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Patients with restrictive, hypertrophic cardiomyopathy may benefit from LVAD therapy
Topilsky Y. Circ Heart Fail. 2011;doi:10.1161/CIRCHEARTFAILURE.110.959288.
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It is possible to improve outcomes in patients with end-stage restrictive or hypertrophic cardiomyopathy by use of a left ventricular assist device, which can be considered as a bridge to transplant, researchers said.
In a new study, 83 patients with NYHA Class IIIb/IV HF were treated with a continuous axial flow LV assist device (HeartMate II, Thoratec) between February 2007 and May 2010. The patients were split into two groups: those with restrictive (RCM) or hypertrophic cardiomyopathy (HCM; n=8) and those with severe dilated or ischemic cardiomyopathies (n=75).
After comparing baseline data from both groups, researchers found that those with RCM and HCM had significantly smaller LV end diastolic dimensions (52.5 ± 6 mm vs. 68.6 ± 8 mm; P<.0001), as well as increased thickness of septal walls (16 mm vs. 10 mm, P=.0003) and LV ejection fraction (21% vs. 17%; P=.0009).
After LVAD implantation in patients with RCM and HCM, right atrial pressure was higher (18 mm Hg vs. 12 mm Hg; P=.03), and pump flow was lower (4.3 L vs. 5.2 L; P=.001). No statistically significant differences between the two study groups were reported in early mortality or length of stay.
Although the data show that continuous flow axial LVAD therapy may be feasible in patients with end-stage RCM or HCM and further may prove to be a useful option to treat these patients who have end-stage HF, the researchers wrote, “The present preliminary report lacks the statistical power to make conclusions regarding survival, and prospective clinical trials will be required to assess whether LVAD therapy should be used routinely in this challenging group of patients.”
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