Clinical and histopathological effects of heart failure drug therapy in advanced heart failure patients on chronic mechanical circulatory support.

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  • Additional Information
    • Source:
      Publisher: Wiley Country of Publication: England NLM ID: 100887595 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0844 (Electronic) Linking ISSN: 13889842 NLM ISO Abbreviation: Eur J Heart Fail Subsets: MEDLINE
    • Publication Information:
      Publication: 2014- : Chichester : Wiley
      Original Publication: Amsterdam ; New York : Elsevier Science, c1999-
    • Subject Terms:
      Heart-Assist Devices*; Cardiovascular Agents/*therapeutic use ; Heart Failure/*therapy ; Heart Ventricles/*diagnostic imaging ; Myocardium/*pathology ; Ventricular Function, Left/*physiology; Cardiac Catheterization ; Echocardiography ; Female ; Follow-Up Studies ; Heart Failure/diagnosis ; Heart Failure/physiopathology ; Heart Ventricles/physiopathology ; Humans ; Male ; Middle Aged ; Periodicity ; Retrospective Studies ; Time Factors
    • Abstract:
      Aims: Adjuvant heart failure (HF) drug therapy in patients undergoing chronic mechanical circulatory support (MCS) is often used in conjunction with a continuous-flow left ventricular assist device (LVAD), but its potential impact is not well defined. The objective of the present study was to examine the effects of conventional HF drug therapy on myocardial structure and function, peripheral organ function and the incidence of adverse events in the setting of MCS.
      Methods and Results: Patients with chronic HF requiring LVAD support were prospectively enrolled. Paired myocardial tissue samples were obtained prior to LVAD implantation and at transplantation for histopathology. The Meds group comprised patients treated with neurohormonal blocking therapy (concurrent beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and aldosterone antagonist), and the No Meds group comprised patients on none of these. Both the Meds (n = 37) and No Meds (n = 44) groups experienced significant improvements in cardiac structure and function over the 6 months following LVAD implantation. The degree of improvement was greater in the Meds group, including after adjustment for baseline differences. There were no differences between the two groups in arrhythmias, end-organ injury, or neurological events. In patients with high baseline pre-LVAD myocardial fibrosis, treatment with HF drug therapy was associated with a reduction in fibrosis.
      Conclusions: Clinical and histopathological evidence showed that adjuvant HF drug therapy was associated with additional favourable effects on the structure and function of the unloaded myocardium that extended beyond the beneficial effects attributed to LVAD-induced unloading alone. Adjuvant HF drug therapy did not influence the incidence of major post-LVAD adverse events during the follow-up period.
      (© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.)
    • Comments:
      Comment in: Eur J Heart Fail. 2018 Jan;20(1):175-177. (PMID: 29164755)
    • Contributed Indexing:
      Keywords: Chronic mechanical circulatory support; Fibrosis; Heart failure; Left ventricular assist device; Neurohormonal blockade
    • Accession Number:
      0 (Cardiovascular Agents)
    • Publication Date:
      Date Created: 20171103 Date Completed: 20181016 Latest Revision: 20191023
    • Publication Date:
      20221213
    • Accession Number:
      10.1002/ejhf.1018
    • Accession Number:
      29094485