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Prevalence of Myocardial Fibrosis by Left Ventricular Assist Device Apical Core Biopsy and Correlation with Other Markers of Myocardial Recovery

Schultz, Jessica*; John, Ranjit; Martin, Cindy; Kamdar, Forum; Thenappan, Thenappan; Cogswell, Rebecca

doi: 10.1097/MAT.0000000000000774
Adult Circulatory Support
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Myocardial fibrosis identified by apical core pathology at the time of left ventricular assist device (LVAD) implantation may add information regarding myocardial recovery potential. In this analysis, we report the prevalence of myocardial fibrosis by cardiomyopathy type and its association with other known markers of left ventricular recovery. Left ventricular assist device core pathology was reviewed on 332 patients who underwent LVAD implantation at a single institution between 2005 and 2016. Baseline clinical and echocardiographic characteristics were compared among patients with and without myocardial fibrosis by cardiomyopathy type. Among the 332 LVAD core specimens, myocardial fibrosis was present in 79%. Myocardial fibrosis was more common in ischemic than in nonischemic patients (90% vs. 66%; p < 0.001). Patients with fibrosis were older than those without (58 ± 12 vs. 55 ± 19; p < 0.05). Among the nonischemic cardiomyopathy cases, those with fibrosis were more likely to have an implantable cardioverter defibrillator (ICD) 81% and to be diabetic 81%. Fibrosis was not associated with left ventricular end-diastolic diameter (LVEDD), creatinine, or N-terminal prohormone of brain natriuretic peptide (NT-pro BNP). Myocardial fibrosis by apical core biopsy correlated with several known markers of left ventricular recovery including cardiomyopathy type, age, and presence of an ICD. In nonischemic cardiomyopathy patients, the degree of myocardial fibrosis may add information regarding recovery potential.

From the *Department of Medicine, Internal Medicine, University of Minnesota, Minneapolis, Minnesota

Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota

Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.

Submitted for consideration September 2017; accepted for publication in revised form December 2017.

Disclosure: Ranjit John receives grant support from Abbott Labs. Thenappan Thenappan receives honorarium from Gilead Sciences and Actelion. Rebecca Cogswell is member of the Medtronic Heart Failure Advisory Board, her husband owns stock of Medtronic, and she is on the Speaker’s Bureau for Abbott Labs. The other authors have no conflicts of interest to report.

Correspondence: Jessica Schultz, Division of Internal Medicine, University of Minnesota, 420 Delaware St SE, MMC 284, Minneapolis, MN 55455. Email: schu3455@umn.edu.

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