TY - JOUR
T1 - Effects of continuous-flow versus pulsatile-flow left ventricular assist devices on myocardial unloading and remodeling
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
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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U2 - 10.1161/CIRCHEARTFAILURE.111.962142
DO - 10.1161/CIRCHEARTFAILURE.111.962142
M3 - Article
C2 - 21765125
AN - SCOPUS:83555170951
SN - 1941-3289
VL - 4
SP - 546
EP - 553
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
IS - 5
ER -