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Severe heart failure can be reversed in some cases by using a left ventricular assist device to temporarily “unload” the myocardium plus a drug regimen to promote reverse remodeling, reported Dr. Emma J. Birks of the Royal Brompton and Harefield (England) National Health Service Trust and her associates.
In a study of 15 patients who received this treatment for nonischemic cardiomyopathy, 11 recovered sufficiently after a mean of 320 days to qualify for removal of the device. Ten of them survived with marked improvement that has persisted for over 4 years, the researchers said.
Following LVAD implantation, the patients received an ACE inhibitor (lisinopril), angiotensin-receptor blocker (losartan), a nonselective β-blocker (carvedilol), and an aldosterone antagonist (spironolactone) to enhance reverse remodeling. After maximal regression in the left ventricular end-diastolic diameter was achieved, the nonselective β-blocker was replaced with a selective β1-blocker together with clenbuterol, a selective β2-agonist, to prevent myocardial atrophy.
Eleven patients showed significant clinical improvement accompanied by marked functional changes in the myocardium and improved hemodynamics, exercise capacity, and quality of life. Ten (75%) fully recovered after the device was removed (N. Engl. J. Med. 2006;355:1873–84).
This study was supported in part by Thoratec, manufacturer of the HeartMate LVAD.
Severe heart failure can be reversed in some cases by using a left ventricular assist device to temporarily “unload” the myocardium plus a drug regimen to promote reverse remodeling, reported Dr. Emma J. Birks of the Royal Brompton and Harefield (England) National Health Service Trust and her associates.
In a study of 15 patients who received this treatment for nonischemic cardiomyopathy, 11 recovered sufficiently after a mean of 320 days to qualify for removal of the device. Ten of them survived with marked improvement that has persisted for over 4 years, the researchers said.
Following LVAD implantation, the patients received an ACE inhibitor (lisinopril), angiotensin-receptor blocker (losartan), a nonselective β-blocker (carvedilol), and an aldosterone antagonist (spironolactone) to enhance reverse remodeling. After maximal regression in the left ventricular end-diastolic diameter was achieved, the nonselective β-blocker was replaced with a selective β1-blocker together with clenbuterol, a selective β2-agonist, to prevent myocardial atrophy.
Eleven patients showed significant clinical improvement accompanied by marked functional changes in the myocardium and improved hemodynamics, exercise capacity, and quality of life. Ten (75%) fully recovered after the device was removed (N. Engl. J. Med. 2006;355:1873–84).
This study was supported in part by Thoratec, manufacturer of the HeartMate LVAD.
Severe heart failure can be reversed in some cases by using a left ventricular assist device to temporarily “unload” the myocardium plus a drug regimen to promote reverse remodeling, reported Dr. Emma J. Birks of the Royal Brompton and Harefield (England) National Health Service Trust and her associates.
In a study of 15 patients who received this treatment for nonischemic cardiomyopathy, 11 recovered sufficiently after a mean of 320 days to qualify for removal of the device. Ten of them survived with marked improvement that has persisted for over 4 years, the researchers said.
Following LVAD implantation, the patients received an ACE inhibitor (lisinopril), angiotensin-receptor blocker (losartan), a nonselective β-blocker (carvedilol), and an aldosterone antagonist (spironolactone) to enhance reverse remodeling. After maximal regression in the left ventricular end-diastolic diameter was achieved, the nonselective β-blocker was replaced with a selective β1-blocker together with clenbuterol, a selective β2-agonist, to prevent myocardial atrophy.
Eleven patients showed significant clinical improvement accompanied by marked functional changes in the myocardium and improved hemodynamics, exercise capacity, and quality of life. Ten (75%) fully recovered after the device was removed (N. Engl. J. Med. 2006;355:1873–84).
This study was supported in part by Thoratec, manufacturer of the HeartMate LVAD.