Myocardial Fas and Cytokine Expression in End‐Stage Heart Failure: Impact of LVAD Support

Bedi, Maninder; Alvarez, René; Kubota, Takeshi; Sheppard, Richard; Kormos, Robert L.; Siegenthaler, Michael; Feldman, Arthur M.; McTiernan, Charles F.; McNamara, Dennis M.

doi:10.1111/j.1752-8062.2008.00056.x

Cited by 15 publications

(10 citation statements)

References 26 publications

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“…Recently investigation of cytokines and apoptosis on VAD support found the effects of support to be highly variable (14). Fas expression is markedly elevated in subjects with heart failure receiving VAD support and was not reliably reduced by the hemodynamic unloading of VAD support (30). This suggests that hemodynamic unloading may not be enough for clinical recovery in subjects whom have experiences even moderate remodeling without adjunctive therapy to reverse the molecular changes of end stage heart failure.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Remodeling and Myocardial Recovery on Mechanical Circulatory Support

Simon

Primack

Teuteberg

et al. 2010

Journal of Cardiac Failure

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Section: Discussionmentioning

confidence: 99%

Left Ventricular Remodeling and Myocardial Recovery on Mechanical Circulatory Support

Simon

Primack

Teuteberg

et al. 2010

Journal of Cardiac Failure

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“…TNFα is elevated in severe HF and can predict mortality ( 53 ). Decreases of TNFα within the myocardial tissue post-VAD implantation indicate a tissure repair response to VAD treatment although levels remain higher than in controls( 54 – 56 ).…”

Section: Inflammation In Response To Ventricular Assist Devicesmentioning

confidence: 92%

“…This is likely related to the exposure of leukocytes to non-physiological flow and high shear levels in CF-VADs leading to increased activation. As for TNFα, there isan overall reduction in IL-6 in the myocardium following VAD support ( 54 ).…”

Section: Inflammation In Response To Ventricular Assist Devicesmentioning

confidence: 99%

The Inflammatory Response to Ventricular Assist Devices

et al. 2018

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The therapeutic use of ventricular assist devices (VADs) for end-stage heart failure (HF) patients who are ineligible for transplant has increased steadily in the last decade. In parallel, improvements in VAD design have reduced device size, cost, and device-related complications. These complications include infection and thrombosis which share underpinning contribution from the inflammatory response and remain common risks from VAD implantation. An added and underappreciated difficulty in designing a VAD that supports heart function and aids the repair of damaged myocardium is that different types of HF are accompanied by different inflammatory profiles that can affect the response to the implanted device. Circulating inflammatory markers and changes in leukocyte phenotypes receive much attention as biomarkers for mortality and disease progression. However, they are seldom used to monitor progress during and outcomes from VAD therapy or during the design phase for new devices. Even the partial reversal of heart damage associated with heart failure is a desirable outcome from VAD use. Therefore, improved understanding of the interplay between VADs and the recipient's inflammatory response would potentially increase their uptake, improve patient lives, and fuel research related to other blood-contacting medical devices. Here we provide a review of what is currently known about inflammation in heart failure and how this inflammatory profile is altered in heart failure patients receiving VAD therapy.

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“…[65] Resident human cardiac progenitor cells have been demonstrated to be most abundant in the neonatal period, decreasing three---fold by two---years of age. [65] Two more possibly advantageous mechanisms of the pediatric heart include decreased apoptosis, [66] which is consistent with the observed decrease in pro---apoptosis cytokines, [5,50] and the potential for hibernating myocardium that recovers from chronic contractile dysfunction upon reperfusion. [67] …”

Section: Pediatric Cardiomyopathy Patients May Have Greater Potentialmentioning

confidence: 70%

Clinical and Molecular Comparison of Pediatric and Adult Reverse Remodeling With Ventricular Assist Devices

2015

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Ventricular assist device (VAD) support induces reverse remodeling of failing myocardium that leads to occasional functional recovery of the adult heart. While there have been numerous clinical reports in adult patients with end‐stage cardiomyopathy, little is known about reverse remodeling in children, which has increasing clinical potential with the recent expansion of pediatric VADs in the setting of static organ supply for heart transplantation. Pediatric myocardium also promises theoretical advantages for recovery over adult myocardium due to its greater abundance of cardiac progenitor cells. To identify potential targets of future studies, we conducted a literature review with two aims: (i) to summarize clinical cases of pediatric patients who exhibited cardiac recovery following VAD support; and (ii) to analyze genetic changes in pediatric myocardium induced by VAD support compared with those observed in adult patients. Several clinical series of pediatric VAD cases report that small proportions of their cohorts were weaned off from device support, but a lack of information about the etiology and support duration of these patients limits the ability to determine whether they represent reverse remodeling of myocardial structure or just recovery from acute illness. A comparison of pediatric and adult gene expression changes with VAD support reveals approximately 40% of genes to be oppositely regulated, indicating that the pediatric genetic response is distinct. These observations highlight a necessity to better understand reverse remodeling specific to pediatric myocardium, which is crucial to improving clinical strategies for bridge‐to‐recovery in children.

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Myocardial Fas and Cytokine Expression in End‐Stage Heart Failure: Impact of LVAD Support

Cited by 15 publications

References 26 publications

Left Ventricular Remodeling and Myocardial Recovery on Mechanical Circulatory Support

Left Ventricular Remodeling and Myocardial Recovery on Mechanical Circulatory Support

The Inflammatory Response to Ventricular Assist Devices

Clinical and Molecular Comparison of Pediatric and Adult Reverse Remodeling With Ventricular Assist Devices

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