Background:Variable definitions and an incomplete understanding of the gradient of reverse cardiac remodeling following continuous flow left ventricular assist device (LVAD) implantation has limited the field of myocardial plasticity. We evaluated the continuum of LV remodeling by serial echocardiographic imaging to define 3 stages of reverse cardiac remodeling following LVAD.Methods:The study enrolled consecutive LVAD patients across 4 study sites. A blinded echocardiographer evaluated the degree of structural (LV internal dimension at end-diastole [LVIDd]) and functional (LV ejection fraction [LVEF]) change after LVAD. Patients experiencing an improvement in LVEF ≥40% and LVIDd ≤6.0 cm were termed responders, absolute change in LVEF of ≥5% and LVEF <40% were termed partial responders, and the remaining patients with no significant improvement in LVEF were termed nonresponders.Results:Among 358 LVAD patients, 34 (10%) were responders, 112 (31%) partial responders, and the remaining 212 (59%) were nonresponders. The use of guideline-directed medical therapy for heart failure was higher in partial responders and responders. Structural changes (LVIDd) followed a different pattern with significant improvements even in patients who had minimal LVEF improvement. With mechanical unloading, the median reduction in LVIDd was −0.6 cm (interquartile range [IQR], −1.1 to −0.1 cm; nonresponders), −1.1 cm (IQR, −1.8 to −0.4 cm; partial responders), and −1.9 cm (IQR, −2.9 to −1.1 cm; responders). Similarly, the median change in LVEF was −2% (IQR, −6% to 1%), 9% (IQR, 6%–14%), and 27% (IQR, 23%–33%), respectively.Conclusions:Reverse cardiac remodeling associated with durable LVAD support is not an all-or-none phenomenon and manifests in a continuous spectrum. Defining 3 stages across this continuum can inform clinical management, facilitate the field of myocardial plasticity, and improve the design of future investigations.

中文翻译：

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使用机械循环支持对逆向心脏重塑进行分类的框架：Utah-Inova 阶段

背景：对连续流动左心室辅助装置 (LVAD) 植入后逆向心脏重塑梯度的可变定义和不完全理解限制了心肌可塑性领域。我们通过连续超声心动图成像评估了 LV 重构的连续性，以确定 LVAD 后心脏重构的 3 个阶段。方法：该研究在 4 个研究地点招募了连续的 LVAD 患者。一位双盲超声心动图医师评估了 LVAD 后结构（舒张末期 LV 内部尺寸 [LVIDd]）和功能（LV 射血分数 [LVEF]）变化的程度。LVEF 改善 ≥ 40% 和 LVIDd ≤ 6.0 cm 的患者被称为反应者，LVEF 的绝对变化 ≥ 5% 和 LVEF <40% 被称为部分反应者，结果：358例LVAD患者中，34例（10%）有效，112例（31%）部分有效，其余212例（59%）无反应。在部分反应者和反应者中，指南指导的心力衰竭药物治疗的使用率更高。结构变化 (LVIDd) 遵循不同的模式，即使在 LVEF 改善最小的患者中也有显着改善。通过机械卸载，LVIDd 的中位数减少为 -0.6 cm（四分位距 [IQR]，-1.1 至 -0.1 cm；无反应者）、-1.1 cm（IQR，-1.8 至 -0.4 cm；部分反应者）和 -1.9厘米（IQR，-2.9 至 -1.1 厘米；响应者）。同样，LVEF 的中位变化分别为 -2%（IQR，-6% 至 1%）、9%（IQR，6%–14%）和 27%（IQR，23%–33%）。结论: 与持久的 LVAD 支持相关的逆向心脏重塑并不是一种全有或全无的现象，而是以连续的频谱表现出来。在这个连续体中定义 3 个阶段可以为临床管理提供信息，促进心肌可塑性领域，并改进未来研究的设计。