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. 2022 May;28(5):799-806.
doi: 10.1016/j.cardfail.2021.12.008. Epub 2021 Dec 17.

Left Ventricular Hemodynamics and Relationship With Myocardial Recovery and Optimization in Patients Supported on CF-LVAD Therapy

Andrew N Rosenbaum  1 , Jeffrey B Geske  2 , John M Stulak  3 , Sudhir S Kushwaha  4 , Alfredo L Clavell  4 , Atta Behfar  5
Affiliations

Left Ventricular Hemodynamics and Relationship With Myocardial Recovery and Optimization in Patients Supported on CF-LVAD Therapy

Andrew N Rosenbaum et al. J Card Fail. 2022 May.

Abstract

Background: 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.

Methods and results: 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).

Conclusions: 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.

Keywords: Remodeling; cardiomyopathy; heart failure; myocardial regeneration; pathophysiology.

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Conflict of interest statement

Disclosures: Conflicts of Interest A.N.R., J.B.G, J.M.S., S.S.K, and A.L.C. have no financial relationships with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose. A.B. has no conflicts of interest but would like to declare he is a cofounder of Rion, LLC. He has received grant funding and serves on the scientific advisory board of HCYTE.

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