BACKGROUND Left ventricular (LV) assist devices (LVADs) are known to elicit reverse remodeling by mechanically unloading the left ventricle. Current guidelines target a reduction in LV end-diastolic diameter (LVEDD) of 15% compared with pre-LVAD dimensions; however, there is significant heterogeneity in the degree of unloading achieved. We sought to investigate factors associated with mechanical unloading at 6 months of LVAD support. METHODS Data were retrospectively collected for 75 LVAD recipients at five time points: pre-LVAD, within 14 days post-LVAD, and at 1, 3, and 6 months post-LVAD. The percentage change in LVEDD between the pre-LVAD and 6 months post-LVAD time points was termed ΔLVEDD. Optimal LV unloading was defined as ΔLVEDD of ≥15% at 6 months. Patients who achieved optimal unloading (group A, n = 30) were compared with patients who did not (group B, n = 45). RESULTS At 6 months, optimally unloaded patients (group A) demonstrated higher fractional shortening (15% ± 10% vs 10% ± 7%, P = .007), lower rates of moderate or severe mitral regurgitation (10% vs 33%, P = .02), and lower pulmonary capillary wedge pressure (9 ± 4 vs 16 ± 7 mm Hg, P = .02). Right ventricular dysfunction was more prevalent at 6 months in poorly unloaded (group B) patients (73% vs 43%, P = .008). Between hospital discharge and 6 months, the percentage increase in pump speed (Δ revolutions per minute) was higher in group A patients (4.4% ± 3.7% vs 0.1% ± 2.6%, P < .001). In a multivariate analysis, Δ revolutions per minute and tricuspid annular systolic velocity (S') at 6 months were independently associated with 6-month ΔLVEDD. CONCLUSIONS Recipients of LVADs who undergo progressive pump speed up-titration during outpatient follow-up are more likely to sustain optimal LV unloading. Progressive LVAD-related right ventricular failure is prevalent in suboptimally unloaded patients.

中文翻译：

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左心室辅助装置接受者的最佳机械卸载与泵速的渐进式向上滴定有关。

背景技术已知左心室（LV）辅助装置（LVAD）通过机械地卸载左心室来引发反向重构。当前指南的目标是将 LV 舒张末期直径 (LVEDD) 与 LVAD 前的尺寸相比减少 15%；然而，实现的卸载程度存在显着的异质性。我们试图调查与 LVAD 支持 6 个月时机械卸载相关的因素。方法 在五个时间点回顾性收集 75 名 LVAD 接受者的数据：LVAD 前、LVAD 后 14 天内以及 LVAD 后 1、3 和 6 个月。LVAD 前和 LVAD 后 6 个月时间点之间 LVEDD 的百分比变化称为 ΔLVEDD。最佳 LV 卸载定义为 6 个月时 ΔLVEDD ≥15%。达到最佳卸载的患者（A组，n = 30) 与没有的患者进行比较（B 组，n = 45）。结果 在 6 个月时，最佳卸载患者（A 组）表现出更高的缩短分数（15% ± 10% vs 10% ± 7%，P = .007），中度或重度二尖瓣返流率更低（10% vs 33%， P = .02），以及较低的肺毛细血管楔压（9 ± 4 vs 16 ± 7 mm Hg，P = .02）。6 个月时，右心室功能不全在低负荷（B 组）患者中更为普遍（73% 对 43%，P = .008）。在出院和 6 个月之间，A 组患者的泵速增加百分比（Δ 每分钟转数）更高（4.4% ± 3.7% 对 0.1% ± 2.6%，P < .001）。在多变量分析中，6 个月时 Δ 每分钟转数和三尖瓣环收缩速度 (S') 与 6 个月 ΔLVEDD 独立相关。结论 在门诊随访期间接受渐进式泵速滴定的 LVAD 接受者更有可能维持最佳的 LV 卸载。进行性 LVAD 相关的右心室衰竭在欠负荷的患者中普遍存在。