Reverse Remodeling With Left Ventricular Assist Devices
This review provides a comprehensive overview of the past 25+ years of research into the development of left ventricular assist device (LVAD) to improve clinical outcomes in patients with severe end-stage heart failure and basic insights gained into the biology of heart failure gleaned from studies...
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Veröffentlicht in: | Circulation research 2021-05, Vol.128 (10), p.1594-1612 |
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description | This review provides a comprehensive overview of the past 25+ years of research into the development of left ventricular assist device (LVAD) to improve clinical outcomes in patients with severe end-stage heart failure and basic insights gained into the biology of heart failure gleaned from studies of hearts and myocardium of patients undergoing LVAD support. Clinical aspects of contemporary LVAD therapy, including evolving device technology, overall mortality, and complications, are reviewed. We explain the hemodynamic effects of LVAD support and how these lead to ventricular unloading. This includes a detailed review of the structural, cellular, and molecular aspects of LVAD-associated reverse remodeling. Synergisms between LVAD support and medical therapies for heart failure related to reverse remodeling, remission, and recovery are discussed within the context of both clinical outcomes and fundamental effects on myocardial biology. The incidence, clinical implications and factors most likely to be associated with improved ventricular function and remission of the heart failure are reviewed. Finally, we discuss recognized impediments to achieving myocardial recovery in the vast majority of LVAD-supported hearts and their implications for future research aimed at improving the overall rates of recovery. |
doi_str_mv | 10.1161/CIRCRESAHA.121.318160 |
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Clinical aspects of contemporary LVAD therapy, including evolving device technology, overall mortality, and complications, are reviewed. We explain the hemodynamic effects of LVAD support and how these lead to ventricular unloading. This includes a detailed review of the structural, cellular, and molecular aspects of LVAD-associated reverse remodeling. Synergisms between LVAD support and medical therapies for heart failure related to reverse remodeling, remission, and recovery are discussed within the context of both clinical outcomes and fundamental effects on myocardial biology. The incidence, clinical implications and factors most likely to be associated with improved ventricular function and remission of the heart failure are reviewed. 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Clinical aspects of contemporary LVAD therapy, including evolving device technology, overall mortality, and complications, are reviewed. We explain the hemodynamic effects of LVAD support and how these lead to ventricular unloading. This includes a detailed review of the structural, cellular, and molecular aspects of LVAD-associated reverse remodeling. Synergisms between LVAD support and medical therapies for heart failure related to reverse remodeling, remission, and recovery are discussed within the context of both clinical outcomes and fundamental effects on myocardial biology. The incidence, clinical implications and factors most likely to be associated with improved ventricular function and remission of the heart failure are reviewed. Finally, we discuss recognized impediments to achieving myocardial recovery in the vast majority of LVAD-supported hearts and their implications for future research aimed at improving the overall rates of recovery.</description><subject>Animals</subject><subject>Calcium - metabolism</subject><subject>Cell Death - physiology</subject><subject>Cytokines - metabolism</subject><subject>Cytoskeleton - physiology</subject><subject>Disease Models, Animal</subject><subject>Endothelial Cells - physiology</subject><subject>Extracellular Matrix - physiology</subject><subject>Heart Failure - therapy</subject><subject>Heart-Assist Devices - adverse effects</subject><subject>Heart-Assist Devices - trends</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Macrophages - cytology</subject><subject>Mitochondria, Heart - physiology</subject><subject>Myocardial Contraction</subject><subject>Myocytes, Cardiac - physiology</subject><subject>Transcriptome</subject><subject>Ventricular Function, Left - physiology</subject><subject>Ventricular Remodeling</subject><issn>0009-7330</issn><issn>1524-4571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkN1OwkAQhTdGI4g-gqYvUJzZn3b3xoQgCgmJCf5dbrbtFKqFmm6B-PaWoKhXk8ycc-bkY-wSoY8Y4fVwMhvORo-D8aCPHPsCNUZwxLqouAylivGYdQHAhLEQ0GFn3r8BoBTcnLKOEEYLzXWXxTPaUO0pmNGyyqgsVvPgtWgWwZTyJnihVVMX6bp0dTDwvvBNcEubIiV_zk5yV3q6-J499nw3ehqOw-nD_WQ4mIap5ALDNOI84ZJSjYg8MbFKMdYmypwmrUwi8gyAkkhQBpkizFGaxGgtSTlO2okeu9nnfqyTJWXprpAr7UddLF39aStX2P-XVbGw82pjDQquJLQBah-Q1pX3NeUHL4LdkbS_JG1L0u5Jtr6rv48Prh90rUDuBduqbFqE7-V6S7VdkCubhW3RgwDkIQeOoFBC2G4QxRexBIAd</recordid><startdate>20210514</startdate><enddate>20210514</enddate><creator>Burkhoff, Daniel</creator><creator>Topkara, Veli K.</creator><creator>Sayer, Gabriel</creator><creator>Uriel, Nir</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1701-1593</orcidid><orcidid>https://orcid.org/0000-0003-2301-3587</orcidid><orcidid>https://orcid.org/0000-0003-3995-2466</orcidid></search><sort><creationdate>20210514</creationdate><title>Reverse Remodeling With Left Ventricular Assist Devices</title><author>Burkhoff, Daniel ; 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Clinical aspects of contemporary LVAD therapy, including evolving device technology, overall mortality, and complications, are reviewed. We explain the hemodynamic effects of LVAD support and how these lead to ventricular unloading. This includes a detailed review of the structural, cellular, and molecular aspects of LVAD-associated reverse remodeling. Synergisms between LVAD support and medical therapies for heart failure related to reverse remodeling, remission, and recovery are discussed within the context of both clinical outcomes and fundamental effects on myocardial biology. The incidence, clinical implications and factors most likely to be associated with improved ventricular function and remission of the heart failure are reviewed. 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subjects | Animals Calcium - metabolism Cell Death - physiology Cytokines - metabolism Cytoskeleton - physiology Disease Models, Animal Endothelial Cells - physiology Extracellular Matrix - physiology Heart Failure - therapy Heart-Assist Devices - adverse effects Heart-Assist Devices - trends Hemodynamics Humans Macrophages - cytology Mitochondria, Heart - physiology Myocardial Contraction Myocytes, Cardiac - physiology Transcriptome Ventricular Function, Left - physiology Ventricular Remodeling |
title | Reverse Remodeling With Left Ventricular Assist Devices |
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