Soderlund Karl A, Chivukula Raghu R, Russell Stuart D, Conte John V, Mudd James O, Halushka Marc K
Division of Cardiovascular Pathology, Department of Pathology, Johns Hopkins Medical Institutions, 720 Rutland Avenue, Baltimore, MD 21205, USA.
Cardiovasc Pathol. 2009 Jul-Aug;18(4):217-22. doi: 10.1016/j.carpath.2008.06.007. Epub 2008 Aug 15.
With the increasing use of left ventricular assist devices, the left ventricular apical core has become a more frequently encountered surgical pathology tissue. We investigated the prognostic value of this cardiac tissue in short-term patient mortality. Previous studies have shown that the degree of cardiac fibrosis correlates with improvements in ejection fraction and the likelihood of weaning from an assist device.
Left ventricular apical core tissues from 29 sequential subjects who received a HeartMate II continuous axial flow left ventricular assist device were studied retrospectively to determine whether interstitial fibrosis, replacement fibrosis (scar), the presence of mural thrombus, or other histopathologic findings were associated with hemodynamic changes or mortality in this population. Patients received left ventricular assist devices as bridges to transplantation or as destination therapy. Interstitial fibrosis was determined by observer scoring and digital scoring methods. Before and after left ventricular assist device procedure, right heart catheterizations were reviewed for clinical cardiac data.
The presence of replacement fibrosis in the apical core tissue significantly correlated with decreased improvement in pulmonary capillary wedge pressure after left ventricular assist device placement (P=.02). Ten subjects died over the course of this study. No specimen variables, including scar, interstitial fibrosis, and the presence of mural thrombosis, correlated with patient mortality.
Pathologic findings in left ventricular apical cores have little prognostic utility in guiding patient management as related to overall 1-year mortality, but may indicate patients who are more likely to positively remodel their hearts.
随着左心室辅助装置使用的增加，左心室心尖组织已成为一种更常遇到的手术病理组织。我们研究了这种心脏组织对患者短期死亡率的预后价值。先前的研究表明，心脏纤维化程度与射血分数的改善以及脱离辅助装置的可能性相关。
回顾性研究了29例连续接受HeartMate II连续轴流左心室辅助装置的受试者的左心室心尖组织，以确定间质纤维化、替代性纤维化（瘢痕）、壁血栓的存在或其他组织病理学发现是否与该人群的血流动力学变化或死亡率相关。患者接受左心室辅助装置作为移植桥梁或目标治疗。间质纤维化通过观察者评分和数字评分方法确定。在左心室辅助装置手术前后，回顾右心导管检查以获取临床心脏数据。
心尖组织中替代性纤维化的存在与左心室辅助装置置入后肺毛细血管楔压改善程度降低显著相关（P = 0.02）。在本研究过程中有10名受试者死亡。没有标本变量，包括瘢痕、间质纤维化和壁血栓的存在，与患者死亡率相关。
左心室心尖组织的病理发现对指导与总体1年死亡率相关的患者管理几乎没有预后价值，但可能表明更有可能使心脏正向重塑的患者。
