Effect of left ventricular assist device combination therapy on myocardial blood flow in patients with end-stage dilated cardiomyopathy

Patrick Tansley, Magdi Yacoub, Ornella Rimoldi, Emma Birks, James Hardy, Mandy Hipkin, Christopher Bowles, Heiko Kindler, David Dutka, Paolo G. Camici

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Changes in myocardial blood flow (MBF) and coronary flow reserve (CFR) are independent prognostic risk factors in idiopathic dilated cardiomyopathy (DCM). The aim of this study was to assess the impact of left ventricular unloading using left ventricular assist device (LVAD) combination therapy on resting MBF and CFR in patients with end-stage heart disease. Methods We studied 11 patients with deteriorating end-stage DCM (New York Heart Association Class 4) treated with LVAD support combined with pharmacologic therapy in a recovery program. Absolute MBF was measured using oxygen-15-labeled water (H2 15O) positron emission tomography (PET) at rest during LVAD support and 15 minutes after the LVAD was switched off. Data were corrected for rate pressure product (RPP) when appropriate. Hyperemic MBF (intravenous adenosine, 140 μg/kg·min) was also measured in 6 patients with the LVAD switched off. CFR was calculated as the ratio MBF adenosine/MBF LVAD off (corrected). Data are expressed as mean ± SD. Results At 317 ± 193 days after device implantation, resting MBF was 0.95 ± 0.29 (LVAD on) and 1.46 ± 0.62 (LVAD off, corrected) ml/min·g (p = 0.01). MBF (LVAD on) was comparable with that of 11 age- and gender-matched normal controls (1.09 ± 0.22 ml/min·g). CFR in the LVAD group was 1.49 ± 0.99 compared with 3.56 ± 1.42 in normal controls (p <0.01). Conclusions During LVAD support, resting MBF (LVAD on) was comparable to MBF in normal controls and increased when the LVAD was switched off. However, CFR was significantly impaired, even though all patients studied showed varying degrees of myocardial recovery. The implications of these findings, particularly in the long term, require further study.

Original languageEnglish
Pages (from-to)1283-1289
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume23
Issue number11
DOIs
Publication statusPublished - Nov 2004

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Heart-Assist Devices
Dilated Cardiomyopathy
Therapeutics
Adenosine
Positron-Emission Tomography
Heart Diseases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Effect of left ventricular assist device combination therapy on myocardial blood flow in patients with end-stage dilated cardiomyopathy. / Tansley, Patrick; Yacoub, Magdi; Rimoldi, Ornella; Birks, Emma; Hardy, James; Hipkin, Mandy; Bowles, Christopher; Kindler, Heiko; Dutka, David; Camici, Paolo G.

In: Journal of Heart and Lung Transplantation, Vol. 23, No. 11, 11.2004, p. 1283-1289.

Research output: Contribution to journalArticle

Tansley, Patrick ; Yacoub, Magdi ; Rimoldi, Ornella ; Birks, Emma ; Hardy, James ; Hipkin, Mandy ; Bowles, Christopher ; Kindler, Heiko ; Dutka, David ; Camici, Paolo G. / Effect of left ventricular assist device combination therapy on myocardial blood flow in patients with end-stage dilated cardiomyopathy. In: Journal of Heart and Lung Transplantation. 2004 ; Vol. 23, No. 11. pp. 1283-1289.
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abstract = "Background Changes in myocardial blood flow (MBF) and coronary flow reserve (CFR) are independent prognostic risk factors in idiopathic dilated cardiomyopathy (DCM). The aim of this study was to assess the impact of left ventricular unloading using left ventricular assist device (LVAD) combination therapy on resting MBF and CFR in patients with end-stage heart disease. Methods We studied 11 patients with deteriorating end-stage DCM (New York Heart Association Class 4) treated with LVAD support combined with pharmacologic therapy in a recovery program. Absolute MBF was measured using oxygen-15-labeled water (H2 15O) positron emission tomography (PET) at rest during LVAD support and 15 minutes after the LVAD was switched off. Data were corrected for rate pressure product (RPP) when appropriate. Hyperemic MBF (intravenous adenosine, 140 μg/kg·min) was also measured in 6 patients with the LVAD switched off. CFR was calculated as the ratio MBF adenosine/MBF LVAD off (corrected). Data are expressed as mean ± SD. Results At 317 ± 193 days after device implantation, resting MBF was 0.95 ± 0.29 (LVAD on) and 1.46 ± 0.62 (LVAD off, corrected) ml/min·g (p = 0.01). MBF (LVAD on) was comparable with that of 11 age- and gender-matched normal controls (1.09 ± 0.22 ml/min·g). CFR in the LVAD group was 1.49 ± 0.99 compared with 3.56 ± 1.42 in normal controls (p <0.01). Conclusions During LVAD support, resting MBF (LVAD on) was comparable to MBF in normal controls and increased when the LVAD was switched off. However, CFR was significantly impaired, even though all patients studied showed varying degrees of myocardial recovery. The implications of these findings, particularly in the long term, require further study.",
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AU - Tansley, Patrick

