(Circulation. 1995;91:2717-2720.)
© 1995 American Heart Association, Inc.
Articles |
Reversal of Chronic Ventricular Dilation in Patients With End-Stage Cardiomyopathy by Prolonged Mechanical Unloading
From the Division of Circulatory Physiology, Department of Medicine, and the Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY.
Correspondence to Howard R. Levin, MD, Columbia-Presbyterian Medical Center, Division of Circulatory Physiology, 177 Fort Washington Ave, Milstein 5-435, New York, NY 10032.
Background Ventricular dilation, indexed by marked shifts toward larger volumes of the end-diastolic pressure-volume relation (EDPVR), has been considered to represent an irreversible aspect of ventricular remodeling in end-stage heart failure. However, we hypothesized that such dilation could be reversed with sufficient hemodynamic unloading, such as can be provided by a left ventricular assist device (LVAD).
Methods and Results The EDPVRs of hearts from seven patients with
end-stage idiopathic cardiomyopathy and comparable
baseline hemodynamics were measured ex vivo at the time of cardiac
transplantation; these were compared with EDPVRs from three normal
human hearts that were technically unsuitable for transplantation. Four
of the patients received optimal medical therapy; three of the
patients, who deteriorated on optimal therapy, underwent LVAD support
for 
4 months. Compared with the normal hearts, EDPVRs of hearts from
medically treated patients were shifted toward markedly larger volumes.
In contrast, EDPVRs of hearts from LVAD patients were similar to those
of normal hearts.
Conclusions Chronic hemodynamic unloading of sufficient magnitude and duration can result in reversal of chamber enlargement and normalization of cardiac structure as indexed by the EDPVR, both important aspects of remodeling, even in the most advanced stages of heart failure.
Key Words: diastole • heart failure • ventricles • cardiac volume
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B. C. Sun, K. A. Catanese, T. B. Spanier, M. R. Flannery, M. T. Gardocki, L. S. Marcus, H. R. Levin, E. A. Rose, and M. C. Oz 100 long-term implantable left ventricular assist devices: the Columbia Presbyterian interim experience Ann. Thorac. Surg., August 1, 1999; 68(2): 688 - 694. [Abstract] [Full Text] [PDF]
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R. Hetzer, J. Muller, Y. Weng, G. Wallukat, S. Spiegelsberger, and M. Loebe Cardiac recovery in dilated cardiomyopathy by unloading with a left ventricular assist device Ann. Thorac. Surg., August 1, 1999; 68(2): 742 - 749. [Abstract] [Full Text] [PDF]
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J. M. Chen, J. J. DeRose, J. P. Slater, T. B. Spanier, T. M. Dewey, K. A. Catanese, M. A. Flannery, and M. C. Oz Improved survival rates support left ventricular assist device implantation early after myocardial infarction J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1903 - 1908. [Abstract] [Full Text] [PDF]
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D. L. Mann and J. T. Willerson Left Ventricular Assist Devices and the Failing Heart : A Bridge to Recovery, a Permanent Assist Device, or a Bridge Too Far? Circulation, December 1, 1998; 98(22): 2367 - 2369. [Full Text] [PDF]
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D. M. Mancini, A. Beniaminovitz, H. Levin, K. Catanese, M. Flannery, M. DiTullio, S. Savin, M. E. Cordisco, E. Rose, and M. Oz Low Incidence of Myocardial Recovery After Left Ventricular Assist Device Implantation in Patients With Chronic Heart Failure Circulation, December 1, 1998; 98(22): 2383 - 2389. [Abstract] [Full Text] [PDF]
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 D. J. Goldstein, M. C. Oz, and E. A. Rose Implantable Left Ventricular Assist Devices N. Engl. J. Med., November 19, 1998; 339(21): 1522 - 1533. [Full Text] [PDF]
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S. Westaby, T. Katsumata, R. Houel, R. Evans, D. Pigott, O. H. Frazier, and R. Jarvik Jarvik 2000 Heart : Potential for Bridge to Myocyte Recovery Circulation, October 13, 1998; 98(15): 1568 - 1574. [Abstract] [Full Text] [PDF]
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W. E. Pae Jr, J. M. Anderson, E. H. Blackstone, H. S. Boroevetz, A. Ciarkowski, J. G. Copeland III, M. R. Costanzo-Nordin, K. Daase, M. A. Dew, M. J. Domanski, et al. Bethesda conference: conference for the design of clinical trials to study circulatory support devices for chronic heart failure Ann. Thorac. Surg., October 1, 1998; 66(4): 1452 - 1465. [Full Text] [PDF]
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A. Zafeiridis, V. Jeevanandam, S. R. Houser, and K. B. Margulies Regression of Cellular Hypertrophy After Left Ventricular Assist Device Support Circulation, August 18, 1998; 98(7): 656 - 662. [Abstract] [Full Text] [PDF]
