Skip to main content
Erschienen in: Current Cardiology Reports 3/2012

01.06.2012 | Congestive Heart Failure (J Lindenfeld, Section Editor)

Is Myocardial Recovery Possible and How Do You Measure It?

verfasst von: Douglas L. Mann, Daniel Burkhoff

Erschienen in: Current Cardiology Reports | Ausgabe 3/2012

Einloggen, um Zugang zu erhalten

Abstract

Medical and device therapies that reduce heart failure morbidity and mortality also lead to decreased left ventricular volume and mass, and a more normal elliptical shape of the ventricle. These are due to changes in myocyte size, structure, and organization that have been referred to collectively as “reverse remodeling.” Moreover, there are subsets of patients whose hearts have undergone reverse remodeling following mechanical circulatory support with a ventricular assist device (VAD), who are able to be weaned from their VADs, which has been referred to as “myocardial recovery.” Although the term myocardial recovery has been used to describe the reversal of various aspects of the heart failure phenotype following medical and device therapy, there is no consensus with regard to what constitutes myocardial recovery; moreover, the methodology for identifying myocardial recovery in patients is unclear. These topics will be discussed in the current review.
Literatur
1.
Zurück zum Zitat Kass DA, Baughman KL, Pak PH, Cho PW, Levin HR, Gardner TJ, Halperin HR, Tsitlik JE, Acker MA. Reverse remodeling from cardiomyoplasty in human heart failure. External constraint versus active assist. Circulation. 1995;91:2314–8.PubMed Kass DA, Baughman KL, Pak PH, Cho PW, Levin HR, Gardner TJ, Halperin HR, Tsitlik JE, Acker MA. Reverse remodeling from cardiomyoplasty in human heart failure. External constraint versus active assist. Circulation. 1995;91:2314–8.PubMed
2.
Zurück zum Zitat Levin HR, Oz MC, Chen JM, Packer M, Rose EA, Burkhoff D. Reversal of chronic ventricular dilation in patients with end-stage cardiomyopathy by prolonged mechanical unloading. Circulation. 1995;91:2717–20.PubMed Levin HR, Oz MC, Chen JM, Packer M, Rose EA, Burkhoff D. Reversal of chronic ventricular dilation in patients with end-stage cardiomyopathy by prolonged mechanical unloading. Circulation. 1995;91:2717–20.PubMed
3.
Zurück zum Zitat Westaby S, Jin XY, Katsumata T, Taggart DP, Coats AJ, Frazier OH: Mechanical support in dilated cardiomyopathy: signs of early left ventricular recovery; 1997, pp 1303–1308. Westaby S, Jin XY, Katsumata T, Taggart DP, Coats AJ, Frazier OH: Mechanical support in dilated cardiomyopathy: signs of early left ventricular recovery; 1997, pp 1303–1308.
4.
Zurück zum Zitat Frazier OH. First use of an untethered, vented electric left ventricular assist device for long-term support. Circulation. 1994;89:2908–14.PubMed Frazier OH. First use of an untethered, vented electric left ventricular assist device for long-term support. Circulation. 1994;89:2908–14.PubMed
5.
Zurück zum Zitat Levin HR, Oz MC, Catanese KA, Rose EA, Burkhoff D. Transient normalization of systolic and diastolic function after support with a left ventricular assist device in a patient with dilated cardiomyopathy. J Heart Lung Transplant. 1996;15:840–2.PubMed Levin HR, Oz MC, Catanese KA, Rose EA, Burkhoff D. Transient normalization of systolic and diastolic function after support with a left ventricular assist device in a patient with dilated cardiomyopathy. J Heart Lung Transplant. 1996;15:840–2.PubMed
6.
Zurück zum Zitat Konstam MA, Kronenberg MW, Rousseau MF, Udelson JE, Melin J, Stewart D, Dolan N, Edens TR, Ahn S, Kinan D. Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction. SOLVD (Studies of Left Ventricular Dysfunction) Investigators. Circulation. 1993;88:2277–83.PubMed Konstam MA, Kronenberg MW, Rousseau MF, Udelson JE, Melin J, Stewart D, Dolan N, Edens TR, Ahn S, Kinan D. Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction. SOLVD (Studies of Left Ventricular Dysfunction) Investigators. Circulation. 1993;88:2277–83.PubMed
