Regression of fibrosis and hypertrophy in failing myocardium following mechanical circulatory support

Bruckner, Brian A.; Stetson, Sonny J.; Perez‐Verdia, Alejandro; Youker, Keith A.; Radovančević, Branislav; Connelly, John H.; Koerner, Michael M.; Entman, Mark; Frazier, O.H.; Noon, George P.; Torre‐Amione, Guillermo

doi:10.1016/s1053-2498(00)00321-1

Cited by 185 publications

(98 citation statements)

References 18 publications

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“…27 Whether a reduction of interstitial fibrosis occurs with LVAS is still controversial. Bruckner et al demonstrated a significant decrease in the total collagen content after LVAS support, 28 and Müller et al demonstrated a significant reduction of the fibrosed area in 5 patients successfully weaned from LVAS. 4 However, Klotz et al demonstrated increases in the total content and cross-linking of collagen, and a resultant increase in LV stiffness.…”

Section: Morphological Changesmentioning

confidence: 99%

Myocardial Recovery by Mechanical Unloading With Left Ventricular Assist System

Matsumiya

Saitoh

Sakata

et al. 2009

Circ J

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dvanced congestive heart failure (CHF) has been generally believed to be progressive and associated with substantial morbidity and mortality. 1 Cardiac transplantation has been the only curative treatment for end-stage CHF, but the number of heart transplantation is severely limited, especially in Japan. Instead, there has been increasing application of left ventricular assist systems (LVAS) for the treatment of severe CHF. 2 The LVAS consists of an electrically or pneumatically driven pump, installed either extra-or intra-corporeally. The main purpose of the LVAS is a "bridge to transplantation", but recent refinements in the engineering of the devices have enabled long-term use as "destination therapy". 3 The pump transports blood from the left ventricle (LV) to the ascending aorta, thereby restoring the systemic circulation to normal. Moreover, the pump provides potent pressure and volume unloading of the LV. These favorable effects have lead to a new indication for the use of LVAS, because there is increasing evidence that mechanical unloading with the LVAS occasionally reverses the progress of CHF and permits device explantation. [4][5][6][7] This "bridge to recovery" with the LVAS is an attractive strategy for the treatment of patients with severe CHF for whom heart transplantation or permanent LVAS use has been the only treatment option. Interest relates not only to the treatment of severe CHF, 8-10 but also to the study of the mechanisms involved in the remodeling process and its regression (ie, "reverse remodeling"). The pathophysiological mechanisms involved in the reverse remodeling induced by mechanical unloading have become a focus of intense research, with the hope of establishing reliable indicators of sustained recovery and strategies to enhance this process. 8,9 Clinically, there still exist many questions about the application of this strategy. The evaluation of LV function while on the LVAS and the prediction of sustained recovery after device explantation have been the major concerns regarding the use of this strategy for a wider range of patients. 10,11 How to evaluate LV function and decide when LVAS explantation is performed are the focus of studies. 6,10,12 Furthermore, to promote the recovery process, pharmacological, 4,7 surgical 13,14 or cell-based therapies, 15,16 combined with LVAS, are under intense investigation. In Japan, the donor supply is severely limited and almost all patients on LVAS are waiting nearly 3 years for a heart transplant. 2 Therefore, we have been forced to adopt more generous criteria for LVAS weaning compared with those used in studies from other countries. Based on this, we evaluated the factors that predict successful explantation of the LVAS and sustained functional LV recovery to determine if we can expand the population of patients who can benefit from the LVAS as a bridge to recovery. Both the clinical and laboratory findings, including our own of bridge to recovery experience with mechanical circulatory support, are reviewed. Clinical ObservationsAn earl...

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Section: Morphological Changesmentioning

confidence: 99%

Myocardial Recovery by Mechanical Unloading With Left Ventricular Assist System

Matsumiya

Saitoh

Sakata

et al. 2009

Circ J

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“…24, 25 In another study, Bruckner et al confirmed the return of the myocyte to its normal length and mass at the cellular level, showing an average reduction of 26% in myocyte size. 26 CMR is ideally suited for the assessment of RR because it is the current gold standard for measuring cardiac volumetry and mass, and offers the ability to track changes in ventricular metrics with low interobserver variability. 16, 28 Moreover, its non-invasiveness makes it suitable for repetitive analysis.…”

Section: Myocardial Thicknessmentioning

confidence: 99%

Magnetic Resonance Imaging of Reverse Remodeling After Coronary Revascularization in Ischemic Heart Disease　– Morphologic Evaluation –

Park

Lee

et al. 2016

Circ J

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“…Type 1 collagen, type 1: type 3 collagen ratio, collagen cross linking and fibrosis have been shown to be elevated in a variety of clinical as well as experimental disease states (Avendano et al 1999;Badenhorst et al 2003;Marijianowski et al 1995;Mukherjee and Sen 1991;Porter and Turner 2009;Woodiwiss et al 2001). Reports of LVAD-induced ECM changes have been conflicting, with some revealing increased myocardial fibrosis and ECM volume following unloading (Klotz, S. et al 2005b;Li et al 2001;Matsumiya et al 2005;Saito et al 2010), and others showing a reduction (Akgul et al 2004;Bruckner et al 2001;Maybaum et al 2007;Thohan et al 2005;Thompson et al 2005). Bruggink et al demonstrated a biphasic response with initial expansion of ECM and then a subsequent regression with prolonged MU (Bruggink et al 2006).…”

Section: Extracellular Matrixmentioning

confidence: 99%

Myocardial Recovery Following Left Ventricular Assist Device Therapy

Navaratnarajah¹,

Ibrahim²,

Yacoub³

et al. 2011

New Aspects of Ventricular Assist Devices

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Regression of fibrosis and hypertrophy in failing myocardium following mechanical circulatory support

Cited by 185 publications

References 18 publications

Myocardial Recovery by Mechanical Unloading With Left Ventricular Assist System

Myocardial Recovery by Mechanical Unloading With Left Ventricular Assist System

Magnetic Resonance Imaging of Reverse Remodeling After Coronary Revascularization in Ischemic Heart Disease　– Morphologic Evaluation –

Myocardial Recovery Following Left Ventricular Assist Device Therapy

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Regression of fibrosis and hypertrophy in failing myocardium following mechanical circulatory support

Cited by 185 publications

References 18 publications

Myocardial Recovery by Mechanical Unloading With Left Ventricular Assist System

Myocardial Recovery by Mechanical Unloading With Left Ventricular Assist System

Magnetic Resonance Imaging of Reverse Remodeling After Coronary Revascularization in Ischemic Heart Disease – Morphologic Evaluation –

Myocardial Recovery Following Left Ventricular Assist Device Therapy

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Magnetic Resonance Imaging of Reverse Remodeling After Coronary Revascularization in Ischemic Heart Disease　– Morphologic Evaluation –