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Účinky odtížení mechanickou podporou levé komory na strukturu a funkci myokardu: současný stav a výzva k akci
[Left ventricular assist device unloading effects on myocardial structure and function: current status of the field and call for action]
Stavros G. Drakos, Abdallah G. Kfoury, Craig H. Selzman, Divya Ratan Verma, John N. Nanas, Dean Y. Li, Josef Stehlik
Language Czech Country Czech Republic
Document type Review
- MeSH
- Endothelium, Vascular MeSH
- Extracellular Matrix MeSH
- Fibrosis MeSH
- Financing, Organized MeSH
- Cardiomegaly MeSH
- Myocytes, Cardiac MeSH
- Humans MeSH
- Microvessels pathology MeSH
- Myocardium pathology MeSH
- Heart-Assist Devices MeSH
- Ventricular Remodeling MeSH
- Heart Ventricles MeSH
- Heart Failure pathology MeSH
- Sympathetic Nervous System MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Myocardial remodeling driven by excess pressure and volume load is believed to be responsible for the vicious cycle of progressive myocardial dysfunction in chronic heart failure. Left ventricular assist devices (LVADs), by providing significant volume and pressure unloading, allow a reversal of stress-related compensatory responses of the overloaded myocardium. Herein, we summarize and integrate insights from studies which investigated how LVAD unloading influences the structure and function of the failing human heart. RECENT FINDINGS: Recent investigations have described the impact of LVAD unloading on key structural features of cardiac remodeling - cardiomyocyte hypertrophy, fibrosis, microvasculature changes, adrenergic pathways and sympathetic innervation. The effects of LVAD unloading on myocardial function, electrophysiologic properties and arrhythmias have also been generating significant interest. We also review information describing the extent and sustainability of the LVAD-induced myocardial recovery, the important advances in understanding of the pathophysiology of heart failure derived from such studies, and the implications of these findings for the development of new therapeutic strategies. Special emphasis is given to the great variety of fundamental questions at the basic, translational and clinical levels that remain unanswered and to specific investigational strategies aimed at advancing the field. SUMMARY: Structural and functional reverse remodeling associated with LVADs continues to inspire innovative research. The ultimate goal of these investigations is to achieve sustained recovery of the failing human heart.
Intermountain Medical Center Cardiology Department Salt Lake City Utah USA
University of Athens 3rd Division of Cardiology Atheny Řecko
Left ventricular assist device unloading effects on myocardial structure and function: current status of the field and call for action
Obsahuje 2 tabulky
Bibliography, etc.Literatura
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- $a Myocardial remodeling driven by excess pressure and volume load is believed to be responsible for the vicious cycle of progressive myocardial dysfunction in chronic heart failure. Left ventricular assist devices (LVADs), by providing significant volume and pressure unloading, allow a reversal of stress-related compensatory responses of the overloaded myocardium. Herein, we summarize and integrate insights from studies which investigated how LVAD unloading influences the structure and function of the failing human heart. RECENT FINDINGS: Recent investigations have described the impact of LVAD unloading on key structural features of cardiac remodeling - cardiomyocyte hypertrophy, fibrosis, microvasculature changes, adrenergic pathways and sympathetic innervation. The effects of LVAD unloading on myocardial function, electrophysiologic properties and arrhythmias have also been generating significant interest. We also review information describing the extent and sustainability of the LVAD-induced myocardial recovery, the important advances in understanding of the pathophysiology of heart failure derived from such studies, and the implications of these findings for the development of new therapeutic strategies. Special emphasis is given to the great variety of fundamental questions at the basic, translational and clinical levels that remain unanswered and to specific investigational strategies aimed at advancing the field. SUMMARY: Structural and functional reverse remodeling associated with LVADs continues to inspire innovative research. The ultimate goal of these investigations is to achieve sustained recovery of the failing human heart.
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