Rosenbaum Andrew N, Geske Jeffrey B, Stulak John M, Kushwaha Sudhir S, Clavell Alfredo L, Behfar Atta
Department of Cardiovascular Medicine, Division of Circulatory Failure, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, Division of Structural Heart Disease, Mayo Clinic, Rochester, Minnesota.
J Card Fail. 2022 May;28(5):799-806. doi: 10.1016/j.cardfail.2021.12.008. Epub 2021 Dec 17.
Despite interest in left ventricular (LV) recovery, there is an absence of data on the relationship between intrinsic LV hemodynamics and both reverse remodeling on a continuous flow LV assist device (CF-LVAD) therapy. We hypothesized that the markers of intrinsic LV function would be associated with remodeling, optimization, and outcomes.
Patients with continuous flow LVADs between 2015 and 2019 who underwent combined left and right heart catheterization ramp protocol at a single institution were enrolled. Patients were stratified by response to continuous flow LV assist device therapy: full responders, partial responders, or nonresponders per the Utah-Inova criteria. Hemodynamic data, including LV hemodynamics of peak LV dP/dt and tau (τ) were obtained at each phase. The 1-year heart failure hospitalization-free survival was the primary end point. Among 61 patients included in the current study 38 (62%) were classified as nonresponders, 14 as partial responders (23%), and 9 as full responders (15%). The baseline LV dP/dt and τ varied by response status (P ≤ .02) and generally correlated with reverse remodeling on linear regression. Biventricular filling pressures varied with τ and there was an interaction effect of speed on the relationship between τ and pulmonary capillary wedge pressure (P = .04). Last, τ was a prognostic marker and associated with 1-year HF hospital-free survival (odds ratio 1.04, 95% confidence interval 1.00-1.07, P = .02 per millisecond increase).
Significant correlations between τ and LV dP/dt and reverse remodeling were noted, with τ serving as a prognostic marker. A higher LVAD speed was associated with a greater reliance on LVAD for unloading. Future work should focus on defining the optimal level of LVAD support in relation to LV recovery.
尽管人们对左心室（LV）恢复感兴趣，但关于左心室内在血流动力学与持续血流左心室辅助装置（CF-LVAD）治疗时的逆向重构之间的关系，目前尚无相关数据。我们假设左心室内在功能的标志物将与重构、优化及预后相关。
纳入2015年至2019年间在单一机构接受左右心导管检查斜坡方案的持续血流LVAD患者。根据犹他-伊诺瓦标准，将患者按对持续血流左心室辅助装置治疗的反应进行分层：完全反应者、部分反应者或无反应者。在每个阶段获取血流动力学数据，包括左心室峰值dP/dt和tau（τ）的左心室血流动力学数据。1年无心力衰竭住院生存率是主要终点。在本研究纳入的61例患者中，38例（62%）被分类为无反应者，14例为部分反应者（23%），9例为完全反应者（15%）。基线左心室dP/dt和τ因反应状态而异（P≤0.02），并且在线性回归中通常与逆向重构相关。双心室充盈压随τ变化，并且速度对τ与肺毛细血管楔压之间的关系有交互作用（P = 0.04）。最后，τ是一个预后标志物，与1年无心力衰竭住院生存率相关（每增加一毫秒，比值比为1.04，95%置信区间为1.00 - 1.07，P = 0.02）。
注意到τ与左心室dP/dt和逆向重构之间存在显著相关性，τ作为一个预后标志物。较高的LVAD速度与对LVAD卸载的更大依赖相关。未来的工作应集中于确定与左心室恢复相关的LVAD支持的最佳水平。
