The Impact of Diabetes Mellitus and Glycemia on Myocardial Recovery

Abstract

Purpose: The RESTAGE-HF multicenter study demonstrated high rates of myocardial recovery by implementing protocolized HF pharmacological therapy, LVAD optimization and regular cardiac function monitoring. The purpose of this study was to identify the pre-implant and early post-implant predictors of myocardial recovery sufficient to allow LVAD explantation. Methods: We studied 36 HeartMate II LVAD patients with advanced nonischemic cardiomyopathy, cardiomegaly, age <60yo and chronic HF history <5 years who completed the RESTAGE-HF study protocol. LVAD explantation took place when patients met the following criteria with the LVAD reduced to minimum speed: LVEF >45%, left ventricular end diastolic diameter (LVEDD) <60mm, end systolic diameter <50mm, PCWP ≤15mmHg, cardiac index >2.4 L/min/m2. Univariate and stepwise multivariable logistic regression were used to determine independent effects of pre-implant and early post-implant clinical, laboratory, echocardiographic and hemodynamic parameters on resultant myocardial recovery sufficient for explantation. Results: Nineteen patients (53%) met the reverse remodeling criteria and underwent LVAD explantation. On both multivariable and univariate analysis ethnicity, post LVAD pre-discharge on pump LVEDD <6.0cm and (an unloaded) change in LVEDD after LVAD implantation >0.75cm were associated with subsequent explantation. Additionally pre-LVAD PA Systolic Pressure <55mmHg and PA Diastolic Pressure <27mmHg and post LVAD pre-discharge on pump LVEF >33% and LVESD <4.7cm were also associated with explantation by univariate analysis (Table 1). Conclusion:In this multi-center study ethnicity and a good initial response to unloading (LVEDD on pump pre discharge <6.0cm and reduction in LVEDD >0.75cm) were identified as predictors of myocardial recovery sufficient for subsequent LVAD removal. Larger scale prospective studies are required to validate these findings that could inform patient management.