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

2021 ◽  
Author(s):  
Andrew N. Rosenbaum ◽  
Jeffrey B. Geske ◽  
John M. Stulak ◽  
Sudhir S. Kushwaha ◽  
Alfredo L. Clavell ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Myocardial Recovery

scholarly journals Prognostic value of NT-proBNP for myocardial recovery in peripartum cardiomyopathy (PPCM)

2021 ◽  
Author(s):  
J. Hoevelmann ◽  
E. Muller ◽  
F. Azibani ◽  
S. Kraus ◽  
J. Cirota ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Systolic Function ◽  
Point Of Care ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Lv Function ◽  
Myocardial Recovery ◽  
End Diastolic Volume

Abstract Introduction Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure worldwide. Although a significant number of women recover their left ventricular (LV) function within 12 months, some remain with persistently reduced systolic function. Methods Knowledge gaps exist on predictors of myocardial recovery in PPCM. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the only clinically established biomarker with diagnostic value in PPCM. We aimed to establish whether NT-proBNP could serve as a predictor of LV recovery in PPCM, as measured by LV end-diastolic volume (LVEDD) and LV ejection fraction (LVEF). Results This study of 35 women with PPCM (mean age 30.0 ± 5.9 years) had a median NT-proBNP of 834.7 pg/ml (IQR 571.2–1840.5) at baseline. Within the first year of follow-up, 51.4% of the cohort recovered their LV dimensions (LVEDD < 55 mm) and systolic function (LVEF > 50%). Women without LV recovery presented with higher NT-proBNP at baseline. Multivariable regression analyses demonstrated that NT-proBNP of ≥ 900 pg/ml at the time of diagnosis was predictive of failure to recover LVEDD (OR 0.22, 95% CI 0.05–0.95, P = 0.043) or LVEF (OR 0.20 [95% CI 0.04–0.89], p = 0.035) at follow-up. Conclusions We have demonstrated that NT-proBNP has a prognostic value in predicting LV recovery of patients with PPCM. Patients with NT-proBNP of ≥ 900 pg/ml were less likely to show any improvement in LVEF or LVEDD. Our findings have implications for clinical practice as patients with higher NT-proBNP might require more aggressive therapy and more intensive follow-up. Point-of-care NT-proBNP for diagnosis and risk stratification warrants further investigation.

Machine Learning-Based Prediction of Myocardial Recovery in Patients With Left Ventricular Assist Device Support

2021 ◽  
Author(s):  
Veli K. Topkara ◽  
Pierre Elias ◽  
Rashmi Jain ◽  
Gabriel Sayer ◽  
Daniel Burkhoff ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Receiver Operating Curve ◽  
Myocardial Recovery ◽  
Assist Device ◽  
Validation Data ◽  
Data Set ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Selection Operator ◽  
Receiver Operating

Background: Prospective studies demonstrate that aggressive pharmacological therapy combined with pump speed optimization may result in myocardial recovery in larger numbers of patients supported with left ventricular assist device (LVAD). This study sought to determine whether the use of machine learning (ML) based models predict LVAD patients with myocardial recovery resulting in pump explant. Methods: A total of 20 270 adult patients with a durable continuous-flow LVAD in the INTERMACS registry (Interagency Registry for Mechanically Assisted Circulatory Support) were included in the study. Ninety-eight raw clinical variables were screened using the least absolute shrinkage and selection operator for selection of features associated with LVAD-induced myocardial recovery. ML models were developed in the training data set (70%) and were assessed in the validation data set (30%) by receiver operating curve and Kaplan-Meier analysis. Results: Least absolute shrinkage and selection operator identified 28 unique clinical features associated with LVAD-induced myocardial recovery, including age, cause of heart failure, psychosocial risk factors, laboratory values, cardiac rate and rhythm, and echocardiographic indices. ML models achieved area under the receiver operating curve of 0.813 to 0.824 in the validation data set outperforming logistic regression-based new INTERMACS recovery risk score (area under the receiver operating curve of 0.796) and previously established LVAD recovery risk scores (INTERMACS Cardiac Recovery Score and INTERMACS Recovery Score by Topkara et al.) with area under the receiver operating curve of 0.744 and 0.748 ( P <0.05). Patients who were predicted to recover by ML models demonstrated a significantly higher incidence of myocardial recovery resulting in LVAD explant in the validation cohort compared with those who were not predicted to recover (18.8% versus 2.6% at 4 years of pump support). Conclusions: ML can be a valuable tool to identify subsets of LVAD patients who may be more likely to respond to myocardial recovery protocols.

