echocardiography

KW - Heart assist device

KW - Heart failure

KW - Remodeling

KW - Transplant

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