7.
Zurück zum Zitat Lindpaintner K, Lee MA, Larson MG, Rao S, Pfeffer MA, Ordovas JM, Schaefer EJ, Wilson AF, Wilson PWF, Vasan RS, Myers RH, Levy D. Absence of association or genetic linkage between the angiotensin-converting-enzyme gene and left ventricular mass. N Engl J Med. 1996;334:1023–8.PubMedCrossRef Lindpaintner K, Lee MA, Larson MG, Rao S, Pfeffer MA, Ordovas JM, Schaefer EJ, Wilson AF, Wilson PWF, Vasan RS, Myers RH, Levy D. Absence of association or genetic linkage between the angiotensin-converting-enzyme gene and left ventricular mass. N Engl J Med. 1996;334:1023–8.PubMedCrossRef
8.
Zurück zum Zitat •• Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller MA, Ulisney KL, Baldwin JT, Young JB: Third INTERMACS Annual Report: the evolution of destination therapy in the United States. J Heart Lung Transplant 2011, 30:115–23. This is the most recent report from the INTERMACS registry that shows that 1 % of VAD patients were explanted for myocardial recovery. •• Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller MA, Ulisney KL, Baldwin JT, Young JB: Third INTERMACS Annual Report: the evolution of destination therapy in the United States. J Heart Lung Transplant 2011, 30:115–23. This is the most recent report from the INTERMACS registry that shows that 1 % of VAD patients were explanted for myocardial recovery.
9.
Zurück zum Zitat •• Mann DL, Burkhoff D: Myocardial expression levels of micro-ribonucleic acids in patients with left ventricular assist devices signature of myocardial recovery, signature of reverse remodeling, or signature with no name? J Am Coll Cardiol 2011, 58:2279–81. This is an editorial that provides the first working definition of myocardial recovery. •• Mann DL, Burkhoff D: Myocardial expression levels of micro-ribonucleic acids in patients with left ventricular assist devices signature of myocardial recovery, signature of reverse remodeling, or signature with no name? J Am Coll Cardiol 2011, 58:2279–81. This is an editorial that provides the first working definition of myocardial recovery.
10.
Zurück zum Zitat Margulies KB, Matiwala S, Cornejo C, Olsen H, Craven WA, Bednarik D. Mixed messages: transcription patterns in failing and recovering human myocardium. Circ Res. 2005;96:592–9.PubMedCrossRef Margulies KB, Matiwala S, Cornejo C, Olsen H, Craven WA, Bednarik D. Mixed messages: transcription patterns in failing and recovering human myocardium. Circ Res. 2005;96:592–9.PubMedCrossRef
11.
Zurück zum Zitat Rodrigue-Way A, Burkhoff D, Geesaman BJ, Golden S, Xu J, Pollman MJ, Donoghue M, Jeyaseelan R, Houser S, Breitbart RE, Marks A, Acton S. Sarcomeric genes involved in reverse remodeling of the heart during left ventricular assist device support. J Heart Lung Transplant. 2005;24:73–80.PubMedCrossRef Rodrigue-Way A, Burkhoff D, Geesaman BJ, Golden S, Xu J, Pollman MJ, Donoghue M, Jeyaseelan R, Houser S, Breitbart RE, Marks A, Acton S. Sarcomeric genes involved in reverse remodeling of the heart during left ventricular assist device support. J Heart Lung Transplant. 2005;24:73–80.PubMedCrossRef
12.
Zurück zum Zitat • Schwientek P, Ellinghaus P, Steppan S, D'Urso D, Seewald M, Kassner A, Cebulla R, Schulte-Eistrup S, Morshuis M, Rofe D, El BA, Korfer R, Milting H: Global gene expression analysis in nonfailing and failing myocardium pre- and postpulsatile and nonpulsatile ventricular assist device support. Physiol Genomics 2010, 42:397–405. This is a recent microarray analysis showing that the heart failure gene program is not reversed following pulsatile and nonpulsatile VADs. • Schwientek P, Ellinghaus P, Steppan S, D'Urso D, Seewald M, Kassner A, Cebulla R, Schulte-Eistrup S, Morshuis M, Rofe D, El BA, Korfer R, Milting H: Global gene expression analysis in nonfailing and failing myocardium pre- and postpulsatile and nonpulsatile ventricular assist device support. Physiol Genomics 2010, 42:397–405. This is a recent microarray analysis showing that the heart failure gene program is not reversed following pulsatile and nonpulsatile VADs.
