Key result
Left ventricular assist device implantation increased myocardial mast cell density compared to pre-implantation levels.
Why the study?
Does mechanical ventricular unloading with LVAD implantation alter cardiac mast cell density and myocardial fibrosis in patients with end-stage cardiomyopathy?
Observational (n=30)
Does mechanical ventricular unloading with LVAD implantation alter cardiac mast cell density and myocardial fibrosis in patients with end-stage cardiomyopathy?
Mechanical unloading with LVAD increases myocardial mast cell density and decreases fibrosis, suggesting a role for mast cells in cardiac reverse remodeling.
Answers are grounded in this paper and cite their sources.
LVAD-linked mast cell rise supports hypothesis-generating role in reverse remodeling; should not yet change practice or guide therapy.
Mast cells have been implicated as important in tissue remodeling and fibrosis. We investigated the effect of mechanical ventricular unloading upon myocardial fibrosis and cardiac mast cell density in patients undergoing left ventricular assist device (LVAD) implantation. Paired myocardial tissue samples were obtained from 30 patients with end-stage cardiomyopathy at the time of LVAD implantation and at the time of removal and were compared with samples taken from donor hearts. Tissue sections were stained and quantitated for mast cells and myocardial fibrosis. Mast cell density (tryptase positive cells) in cardiomyopathy was higher than that in donor hearts (33.5 +/- 3.6 SEM cells/10 fields vs.15.2 +/- 2.0 SEM cells/10 fields respectively, p = 0.04) and was lower than LVAD supported hearts (33.5 +/- 3.6 SEM cells/10 fields vs. 49.8 +/- 5.7 SEM cells/10 fields respectively, p = 0.01). Mast cells are primarily localized in areas of increased interstitial fibrosis adjacent to myocardial cells and not vessels. There was statistically significant correlation between mast cells and interstitial collagen (p = 0.03) in patients before LVAD implantation that did not persist after mechanical support (p = 0.18). These results suggest that mechanical support with left ventricular assist devices induces an increase in mast cell number in the myocardium and an associated decrease in myocardial fibrosis. We believe these data demonstrate a dual role for cardiac mast cells in the increase in fibrosis in heart failure and the decrease after LVAD and its associated cardiac improvement.
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Akgül et al. (2005) conducted an observational in End-stage cardiomyopathy (n=30). Left ventricular assist device (LVAD) implantation vs. Pre-LVAD implantation (paired samples) and donor hearts was evaluated on Mast cell density (tryptase positive cells per 10 fields) (p=0.01). Left ventricular assist device implantation increased myocardial mast cell density compared to pre-implantation levels.
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