Department of Cardiovascular Pathology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX 77225-0345, USA.
Cardiovasc Pathol. 2011 May-Jun;20(3):139-45. doi: 10.1016/j.carpath.2010.01.011. Epub 2010 Feb 25.
Left ventricular assist devices unload the failing heart and improve hemodynamic function and tissue architecture. In some patients improvement allows for left ventricular assist device removal. We retrospectively compared histologic features in patients who were weaned off left ventricular assist device support with those who remained on support without evidence of clinical remission.
We graded left ventricular core samples taken at implantation on a scale we designed for evaluating severity and extent of fibrosis and hypertrophy. We correlated the grades with a computerized semiquantitative analysis of picrosirius-red and Masson's trichrome-stained sections. We evaluated interstitial (10×), perivascular (20×), and replacement (4×) fibrosis. Hypertrophy was assessed by myocyte diameter, cytoplasmic area, and nuclear/cytoplasmic ratio.
All patients (N=17) underwent left ventricular assist device implantation for heart failure. In eight patients improvement allowed left ventricular assist device removal. The groups did not differ in age (24.1 vs. 25 years, P=.4) or mean time on left ventricular assist device support (506 vs. 414 days, P=.24). All mean measures showed significantly less hypertrophy in the left ventricular assist device-removal group than in the nonremoval group, respectively (cytoplasmic area, 58.00 vs. 77.18 μm(2), P=.021; myocyte diameter, 20.32 vs. 25.35 μm, P=.004; nuclear/cytoplasmic ratio, 11.04 vs. 8.69, P=.053). Although not statistically significant, the left ventricular assist device-removal group tended toward less overall fibrosis than the nonremoval group (11.57 vs. 13.24, P=.214).
Left ventricular assist device-removal patients had less hypertrophy and fibrosis overall than did nonremoval patients. These findings may help identify patients with a higher probability of left ventricular assist device removal and myocardial recovery.
左心室辅助装置可减轻衰竭心脏的负担，改善血液动力学功能和组织结构。在某些患者中，改善情况允许移除左心室辅助装置。我们回顾性比较了在没有临床缓解证据的情况下从左心室辅助装置支持中脱机的患者与仍在支持中的患者的组织学特征。
我们根据我们设计的评估纤维化和肥大严重程度和范围的评分标准，对植入时的左心室核心样本进行分级。我们将这些等级与 picrosirius 红和 Masson 三色染色切片的计算机半定量分析相关联。我们评估了间质（10×）、血管周围（20×）和替代（4×）纤维化。通过肌细胞直径、细胞质面积和核/细胞质比评估肥大。
所有患者（N=17）均因心力衰竭接受左心室辅助装置植入。在 8 名患者中，改善情况允许移除左心室辅助装置。两组在年龄（24.1 岁与 25 岁，P=.4）或左心室辅助装置支持的平均时间（506 天与 414 天，P=.24）方面无差异。所有平均值均显示，在左心室辅助装置移除组中，肥大程度均明显低于未移除组，分别为（细胞质面积，58.00 与 77.18 μm²，P=.021；肌细胞直径，20.32 与 25.35 μm，P=.004；核/细胞质比，11.04 与 8.69，P=.053）。尽管没有统计学意义，但左心室辅助装置移除组的总纤维化程度倾向于低于未移除组（11.57 与 13.24，P=.214）。
与未移除组相比，左心室辅助装置移除患者的总体肥大和纤维化程度较低。这些发现可能有助于识别更有可能移除左心室辅助装置和心肌恢复的患者。