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L. Pietsch, H. Laube, G. Baumann, and W. Konertz Recovery from end-stage ischemic cardiomyopathy during long-term LVAD support Ann. Thorac. Surg., August 1, 1998; 66(2): 555 - 557. [Abstract] [Full Text] [PDF]
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S. H. Lee, N. Doliba, M. Osbakken, M. Oz, and D. Mancini Improvement of myocardial mitochondrial function after hemodynamic support with left ventricular assist devices in patients with heart failure J. Thorac. Cardiovasc. Surg., August 1, 1998; 116(2): 344 - 349. [Abstract] [Full Text] [PDF]
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 M. L. Dickstein Anesthesia for Heart Transplantation Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 1998; 2(2): 131 - 139. [Abstract] [PDF]
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K. Dipla, J. A. Mattiello, V. Jeevanandam, S. R. Houser, and K. B. Margulies Myocyte Recovery After Mechanical Circulatory Support in Humans With End-Stage Heart Failure Circulation, June 16, 1998; 97(23): 2316 - 2322. [Abstract] [Full Text] [PDF]
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L. F. P. Moreira, N. A. G. Stolf, E. A. Bocchi, F. Bacal, M. C. P. Giorgi, J. R. Parga, and A. D. Jatene Partial left ventriculectomy with mitral valve preservation in the treatment of patients with dilated cardiomyopathy J. Thorac. Cardiovasc. Surg., April 1, 1998; 115(4): 800 - 807. [Abstract] [Full Text] [PDF]
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N. Moazami, M. Argenziano, T. Kohomoto, S. Yazdani, E. A. Rose, D. Burkhoff, and M. C. Oz Inflow Valve Regurgitation During Left Ventricular Assist Device Support May Interfere With Reverse Ventricular Remodeling Ann. Thorac. Surg., March 1, 1998; 65(3): 628 - 631. [Abstract] [Full Text] [PDF]
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 W. A. Hsueh, R. E. Law, and Y. S. Do Integrins, Adhesion, and Cardiac Remodeling Hypertension, January 1, 1998; 31(1): 176 - 180. [Abstract] [Full Text] [PDF]
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M. Komeda, A. DeAnda Jr, J. R. Glasson, A. F. Bolger, G. T. Daughters II, N. B. Ingels Jr, and D. C. Miller Complete Unloading Alone May Not Adequately Protect the Left Ventricle Ann. Thorac. Surg., November 1, 1997; 64(5): 1250 - 1255. [Abstract] [Full Text]
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S. Westaby, X. Y. Jin, T. Katsumata, D. P. Taggart, A. J. S. Coats, and O. H. Frazier Mechanical Support in Dilated Cardiomyopathy: Signs of Early Left Ventricular Recovery Ann. Thorac. Surg., November 1, 1997; 64(5): 1303 - 1308. [Abstract] [Full Text]
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S. Westaby, T. Katsumata, R. Evans, D. Pigott, D. P. Taggart, and R. K. Jarvik THE JARVIK 2000 OXFORD SYSTEM: INCREASING THE SCOPE OF MECHANICAL CIRCULATORY SUPPORT J. Thorac. Cardiovasc. Surg., September 1, 1997; 114(3): 467 - 474. [Abstract] [Full Text]
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J. Muller, G. Wallukat, Y.-G. Weng, M. Dandel, S. Spiegelsberger, S. Semrau, K. Brandes, V. Theodoridis, M. Loebe, R. Meyer, et al. Weaning From Mechanical Cardiac Support in Patients With Idiopathic Dilated Cardiomyopathy Circulation, July 15, 1997; 96(2): 542 - 549. [Abstract] [Full Text]
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H. R. Levin and M. L. Weisfeldt Deep Thoughts on Tin Men: Fact, Fallacy, and Future of Mechanical Circulatory Support Circulation, May 20, 1997; 95(10): 2340 - 2343. [Full Text]
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B. E. Jaski, J. Kim, R. S. Maly, K. R. Branch, R. Adamson, L. K. Favrot, S. C. Smith Jr, and W. P. Dembitsky Effects of Exercise During Long-term Support With a Left Ventricular Assist Device : Results of the Experience With Left Ventricular Assist Device With Exercise (EVADE) Pilot Trial Circulation, May 20, 1997; 95(10): 2401 - 2406. [Abstract] [Full Text]
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MehmetC. Oz, M. Argenziano, K. A. Catanese, M. T. Gardocki, D. J. Goldstein, R. C. Ashton, A. C. Gelijns, E. A. Rose, and H. R. Levin Bridge Experience With Long-term Implantable Left Ventricular Assist Devices: Are They an Alternative to Transplantation? Circulation, April 1, 1997; 95(7): 1844 - 1852. [Abstract] [Full Text]
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O. H. Frazier, C. R. Benedict, B. Radovancevic, R. J. Bick, P. Capek, W. E. Springer, M. P. Macris, R. Delgado, and L. M. Buja Improved Left Ventricular Function After Chronic Left Ventricular Unloading Ann. Thorac. Surg., September 1, 1996; 62(3): 675 - 681. [Abstract] [Full Text]
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