Left Ventricular Assist Device Support and Myocardial Recovery in Recent Onset Cardiomyopathy

• Published in: Journal of cardiac failure Vol. 18; no. 10; pp. 755 - 761
• Main Authors: Boehmer, John P., Starling, Randall C., Cooper, Leslie T., Torre-Amione, Guillermo, Wittstein, Ilan, Dec, G. William, Markham, David W., Zucker, Mark J., Gorcsan, John, McTiernan, Charles, Kip, Kevin, McNamara, Dennis M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2012
• Subjects: Adult; Cardiomyopathies - pathology; Cardiomyopathies - therapy; Cardiovascular; Cohort Studies; Female; Heart Ventricles - innervation; Heart Ventricles - pathology; Heart-Assist Devices; Hemodynamics; Humans; Male; Mechanical circulatory support (MCS); Middle Aged; myocarditis; Myocardium - pathology; nonischemic cardiomyopathy; outcomes; Registries; Stroke Volume; Time Factors; Ventricular Function, Left; nonischemic cardiomyopathy; outcomes; Mechanical circulatory support (MCS); myocarditis
• ISSN: 1071-9164; 1532-8414; 1532-8414
• DOI: 10.1016/j.cardfail.2012.08.001

Left ventricular assist device (LVAD) support as bridge to recovery (BTR) is uncommon for subjects with chronic heart failure. Myocardial recovery is more evident in recent onset nonischemic cardiomyopathy (ROCM); however, the prevalence of BTR in this subset has not been addressed. We examined the use of LVAD support for subjects with ROCM in the Intervention in Myocarditis and Acute Cardiomyopathy 2 (IMAC2) study. The overall cohort (n = 373) was 38% female, 21% black, with a mean age of 45 ± 14 years. LVAD support was used in 3.8% (n = 14, 43% female, age 32 ± 10). Of LVAD subjects, 57% (8/14) were BTR, including 73% (8/11) of subjects with symptoms ≤4 months at the time of support. Left ventricular end-diastolic diameter (LVEDD) was smaller in BTR than nonrecovered (NR) subjects (P = .04). Myocardial inflammation was more common in BTR (75% versus 0%, P = .005), whereas fibrosis was less evident (25% versus 100%, P = .005). Of BTR subjects, 7/8 (87.5%) were alive and free of transplant with median follow-up of 19 months. In a multicenter registry of ROCM, BTR was common and occurred in the majority of subjects requiring LVAD support. Histology and LVEDD may assist in predicting potential for BTR in ROCM.