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. 2012 Jul 10;126(2):230-41.
doi: 10.1161/CIRCULATIONAHA.111.040261.

Bridge to recovery: understanding the disconnect between clinical and biological outcomes

Stavros G Drakos  1 , Abdallah G Kfoury, Josef Stehlik, Craig H Selzman, Bruce B Reid, John V Terrovitis, John N Nanas, Dean Y Li
Affiliations

Bridge to recovery: understanding the disconnect between clinical and biological outcomes

Stavros G Drakos et al. Circulation. .
No abstract available

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Conflict of interest statement

Conflict of Interest Disclosures: None

Figures

Figure 1
Figure 1
Serial chest radiographs and echocardiograms (M-mode, parasternal long axis view) from a 59-year old patient with a multi-year history of idiopathic dilated cardiomyopathy and HF refractory to standard therapy including inotropes (University of Athens, Greece). The patient underwent a combination of LVAD unloading and pharmacologic therapy (Harefield protocol – see text for details) and was successfully weaned from the LVAD six months after implantation. He continued on standard HF pharmacologic therapy and achieved sustained functional recovery with no signs or symptoms of HF over a 7-year follow-up period. EF: left ventricular ejection fraction, LVAD: left ventricular assist device, LVIDd: left ventricular end-diastolic diameter
Figure 2
Figure 2
Cardiovascular functional effects of pulsatile vs. continuous flow LVADs in advanced HF patients (1, 21, 27-30, 32, 36, 38). E: pulsed wave Doppler early mitral peak inflow velocity, E’: tissue Doppler early diastolic mitral annular velocity, dP/dt max: first derivative of LV pressure with respect to time, LVAD: left ventricular assist device, LVEF: left ventricular assist device, m: months, PHT: fixed pulmonary hypertension, RVF: acute right ventricular failure post LVAD implant requiring right ventricular assist device support
Figure 3
Figure 3
LVAD unloading and cardiac reverse remodeling: unresolved issues - future directions. The figure includes a typical depiction of the progression of LV remodeling (maladaptive changes in structure and function) , and emphasizes the central role of increased load in the vicious cycle of HF progression. LVAD therapy intervenes in this vicious cycle by inducing a profound degree of pressure and volume unloading (white rectangles). Ongoing research targets (identified with circled numbers) have been placed in specific locations corresponding to their potential relationship in the continuum of the cardiac remodeling and myocardial recovery processes (see text, section 5, for details). HF: heart failure, LV: Left ventricle, LVAD: left ventricular assist device. *Absence of studies directly addressing the issues mentioned under this heading
See this image and copyright information in PMC

References

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