AN ANALYSIS OF CLINICAL, GENE EXPRESSION, AND PROTEIN DATA FROM PATIENTS WHO WERE WEANED FROM A CARDIAC ASSIST DEVICE

Abstract

Background: In selected patients under well-defined conditions an improvement of cardiac function has been observed during support by a LVAD. Factors that allow pre-implant estimation whether a patient can be weaned from LVAD, are not available. Methods, Results: An analysis of data of patients with lasting recovery (group A, n=16) and those with recurrence of heart failure (HF) after weaning (group B. n=9). showed no significant differences between group A and B regarding mean age of the patients (A: 42.5 ″ 8.9 ws B: 48.3 ″ 11.2 years). mean left ventricular diameter at time of implantation (LVIDd) (A: 76.2 ″ 7.3 ws 6: 77.7 '5.2 mm), mean ejection fraction (LVEF) {A: 75.2 ″ 3.4 ws 6: 18.7 ″ 2.8 %). and mean LlVDd two months after LVAD placement (A: 53.1 ″ 5.9 vs B: 56.1 ″ 6.4 mm). Significant differences were found in mean duration of assist support until improvement (A: 179.3 ″ 98.2 vs 6: 288 −34.7 days; p=0.0766). mean duration of HF before implantation (A: 2.4 −7.5vs B: 7.9 ″ 5.7 years;p=0.0003).mean LVlDd at time of explantation (A: 51.2 '4.9 vs B: 58.1 ″ 8.9 mm; p=0.0210), mean LVEF two months after implantation (A: 44.7 ″ 7.9 vs 6: 34.9 '7.9 %; p=0.0211). mean LVEF at time of device removal (A: 48.2 '3.3 vs 6:39.4 ″ 4.1 %; p=0.0007) and mean period after implantation until specific autoantibodies has been disappeared(A: 8.7 '2.1 vs 6: 9.4 ″ 3.8 weeks; p=0.0027). At time of implantation. markers (gene expression, protein) for fibrosis (MMPS. lysyloxidase. collagen Ill) were extremely more pronounced as compared lo healthy myocardium but they showed no difference between the groups. Conclusions: Successfully weaned patients had a shorter history of HF. followed a faster and needed a shorter period for improvement than patients who demonstrated recurrence of HF. Just as, the period until the autoantibodies disappeared were significant shorter in patients with lasting recovery. Fibrosis of the myocardium seems to play an important role for improvement.