Table 1.
Prospective Studies Investigating Cardiac Functional and Structural Improvement During Chronic LVAD Support
| Group, Year (Ref. #) | n | HF Etiology | Adjuvant Drug Therapy Protocol | Heart Function Monitoring Protocol | LVAD Support Duration (Months) | Cardiac Recovery∗ | Freedom From HF Recurrence After Explantation, Follow-Up Duration |
|---|---|---|---|---|---|---|---|
| U.S. LVAD Working Group, 2007 (8) | 67 | NICM: 55% ICM: 45% |
Not standardized | Yes | 4.5 | NICM: 13.5% ICM: 3.3% |
100%, 6 months |
| Berlin, 2008 and 2010 9, 10 | 188 | NICM: 100% | Not standardized | Yes | 4 | NICM: 19% | 74% and 66%, 3 and 5 yrs, respectively |
| Utah Cardiac Recovery Program, 2016 (11) | 154 | NICM: 60% ICM: 40% |
Not standardized | Yes | 6 | NICM: 21% ICM: 5% |
N/A |
| Montefiore, 2013 (12) | 21 | NICM: 62% ICM: 38% |
Yes | Yes | 9 | NICM: 23% ICM: 0% |
100%, 57 months |
| Gothenburg, 2006 (13) | 18 | NICM: 83% ICM: 17% |
Not standardized | Yes | 7 | NICM: 17% ICM: 0% |
33%, 8 yrs |
| Vancouver, 2011 (14) | 17 | Not reported | Not standardized | Yes Yes |
7 | NICM and ICM: 23% |
100%, 2 yrs |
| Pittsburgh, 2003 (15) | 18 | NICM: 72% ICM: 28% |
Not standardized | Yes | 8 | NICM: 38% ICM: 20% |
67%, 16.5 months |
| Texas Heart Institute, 2003 (16) | 16 | NICM: 75% ICM: 25% |
Yes | Yes | 8 | NICM: 58% ICM: 50% |
78%, 14.3 months |
| U.S. IMAC, 2012 (17) | 14 | NICM: 100%† | Not standardized | Yes | 3.5 | NICM: 67% | 87.5%, 17.5 months |
| Harefield, 2006 (18) | 15 | NICM: 100% | Yes | Yes | 11 | NICM: 73% | 100% and 89%, 1 and 4 yrs, respectively |
| Harefield, 2011 (19) | 20 | NICM: 100% | Yes | Yes | 9 | NICM: 60% | 83%, 3 yrs |
| University of Athens, 2007 (20) | 8 | NICM: 100% | Yes | Yes | 7 | NICM: 50% | 100%, 2 yrs |
HF = heart failure; ICM = ischemic cardiomyopathy; NICM = nonischemic cardiomyopathy; LVAD = left ventricular assist device; N/A = not applicable.
”Cardiac recovery” was defined in all studies but the Utah Cardiac Recovery study as LVAD explantation due to cardiac functional and structural improvement (degree of improvement and specific criteria varied between studies). In the Utah Cardiac Recovery study (11), “cardiac recovery” was defined as post-LVAD left ventricular ejection fraction ≥40% in at least 2 consecutive turn-down echocardiograms and no LVEF <40% at later time points (independently of whether the device was eventually explanted). Despite the heterogeneity in the study design, it appears that most programs (Berlin, U.S. LVAD Working Group, Montefiore, Gothenburg, Vancouver, and Utah groups) identified significant cardiac functional and structural improvement in 15% to 25% of NICM and 4% to 5% of ICM.
The U.S. IMAC (Intervention in Myocarditis and Acute Cardiomyopathy) study group (17) included only patients with “recent onset cardiomyopathy.”