13.
Zurück zum Zitat Lowes BD, Zolty R, Shakar SF, Brieke A, Gray N, Reed M, Calalb M, Minobe W, Lindenfeld J, Wolfel EE, Geraci M, Bristow MR, Cleveland Jr J. Assist devices fail to reverse patterns of fetal gene expression despite beta-blockers. J Heart Lung Transplant. 2007;26:1170–6.PubMedCrossRef Lowes BD, Zolty R, Shakar SF, Brieke A, Gray N, Reed M, Calalb M, Minobe W, Lindenfeld J, Wolfel EE, Geraci M, Bristow MR, Cleveland Jr J. Assist devices fail to reverse patterns of fetal gene expression despite beta-blockers. J Heart Lung Transplant. 2007;26:1170–6.PubMedCrossRef
14.
Zurück zum Zitat Barbone A, Oz MC, Burkhoff D, Holmes JW. Normalized diastolic properties after left ventricular assist result from reverse remodeling of chamber geometry. Circulation. 2001;104:I229–32.PubMedCrossRef Barbone A, Oz MC, Burkhoff D, Holmes JW. Normalized diastolic properties after left ventricular assist result from reverse remodeling of chamber geometry. Circulation. 2001;104:I229–32.PubMedCrossRef
15.
Zurück zum Zitat Birks EJ, Tansley PD, Hardy J, George RS, Bowles CT, Burke M, Banner NR, Khaghani A, Yacoub MH. Left ventricular assist device and drug therapy for the reversal of heart failure. N Engl J Med. 2006;355:1873–84.PubMedCrossRef Birks EJ, Tansley PD, Hardy J, George RS, Bowles CT, Burke M, Banner NR, Khaghani A, Yacoub MH. Left ventricular assist device and drug therapy for the reversal of heart failure. N Engl J Med. 2006;355:1873–84.PubMedCrossRef
16.
Zurück zum Zitat Hall JL, Birks EJ, Grindle S, Cullen ME, Barton PJ, Rider JE, Lee S, Harwalker S, Mariash A, Adhikari N, Charles NJ, Felkin LE, Polster S, George RS, Miller LW, Yacoub MH. Molecular signature of recovery following combination left ventricular assist device (LVAD) support and pharmacologic therapy. Eur Heart J. 2007;28:613–27.PubMedCrossRef Hall JL, Birks EJ, Grindle S, Cullen ME, Barton PJ, Rider JE, Lee S, Harwalker S, Mariash A, Adhikari N, Charles NJ, Felkin LE, Polster S, George RS, Miller LW, Yacoub MH. Molecular signature of recovery following combination left ventricular assist device (LVAD) support and pharmacologic therapy. Eur Heart J. 2007;28:613–27.PubMedCrossRef
17.
Zurück zum Zitat Mancini DM, Beniaminovitz A, Levin H, Catanese K, Flannery M, DiTullio M, Savin S, Cordisco ME, Rose E, Oz M. Low incidence of myocardial recovery after left ventricular assist device implantation in patients with chronic heart failure. Circulation. 1998;98:2383–9.PubMed Mancini DM, Beniaminovitz A, Levin H, Catanese K, Flannery M, DiTullio M, Savin S, Cordisco ME, Rose E, Oz M. Low incidence of myocardial recovery after left ventricular assist device implantation in patients with chronic heart failure. Circulation. 1998;98:2383–9.PubMed
18.
Zurück zum Zitat • Birks EJ, George RS, Hedger M, Bahrami T, Wilton P, Bowles CT, Webb C, Bougard R, Amrani M, Yacoub MH, Dreyfus G, Khaghani A: Reversal of Severe Heart Failure With a Continuous-Flow Left Ventricular Assist Device and Pharmacological Therapy: A Prospective Study. Circulation 2011, 123:381–390. This is a recent prospective study that shows that the a combination of medical therapy and VAD support resulted in recovery in 60 % of the patients that were studied. • Birks EJ, George RS, Hedger M, Bahrami T, Wilton P, Bowles CT, Webb C, Bougard R, Amrani M, Yacoub MH, Dreyfus G, Khaghani A: Reversal of Severe Heart Failure With a Continuous-Flow Left Ventricular Assist Device and Pharmacological Therapy: A Prospective Study. Circulation 2011, 123:381–390. This is a recent prospective study that shows that the a combination of medical therapy and VAD support resulted in recovery in 60 % of the patients that were studied.