Effects of arterial hypertension on myocardial recovery after ischemic injury

1992 ◽  
Vol 263 (2) ◽  
pp. H559-H564 ◽  
Author(s):  
J. R. Elbeery ◽  
R. F. Williams ◽  
J. S. Rankin ◽  
D. D. Glower ◽  
D. C. Sabiston ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Systolic Function ◽  
Ischemic Injury ◽  
Left Ventricular ◽  
Segment Length ◽  
Myocardial Segment ◽  
Stroke Work ◽  
Myocardial Recovery ◽  
Length Relationship ◽  
Injured Myocardium

Although improved surgery, angioplasty, and thrombolysis have made early revascularization of ischemic myocardium commonplace, the effects of arterial hypertension on myocardial recovery remain unclear. Therefore eight conscious dogs were instrumented to measure left ventricular transmural pressure and myocardial segment length in the left anterior descending (LAD) coronary distribution. Reversible ischemic injury was produced by two 15-min LAD occlusions separated by 4 days of reperfusion, with each dog randomly receiving either phenylephrine or placebo infusion for 30 min beginning 1 h after reperfusion. With ischemia, systolic myocardial performance fell to 14.3 +/- 3.7% of control and required greater than 48 h to recover. Compared with placebo, phenylephrine significantly depressed recovery of systolic function assessed by systolic shortening (57 +/- 12 vs. 85 +/- 13% control) or the area under the stroke work vs. end-diastolic length relationship (62 +/- 14 vs. 93 +/- 7% control) (both P less than 0.05). These data imply that ischemically injured myocardium is highly sensitive to arterial hypertension and that ventricular loading is a major determinant of the rate of myocardial recovery.

scholarly journals Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: an ESC EORP registry

2020 ◽  
Vol 41 (39) ◽  
pp. 3787-3797 ◽  
Author(s):  
Karen Sliwa ◽  
Mark C Petrie ◽  
Peter van der Meer ◽  
Alexandre Mebazaa ◽  
Denise Hilfiker-Kleiner ◽  
...  
Keyword(s):  
Heart Failure ◽  
Middle East ◽  
Regional Variation ◽  
Clinical Presentation ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Asia Pacific ◽  
Left Ventricular Ejection ◽  
Myocardial Recovery ◽  
Ventricular Ejection Fraction

Abstract Aims  We sought to describe the clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy (PPCM) globally. Methods and results  In 2011, &gt;100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EURObservational Research Programme. These societies were tasked with identifying centres who could participate in this registry. In low-income countries, e.g. Mozambique or Burkina Faso, where there are no national societies due to a shortage of cardiologists, we identified potential participants through abstracts and publications and encouraged participation into the study. Seven hundred and thirty-nine women were enrolled in 49 countries in Europe (33%), Africa (29%), Asia-Pacific (15%), and the Middle East (22%). Mean age was 31 ± 6 years, mean left ventricular ejection fraction (LVEF) was 31 ± 10%, and 10% had a previous pregnancy complicated by PPCM. Symptom-onset occurred most often within 1 month of delivery (44%). At diagnosis, 67% of patients had severe (NYHA III/IV) symptoms and 67% had a LVEF ≤35%. Fifteen percent received bromocriptine with significant regional variation (Europe 15%, Africa 26%, Asia-Pacific 8%, the Middle East 4%, P &lt; 0.001). Follow-up was available for 598 (81%) women. Six-month mortality was 6% overall, lowest in Europe (4%), and highest in the Middle East (10%). Most deaths were due to heart failure (42%) or sudden (30%). Re-admission for any reason occurred in 10% (with just over half of these for heart failure) and thromboembolic events in 7%. Myocardial recovery (LVEF &gt; 50%) occurred only in 46%, most commonly in Asia-Pacific (62%), and least commonly in the Middle East (25%). Neonatal death occurred in 5% with marked regional variation (Europe 2%, the Middle East 9%). Conclusion  Peripartum cardiomyopathy is a global disease, but clinical presentation and outcomes vary by region. Just under half of women experience myocardial recovery. Peripartum cardiomyopathy is a disease with substantial maternal and neonatal morbidity and mortality.

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