Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA, USA.
J Card Fail. 2010 Feb;16(2):99-105. doi: 10.1016/j.cardfail.2009.10.018. Epub 2009 Nov 14.
Myocardial recovery after ventricular assist devices (VAD) is rare but appears more common in nonischemic cardiomyopathies (NICM). We sought to evaluate left ventricular (LV) end diastolic diameter (LVEDD) for predicting recovery after VAD.
NICM patients receiving long-term mechanical support between 1996 and 2008 were reviewed. Subjects were divided into 3 groups: mild, moderate, and severe dilation (Group A: LVEDD <6.0 cm [n = 22]; Group B: 6.0-7.0 cm [n = 32]; Group C: >7.0 cm [n = 48], respectively). Overall, recovery (successful explant without transplantation) occurred in 14 of 102 subjects (14%). Of these, 2 died and 2 required transplantation within 1 year. Recovery was more common in patients without LV dilation (Groups A/B/C = 32%/22%/0%, P < .001), as was sustained recovery (alive and transplant free 1 year after explant; A/B/C = 27%/10%/0%, P = .001). Of the recovery patients in Group A, 6/7 (86%) had sustained recovery versus 3/6 (50%) in Group B.
Recovery occurred in 32% of NICM patients without significant LV dilation at time of VAD, the majority of whom experienced significant sustained recovery. Recovery was not evident in those with severe LV dilation. Routine echocardiography at the time of implant may assist in targeting patients for recovery after VAD.
心室辅助装置（VAD）后心肌恢复很少见，但在非缺血性心肌病（NICM）中似乎更为常见。我们试图评估左心室（LV）舒张末期直径（LVEDD）以预测 VAD 后的恢复情况。
回顾了 1996 年至 2008 年期间接受长期机械支持的 NICM 患者。受试者分为 3 组：轻度、中度和重度扩张（A 组：LVEDD<6.0cm[n=22]；B 组：6.0-7.0cm[n=32]；C 组：>7.0cm[n=48]）。总体而言，102 例患者中有 14 例（14%）成功进行了移植前的心脏移除（即恢复）。其中，2 例死亡，2 例在 1 年内需要进行移植。在没有 LV 扩张的患者中，恢复更为常见（A/B/C 组=32%/22%/0%，P<0.001），持续恢复（心脏移除后 1 年仍存活且无需移植）也更为常见（A/B/C 组=27%/10%/0%，P=0.001）。在 A 组的恢复患者中，6/7（86%）患者有持续恢复，而 B 组中 3/6（50%）患者有持续恢复。
在接受 VAD 时无明显 LV 扩张的 NICM 患者中，有 32%发生了恢复，其中大多数患者有明显的持续恢复。在 LV 严重扩张的患者中未出现恢复。在植入时进行常规超声心动图检查可能有助于确定 VAD 后可恢复的患者。