19.
Zurück zum Zitat Mann DL. Mechanisms and models in heart failure: a combinatorial approach. Circulation. 1999;100:999–1088.PubMed Mann DL. Mechanisms and models in heart failure: a combinatorial approach. Circulation. 1999;100:999–1088.PubMed
20.
Zurück zum Zitat Maybaum S, Mancini D, Xydas S, Starling RC, Aaronson K, Pagani FD, Miller LW, Margulies K, McRee S, Frazier OH, Torre-Amione G. Cardiac improvement during mechanical circulatory support: a prospective multicenter study of the LVAD Working Group. Circulation. 2007;115:2497–505.PubMedCrossRef Maybaum S, Mancini D, Xydas S, Starling RC, Aaronson K, Pagani FD, Miller LW, Margulies K, McRee S, Frazier OH, Torre-Amione G. Cardiac improvement during mechanical circulatory support: a prospective multicenter study of the LVAD Working Group. Circulation. 2007;115:2497–505.PubMedCrossRef
21.
Zurück zum Zitat Dandel M, Weng Y, Siniawski H, Potapov E, Drews T, Lehmkuhl HB, Knosalla C, Hetzer R. Prediction of cardiac stability after weaning from left ventricular assist devices in patients with idiopathic dilated cardiomyopathy. Circulation. 2008;118:S94–S105.PubMedCrossRef Dandel M, Weng Y, Siniawski H, Potapov E, Drews T, Lehmkuhl HB, Knosalla C, Hetzer R. Prediction of cardiac stability after weaning from left ventricular assist devices in patients with idiopathic dilated cardiomyopathy. Circulation. 2008;118:S94–S105.PubMedCrossRef
22.
Zurück zum Zitat Dandel M, Weng Y, Siniawski H, Stepanenko A, Krabatsch T, Potapov E, Lehmkuhl HB, Knosalla C, Hetzer R. Heart failure reversal by ventricular unloading in patients with chronic cardiomyopathy: criteria for weaning from ventricular assist devices. Eur Heart J. 2011;32:1148–60.PubMedCrossRef Dandel M, Weng Y, Siniawski H, Stepanenko A, Krabatsch T, Potapov E, Lehmkuhl HB, Knosalla C, Hetzer R. Heart failure reversal by ventricular unloading in patients with chronic cardiomyopathy: criteria for weaning from ventricular assist devices. Eur Heart J. 2011;32:1148–60.PubMedCrossRef
23.
Zurück zum Zitat Drakos SG, Terrovitis JV, Nastasiou-Nana MI, Nanas JN. Reverse remodeling during long-term mechanical unloading of the left ventricle. J Mol Cell Cardiol. 2007;43:231–42.PubMedCrossRef Drakos SG, Terrovitis JV, Nastasiou-Nana MI, Nanas JN. Reverse remodeling during long-term mechanical unloading of the left ventricle. J Mol Cell Cardiol. 2007;43:231–42.PubMedCrossRef
24.
Zurück zum Zitat Drakos SG, Charitos EI, Nanas SN, Nanas JN. Ventricular-assist devices for the treatment of chronic heart failure. Expert Rev Cardiovasc Ther. 2007;5:571–84.PubMedCrossRef Drakos SG, Charitos EI, Nanas SN, Nanas JN. Ventricular-assist devices for the treatment of chronic heart failure. Expert Rev Cardiovasc Ther. 2007;5:571–84.PubMedCrossRef
25.
Zurück zum Zitat Liden H, Karason K, Bergh CH, Nilsson F, Koul B, Wiklund L. The feasibility of left ventricular mechanical support as a bridge to cardiac recovery. Eur J Heart Fail. 2007;9:525–30.PubMedCrossRef Liden H, Karason K, Bergh CH, Nilsson F, Koul B, Wiklund L. The feasibility of left ventricular mechanical support as a bridge to cardiac recovery. Eur J Heart Fail. 2007;9:525–30.PubMedCrossRef
26.
Zurück zum Zitat Gorcsan III J, Severyn D, Murali S, Kormos RL. Non-invasive assessment of myocardial recovery on chronic left ventricular assist device: results associated with successful device removal. J Heart Lung Transplant. 2003;22:1304–13.PubMedCrossRef Gorcsan III J, Severyn D, Murali S, Kormos RL. Non-invasive assessment of myocardial recovery on chronic left ventricular assist device: results associated with successful device removal. J Heart Lung Transplant. 2003;22:1304–13.PubMedCrossRef
27.
