Evidence map›Paper›PMID 33947201›Full record

ArticleCirculation. Heart failure2021

Framework to Classify Reverse Cardiac Remodeling With Mechanical Circulatory Support: The Utah-Inova Stages.

Palak Shah, Mitchell Psotka, Iosif Taleb, Rami Alharethi, Mortada A Shams, Omar Wever-Pinzon, Michael Yin, Federica Latta, Josef Stehlik, James C Fang and 11 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation. Heart failure, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

27 citing papers in PubMed.

  1. Review
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  13. Review
  14. Hypoxia Attenuates Pressure Overload-Induced Heart Failure.Journal of the American Heart Association · 2024
    Article
  15. Review
  16. Left ventricular functional improvement appears to contribute to lower rates of device thrombosis in patients on durable mechanical circulatory support.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2023
    Article
  17. Myocardial Recovery.Diagnostics (Basel, Switzerland) · 2023
    Review
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Palak Shah *Heart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.
Mitchell Psotka *Heart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.
Iosif Taleb *Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Rami AlharethiUtah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Mortada A ShamsHeart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.
Omar Wever-PinzonUtah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Michael YinUtah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Federica LattaHeart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.
Josef StehlikUtah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
James C FangUtah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Guoqing DiaoDepartment of Biostatistics and Bioinformatics (G.D.), George Washington University, Washington, DC.
Ramesh SinghCardiac Surgery (R.S.), Inova Heart and Vascular Institute, Falls Church, Virginia.
Naila IjazHeart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.
Christos P KyriakopoulosUtah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Wei ZhuHeart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.
Christopher W MayHeart Failure, Mechanical Circulatory Support and Transplant (P.S., M.P., M.A.S., F.L., N.I., W.Z., C.W.M.), Inova Heart and Vascular Institute, Falls Church, Virginia.
Lauren B CooperUtah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Shashank S DesaiUtah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Craig H SelzmanUtah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Abdallah G KfouryUtah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).
Stavros G DrakosUtah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, University of Utah Health and School of Medicine, Intermountain Medical Center and Salt Lake Veterans Affairs Medical Center (I.T., R.A., O.W.-P., M.Y., J.S., J.C.F., C.P.K., L.B.C., S.S.D., C.H.S., A.K., S.G.D.).

Funding

TRAINING IN CARDIOVASCULAR RESEARCHT32HL007576 · NHLBI · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · PI Stavros George Drakos, Robin M Shaw · 1985 to 2026
$10.6M
Clinical and Metabolic Signature of Recovered Myocardium in Human Heart FailureR01HL135121 · NHLBI · UNIVERSITY OF UTAH · PI DRAKOS, STAVROS GEORGE · 2017 to 2021
$1.9M
Cellular Remodeling in Heart Failure and after LVAD UnloadingR01HL132067 · NHLBI · UNIVERSITY OF UTAH · PI DRAKOS, STAVROS GEORGE, SACHSE, FRANK BERND · 2017 to 2020
$1.5M
Role of DNA methylation in cardiac failure and recoveryK23HL150322 · NHLBI · UNIVERSITY OF UTAH · PI WEVER-PINZON, OMAR ENRIQUE · 2020 to 2024
$994k
MicroRNA Biomarkers of Allograft Rejection and Cardiac Allograft Vasculopathy in Cardiac TransplantationK23HL143179 · NHLBI · INOVA HEALTH CARE SERVICES · PI SHAH, PALAK · 2020 to 2024
$927k
NHLBI NIH HHS K23 HL143179NHLBI NIH HHS K23 HL150322NHLBI NIH HHS R01 HL132067NHLBI NIH HHS R01 HL135121NHLBI NIH HHS T32 HL007576
6 · The paper itself

Abstract

backgroundVariable definitions and an incomplete understanding of the gradient of reverse cardiac remodeling following continuous flow left ventricular assist device (LVAD) implantation has limited the field of myocardial plasticity. We evaluated the continuum of LV remodeling by serial echocardiographic imaging to define 3 stages of reverse cardiac remodeling following LVAD.

methodsThe study enrolled consecutive LVAD patients across 4 study sites. A blinded echocardiographer evaluated the degree of structural (LV internal dimension at end-diastole [LVIDd]) and functional (LV ejection fraction [LVEF]) change after LVAD. Patients experiencing an improvement in LVEF ≥40% and LVIDd ≤6.0 cm were termed responders, absolute change in LVEF of ≥5% and LVEF <40% were termed partial responders, and the remaining patients with no significant improvement in LVEF were termed nonresponders.

resultsAmong 358 LVAD patients, 34 (10%) were responders, 112 (31%) partial responders, and the remaining 212 (59%) were nonresponders. The use of guideline-directed medical therapy for heart failure was higher in partial responders and responders. Structural changes (LVIDd) followed a different pattern with significant improvements even in patients who had minimal LVEF improvement. With mechanical unloading, the median reduction in LVIDd was -0.6 cm (interquartile range [IQR], -1.1 to -0.1 cm; nonresponders), -1.1 cm (IQR, -1.8 to -0.4 cm; partial responders), and -1.9 cm (IQR, -2.9 to -1.1 cm; responders). Similarly, the median change in LVEF was -2% (IQR, -6% to 1%), 9% (IQR, 6%-14%), and 27% (IQR, 23%-33%), respectively.

conclusionsReverse cardiac remodeling associated with durable LVAD support is not an all-or-none phenomenon and manifests in a continuous spectrum. Defining 3 stages across this continuum can inform clinical management, facilitate the field of myocardial plasticity, and improve the design of future investigations.

Indexed as

AgedFemaleHeart-Assist DevicesHeart FailureHeart VentriclesHumansMaleMiddle AgedMyocardiumRecovery of FunctionStroke VolumeVentricular Function, LeftVentricular Remodelingcardiomyopathyheart failureleft ventricular remodelingmyocardial recoveryventricular assist device

Identifiers

PMID33947201
PMCPMC8137588

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