Imamura Teruhiko, Kinugawa Koichiro, Hatano Masaru, Fujino Takeo, Muraoka Hironori, Inaba Toshiro, Maki Hisataka, Kagami Yukie, Endo Miyoko, Kinoshita Osamu, Nawata Kan, Kyo Shunei, Ono Minoru
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan,
J Artif Organs. 2014 Mar;17(1):23-32. doi: 10.1007/s10047-013-0748-7. Epub 2013 Dec 15.
To date, there have been few reports demonstrating preoperative predictors for left ventricular reverse remodeling (LVRR) after LV assist device (LVAD) implantation, especially among patients with dilated cardiomyopathy (DCM). We retrospectively analyzed 60 patients with stage D heart failure due to DCM who had received LVAD treatment [pulsatile flow (PF) type, 26; continuous flow type, 34]. Data were evaluated at 6 months or just before explantation of the LVAD. We defined "LV reverse remodeling" (LVRR) by the achievement of an LV ejection fraction (LVEF) of ≥ 35 % after 6 months of LVAD support or explantation of LVAD within 6 months. LVRR occurred in 16 of our patients (26.7 %). Uni/multivariate logistic regression analyses for LVRR demonstrated that of the preoperative variables evaluated, PF LVAD usage and insufficient preoperative β-blocker treatment were independent predictors for LVRR. Patients who accomplished LVRR had a better clinical course, including lower levels of aortic valve insufficiency and lower levels of plasma B-type natriuretic peptide. Of the six patients (10.0 %) in whom LVADs were eventually explanted, all had an LVEF of ≥ 35 % before explantation or at 6 months. Based on these results, we conclude that DCM patients with insufficient preoperative β-blocker treatment have a chance to achieve LVRR under LVAD support as a bridge to recovery.
迄今为止，很少有报告表明左心室辅助装置（LVAD）植入术后左心室逆向重构（LVRR）的术前预测因素，尤其是在扩张型心肌病（DCM）患者中。我们回顾性分析了60例因DCM接受LVAD治疗的D期心力衰竭患者[搏动血流（PF）型，26例；连续血流型，34例]。在LVAD植入6个月时或即将取出LVAD之前评估数据。我们将“左心室逆向重构”（LVRR）定义为在LVAD支持6个月后或在6个月内取出LVAD时左心室射血分数（LVEF）≥35%。我们的患者中有16例（26.7%）发生了LVRR。对LVRR进行单因素/多因素逻辑回归分析表明，在所评估的术前变量中，使用PF型LVAD和术前β受体阻滞剂治疗不足是LVRR的独立预测因素。实现LVRR的患者临床病程较好，包括主动脉瓣关闭不全程度较低和血浆B型利钠肽水平较低。在最终取出LVAD的6例患者（10.0%）中，所有患者在取出LVAD前或6个月时LVEF均≥35%。基于这些结果，我们得出结论，术前β受体阻滞剂治疗不足的DCM患者在LVAD支持下有机会实现LVRR，作为恢复的桥梁。
