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Myocardial histological changes in dilated cardiomyopathy during a long-term left ventricular assist device support
S Taketani1, Y Sawa, N Fukushima
1First Department of Surgery, Osaka University Medical School, Japan.
Insights
Left ventricular assist devices (LVAD) offer hemodynamic support for end-stage dilated cardiomyopathy (DCM). However, long-term LVAD use in DCM patients showed continued myocardial deterioration, including increased cell size and fibrosis.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Dilated cardiomyopathy (DCM) leads to progressive myocardial deterioration and reduced left ventricular function.
- End-stage DCM patients may require left ventricular assist device (LVAD) implantation or heart transplantation.
- Limited data exist on the long-term effects of LVAD support on the myocardium in DCM patients.
Observation:
- Two patients with end-stage DCM received LVAD support for extended periods (524 and 245 days).
- Serial myocardial biopsies were performed to assess cardiac tissue changes.
Findings:
- Despite excellent hemodynamic support from the LVAD, myocardial biopsies revealed significant increases in myocardial cell diameter.
- Progressive intercellular fibrosis was also observed in the myocardial tissue.
- These changes indicate continued deterioration of the myocardium even with reduced left ventricular pre-load.
Implications:
- Long-term LVAD support may not halt or reverse myocardial pathology in end-stage DCM.
- Further research is needed to understand the mechanisms of ongoing myocardial deterioration under LVAD support.
- This highlights the complex challenges in managing end-stage heart failure and the need for novel therapeutic strategies.
Abstract:
As the myocardium in patients with dilated cardiomyopathy (DCM) is deteriorating progressively, resulting in a decrease in left ventricular function, patients with end-stage DCM may require implantation of a left ventricular assist device (LVAD) unless they undergo heart transplantation. Although LVAD has been reported to provide excellent hemodynamic support, no data are currently available about the effects of long-term LVAD support on the myocardium in patients with DCM. We describe two patients with end-stage DCM who underwent LVAD implantation and were supported with LVAD for 524 and 245 days, respectively. Serial myocardial biopsies showed increases in myocardial cell diameter and intercellular fibrosis, despite excellent hemodynamic support by LVAD. These data suggest that the myocardium in patients with end-stage DCM deteriorates progressively, even if the pre-load of the left ventricle is reduced by LVAD.