Key result
Myocardial fibrosis was present in 79% of LVAD core specimens and was significantly more common in ischemic than in nonischemic cardiomyopathy patients (90% vs. 66%; p < 0.001).
Why the study?
Does the presence of myocardial fibrosis in LVAD apical core biopsies correlate with markers of myocardial recovery in patients undergoing LVAD implantation?
Cohort (n=332)
No
Does the presence of myocardial fibrosis in LVAD apical core biopsies correlate with markers of myocardial recovery in patients undergoing LVAD implantation?
Myocardial fibrosis is highly prevalent in LVAD apical core biopsies, particularly in ischemic cardiomyopathy, and correlates with clinical markers that may inform myocardial recovery potential.
Answers are grounded in this paper and cite their sources.
Apical core fibrosis assessment may inform LVAD recovery potential; leaves open its clinical utility pending prospective validation.
Myocardial fibrosis identified by apical core pathology at the time of left ventricular assist device (LVAD) implantation may add information regarding myocardial recovery potential. In this analysis, we report the prevalence of myocardial fibrosis by cardiomyopathy type and its association with other known markers of left ventricular recovery. Left ventricular assist device core pathology was reviewed on 332 patients who underwent LVAD implantation at a single institution between 2005 and 2016. Baseline clinical and echocardiographic characteristics were compared among patients with and without myocardial fibrosis by cardiomyopathy type. Among the 332 LVAD core specimens, myocardial fibrosis was present in 79%. Myocardial fibrosis was more common in ischemic than in nonischemic patients (90% vs. 66%; p < 0.001). Patients with fibrosis were older than those without (58 ± 12 vs. 55 ± 19; p < 0.05). Among the nonischemic cardiomyopathy cases, those with fibrosis were more likely to have an implantable cardioverter defibrillator (ICD) 81% and to be diabetic 81%. Fibrosis was not associated with left ventricular end-diastolic diameter (LVEDD), creatinine, or N-terminal prohormone of brain natriuretic peptide (NT-pro BNP). Myocardial fibrosis by apical core biopsy correlated with several known markers of left ventricular recovery including cardiomyopathy type, age, and presence of an ICD. In nonischemic cardiomyopathy patients, the degree of myocardial fibrosis may add information regarding recovery potential.
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Schultz et al. (2018) conducted a cohort in Cardiomyopathy requiring LVAD (n=332). Ischemic cardiomyopathy vs. Nonischemic cardiomyopathy was evaluated on Presence of myocardial fibrosis (p=< 0.001). Myocardial fibrosis was present in 79% of LVAD core specimens and was significantly more common in ischemic than in nonischemic cardiomyopathy patients (90% vs. 66%; p < 0.001).
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