AU - Yacoub, Magdi

AU - Rimoldi, Ornella

AU - Birks, Emma

AU - Hardy, James

AU - Hipkin, Mandy

AU - Bowles, Christopher

AU - Kindler, Heiko

AU - Dutka, David

AU - Camici, Paolo G.

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N2 - Background Changes in myocardial blood flow (MBF) and coronary flow reserve (CFR) are independent prognostic risk factors in idiopathic dilated cardiomyopathy (DCM). The aim of this study was to assess the impact of left ventricular unloading using left ventricular assist device (LVAD) combination therapy on resting MBF and CFR in patients with end-stage heart disease. Methods We studied 11 patients with deteriorating end-stage DCM (New York Heart Association Class 4) treated with LVAD support combined with pharmacologic therapy in a recovery program. Absolute MBF was measured using oxygen-15-labeled water (H2 15O) positron emission tomography (PET) at rest during LVAD support and 15 minutes after the LVAD was switched off. Data were corrected for rate pressure product (RPP) when appropriate. Hyperemic MBF (intravenous adenosine, 140 μg/kg·min) was also measured in 6 patients with the LVAD switched off. CFR was calculated as the ratio MBF adenosine/MBF LVAD off (corrected). Data are expressed as mean ± SD. Results At 317 ± 193 days after device implantation, resting MBF was 0.95 ± 0.29 (LVAD on) and 1.46 ± 0.62 (LVAD off, corrected) ml/min·g (p = 0.01). MBF (LVAD on) was comparable with that of 11 age- and gender-matched normal controls (1.09 ± 0.22 ml/min·g). CFR in the LVAD group was 1.49 ± 0.99 compared with 3.56 ± 1.42 in normal controls (p <0.01). Conclusions During LVAD support, resting MBF (LVAD on) was comparable to MBF in normal controls and increased when the LVAD was switched off. However, CFR was significantly impaired, even though all patients studied showed varying degrees of myocardial recovery. The implications of these findings, particularly in the long term, require further study.

AB - Background Changes in myocardial blood flow (MBF) and coronary flow reserve (CFR) are independent prognostic risk factors in idiopathic dilated cardiomyopathy (DCM). The aim of this study was to assess the impact of left ventricular unloading using left ventricular assist device (LVAD) combination therapy on resting MBF and CFR in patients with end-stage heart disease. Methods We studied 11 patients with deteriorating end-stage DCM (New York Heart Association Class 4) treated with LVAD support combined with pharmacologic therapy in a recovery program. Absolute MBF was measured using oxygen-15-labeled water (H2 15O) positron emission tomography (PET) at rest during LVAD support and 15 minutes after the LVAD was switched off. Data were corrected for rate pressure product (RPP) when appropriate. Hyperemic MBF (intravenous adenosine, 140 μg/kg·min) was also measured in 6 patients with the LVAD switched off. CFR was calculated as the ratio MBF adenosine/MBF LVAD off (corrected). Data are expressed as mean ± SD. Results At 317 ± 193 days after device implantation, resting MBF was 0.95 ± 0.29 (LVAD on) and 1.46 ± 0.62 (LVAD off, corrected) ml/min·g (p = 0.01). MBF (LVAD on) was comparable with that of 11 age- and gender-matched normal controls (1.09 ± 0.22 ml/min·g). CFR in the LVAD group was 1.49 ± 0.99 compared with 3.56 ± 1.42 in normal controls (p <0.01). Conclusions During LVAD support, resting MBF (LVAD on) was comparable to MBF in normal controls and increased when the LVAD was switched off. However, CFR was significantly impaired, even though all patients studied showed varying degrees of myocardial recovery. The implications of these findings, particularly in the long term, require further study.

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