Division of Cardiology, Montefiore Medical Center, Bronx, NY.
Division of Cardiology, Montefiore Medical Center, Bronx, NY.
J Card Fail. 2017 Dec;23(12):859-867. doi: 10.1016/j.cardfail.2017.09.011. Epub 2017 Sep 29.
Patients with restrictive (RCM) and hypertrophic (HCM) cardiomyopathies are felt to be a difficult population to treat with left ventricular assist device (LVAD) therapy. Scarce data exist on outcomes of continuous-flow (CF) LVAD support in these challenging patient cohorts.
The Interagency Registry for Mechanically Assisted Circulatory Support Registry was queried for all patients with RCM (n = 94) and HCM (n = 104) who underwent CF LVAD implantation between March 2008 and March 2014. Survival, adverse event rates, baseline demographics, echocardiography parameters, and competing outcomes were compared with patients with dilated cardiomyopathy (DCM) (n = 8749).
Left ventricular size was smaller and baseline EF was higher in RCM and HCM compared with DCM patients. Nonetheless, these parameters were not completely normal in the RCM and HCM groups, suggesting that most of these patients exhibited features of a DCM and represented a mixed phenotype. In these specific patient populations, survival up to 4 years was not different among the 3 groups (log rank 0.25) and competing outcomes at 1 year were similar. In the subgroup of patients with very small ventricles (ie, < 5.0 cm), survival was far inferior. Finally, overall rates of right ventricular assist device requirement, hemolysis, pump dysfunction, and cardiac arrhythmias were similar among the 3 groups.
Relatively few patients with HCM and RCM undergo CF LVAD implantation, and most that do display some features of a DCM. Overall survival and adverse event profiles of these patients were similar to traditional DCM patients; however, in those with very small ventricles, survival was inferior.
患有限制型（RCM）和肥厚型（HCM）心肌病的患者被认为是接受左心室辅助装置（LVAD）治疗的困难人群。关于这些具有挑战性的患者群体接受连续血流（CF）LVAD 支持的结果，现有数据很少。
在 2008 年 3 月至 2014 年 3 月期间，通过机械循环辅助支持登记处（Interagency Registry for Mechanically Assisted Circulatory Support Registry）对接受 CF LVAD 植入的所有 RCM（n=94）和 HCM（n=104）患者进行了查询。比较了生存率、不良事件发生率、基线人口统计学数据、超声心动图参数和竞争结果与扩张型心肌病（DCM）患者（n=8749）。
与 DCM 患者相比，RCM 和 HCM 患者的左心室大小较小，基线 EF 较高。然而，RCM 和 HCM 组的这些参数并未完全正常，表明这些患者大多数表现出 DCM 的特征，代表一种混合表型。在这些特定的患者群体中，3 组之间的 4 年生存率没有差异（对数秩检验 0.25），1 年的竞争结果相似。在心室非常小的患者亚组（即<5.0cm）中，生存率明显较低。最后，3 组之间的右心室辅助装置需求、溶血、泵功能障碍和心律失常的总体发生率相似。
接受 CF LVAD 植入的 HCM 和 RCM 患者相对较少，而且大多数患者表现出一些 DCM 的特征。这些患者的总体生存率和不良事件谱与传统的 DCM 患者相似；然而，在心室非常小的患者中，生存率较差。
