Location and Density of α- and β-Adrenoreceptor Sub-types in Myocardium After Mechanical Left Ventricular Unloading

Schnee, Pippa M.; Shah, Naeema; Bergheim, Marianne; Poindexter, Brian J.; Buja, L. Maximilian; Gemmato, Courtney; Radovančević, Branislav; Letsou, George V.; Frazier, O.H.; Bick, Roger J.

doi:10.1016/j.healun.2008.03.015

Cited by 18 publications

(13 citation statements)

References 39 publications

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“…Results from this study and our previous study indicate that the presence of high numbers of adrenoreceptors at the time of LVAD implantation was predictive of an increase in adrenoreceptor number at explantation [22]. We have also shown that there are a great many variables that lead to a successful recovery and patients often do not respond as expected on the cellular level.…”

Section: Resultssupporting

confidence: 60%

Myocardial Alterations in Adrenoreceptors After Ventricular Unloading with a Pulsatile vs a Nonpulsatile Device~!2010-02-15~!2010-05-06~!2010-06-10~!

Bick¹,

Poindexter²,

Evans³

et al. 2010

TOCTSJ

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Abstract:We have recently shown that ventricular unloading with an implantable left ventricular assist device (LVAD) leads to improved calcium handling and membrane integrity and redistribution of alpha adrenoreceptors (AARs) and betaadrenoreceptors (BARs). Here, we used fluorescence deconvolution microscopy to examine the effect of LVAD type (pulsatile vs non-pulsatile) on upregulation and redistribution of adrenoreceptors in core biopsy samples of the myocardium before and after the removal LVAD. We noted no major differences between the pulsatile and non-pulsatile groups; however, an individual patient's 'recovery' in adrenoreceptor numbers depended on the pre-LVAD number of receptors. These findings suggest that ventricular unloading is beneficial regardless of LVAD type; however, the degree of repair and recovery may correlate with the patient's level of ventricular dysfunction at implant and the pre-LVAD number of adrenoreceptors (130).

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Section: Resultssupporting

confidence: 60%

Myocardial Alterations in Adrenoreceptors After Ventricular Unloading with a Pulsatile vs a Nonpulsatile Device~!2010-02-15~!2010-05-06~!2010-06-10~!

Bick¹,

Poindexter²,

Evans³

et al. 2010

TOCTSJ

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“…1,2 Left ventricular assist devices (LVADs) are used as a bridge to heart transplantation (HTx) in patients with congestive heart failure (CHF). As described previously, LVAD support can induce reverse left ventricular remodeling, leading to partial recovery of ventricular function, 3 improved condition of patients, 4 reduced cardiomyocyte size 5 and changes in contractile fibers. 6,7 Furthermore, structural and volume changes of ECM and basal membrane components have been described.…”

mentioning

confidence: 60%

“…These changes tend to reverse at least in part after LVAD support. [3][4][5][6][7][8][9][10] Various cellular processes are controlled at the level of mRNA transcription by miRNAs. Also, in the heart, the role of these miRNA has been described in various processes such as cardiomyocyte hypertrophy (miR-208, miR-133), cardiomyocyte hyperplasia (miR-1, miR-2) and ventricular arrhythmias (miR-1).…”

Section: Discussionmentioning

confidence: 99%

Changes in Regulatory MicroRNA Expression in Myocardium of Heart Failure Patients on Left Ventricular Assist Device Support

Schipper

Kuik

Jonge

et al. 2008

The Journal of Heart and Lung Transplantation

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“…The use of new immunohistochemistry techniques for the analysis of collagen content and evaluation of different collagen components, gene expression analyses, distribution of myocyte adrenoreceptors, and more sensitive methods for the evaluation of LV function like strain and strain rate imaging might help predict the reversibility of myocardial alterations during mechanical unloading. 2,26,28 …”

Section: Discussionmentioning

confidence: 99%

Heart failure reversal by ventricular unloading in patients with chronic cardiomyopathy: criteria for weaning from ventricular assist devices

Dandel

Weng

Siniawski

et al. 2010

European Heart Journal

147

208

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AimsUnloading-promoted reversal of heart failure (HF) allows long-term transplant-free outcome after ventricular assist device (VAD) removal. However, because few patients with chronic cardiomyopathy (CCM) were weaned from VADs (the majority only recently), the reliability of criteria used for weaning decisions to predict long-term post-weaning success is barely known. After 15 years of weaning experience, we assessed this issue.Methods and resultsIn 47 patients with CCM as the underlying cause for HF, who were part of a total of 90 patients weaned from bridge-to-transplant-designed VADs since 1995, we analysed data on cardiac morphology and function collected before VAD implantation, echocardiographic parameters recorded during ‘off-pump’ trials, duration of HF before implantation, and stability of recovery before and early after VAD removal. Post-weaning 5 year freedom from HF recurrence reached 66%. Only five patients (10.6%) died due to HF recurrence or weaning-related complications. Pre-explantation off-pump left ventricular ejection fraction (LVEF) of ≥50 and ≥45% revealed predictive values for cardiac stability lasting ≥5 years after VAD removal of 91.7 and 79.1%, respectively. With each unit of LVEF reduction, the risk of HF recurrence became 1.5 times higher. The predictive value of LVEF ≥45% also became >90% if additional parameters like pre-explantation LV size and geometry, stability of unloading-induced cardiac improvement before VAD removal, and HF duration before VAD implantation were also considered. Definite cut-off values for certain parameters (including tissue-Doppler-derived LV wall motion velocity) allowed formulation of weaning criteria with high predictability for post-weaning stability, also in patients with incomplete cardiac recovery.ConclusionsVentricular assist device removal in CCM patients is feasible and can be successful even after incomplete cardiac recovery. Parameters of pre-explantation cardiac function, LV size and geometry, their stability during final off-pump trials, and HF duration allow detection of patients with the potential to remain stable for >5 post-weaning years.

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Location and Density of α- and β-Adrenoreceptor Sub-types in Myocardium After Mechanical Left Ventricular Unloading

Cited by 18 publications

References 39 publications

Myocardial Alterations in Adrenoreceptors After Ventricular Unloading with a Pulsatile vs a Nonpulsatile Device~!2010-02-15~!2010-05-06~!2010-06-10~!

Myocardial Alterations in Adrenoreceptors After Ventricular Unloading with a Pulsatile vs a Nonpulsatile Device~!2010-02-15~!2010-05-06~!2010-06-10~!

Changes in Regulatory MicroRNA Expression in Myocardium of Heart Failure Patients on Left Ventricular Assist Device Support

Heart failure reversal by ventricular unloading in patients with chronic cardiomyopathy: criteria for weaning from ventricular assist devices

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