Zurück zum Zitat Matsumiya G, Monta O, Fukushima N, Sawa Y, Funatsu T, Toda K, Matsuda H. Who would be a candidate for bridge to recovery during prolonged mechanical left ventricular support in idiopathic dilated cardiomyopathy? J Thorac Cardiovasc Surg. 2005;130:699–704.PubMedCrossRef Matsumiya G, Monta O, Fukushima N, Sawa Y, Funatsu T, Toda K, Matsuda H. Who would be a candidate for bridge to recovery during prolonged mechanical left ventricular support in idiopathic dilated cardiomyopathy? J Thorac Cardiovasc Surg. 2005;130:699–704.PubMedCrossRef
28.
Zurück zum Zitat Simon MA, Primack BA, Teuteberg J, Kormos RL, Bermudez C, Toyoda Y, Shah H, Gorcsan III J, McNamara DM. Left ventricular remodeling and myocardial recovery on mechanical circulatory support. J Card Fail. 2010;16:99–105.PubMedCrossRef Simon MA, Primack BA, Teuteberg J, Kormos RL, Bermudez C, Toyoda Y, Shah H, Gorcsan III J, McNamara DM. Left ventricular remodeling and myocardial recovery on mechanical circulatory support. J Card Fail. 2010;16:99–105.PubMedCrossRef
29.
Zurück zum Zitat Farrar DJ, Holman WR, McBride LR, Kormos RL, Icenogle TB, Hendry PJ, Moore CH, Loisance DY, El Banayosy A, Frazier H. Long-term follow-up of Thoratec ventricular assist device bridge-to-recovery patients successfully removed from support after recovery of ventricular function. J Heart Lung Transplant. 2002;21:516–21.PubMedCrossRef Farrar DJ, Holman WR, McBride LR, Kormos RL, Icenogle TB, Hendry PJ, Moore CH, Loisance DY, El Banayosy A, Frazier H. Long-term follow-up of Thoratec ventricular assist device bridge-to-recovery patients successfully removed from support after recovery of ventricular function. J Heart Lung Transplant. 2002;21:516–21.PubMedCrossRef
30.
Zurück zum Zitat Drakos SG, Kfoury AG, Selzman CH, Verma DR, Nanas JN, Li DY, Stehlik J. Left ventricular assist device unloading effects on myocardial structure and function: current status of the field and call for action. Curr Opin Cardiol. 2011;26:245–55.PubMedCrossRef Drakos SG, Kfoury AG, Selzman CH, Verma DR, Nanas JN, Li DY, Stehlik J. Left ventricular assist device unloading effects on myocardial structure and function: current status of the field and call for action. Curr Opin Cardiol. 2011;26:245–55.PubMedCrossRef
31.
Zurück zum Zitat Mann DL, Burkhoff D. Myocardial expression levels of micro-ribonucleic acids in patients with left ventricular assist devices signature of myocardial recovery, signature of reverse remodeling, or signature with no name? J Am Coll Cardiol. 2011;58:2279–81.PubMedCrossRef Mann DL, Burkhoff D. Myocardial expression levels of micro-ribonucleic acids in patients with left ventricular assist devices signature of myocardial recovery, signature of reverse remodeling, or signature with no name? J Am Coll Cardiol. 2011;58:2279–81.PubMedCrossRef
Metadaten
Titel
Is Myocardial Recovery Possible and How Do You Measure It?
verfasst von
Douglas L. Mann
Daniel Burkhoff
Publikationsdatum
01.06.2012
Verlag
Current Science Inc.
Erschienen in
Current Cardiology Reports / Ausgabe 3/2012
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-012-0264-z

Weitere Artikel der Ausgabe 3/2012

Current Cardiology Reports 3/2012 Zur Ausgabe

Echocardiography (RM Lang, Section Editor)

Aortic Atherosclerosis and Embolic Events

Congestive Heart Failure (J Lindenfeld, Section Editor)

Role of Self-Care in the Patient with Heart Failure

Echocardiography (RM Lang, Section Editor)

Left Atrial Volume: Clinical Value Revisited

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Adipositas-Medikament auch gegen Schlafapnoe wirksam

24.04.2024 Adipositas Nachrichten

Der als Antidiabetikum sowie zum Gewichtsmanagement zugelassene Wirkstoff Tirzepatid hat in Studien bei adipösen Patienten auch schlafbezogene Atmungsstörungen deutlich reduziert, informiert der Hersteller in einer Vorab-Meldung zum Studienausgang.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.