Abstract 2958: Histopathological Analysis as Predictive Markers of Recovery from End-Stage Heart Failure in Patients with Left Ventricular Assist Device
Background: Cardiac function may improve in a certain amount of patients with end-stage heart failure supported by left ventricular assist device (LVAD). However, the clinical predictive markers for the sufficient improvement of own cardiac functions to wean from LVAD are still unclear. We hypothesized histopathological findings obtained at LVAD implantation would be of clinical values for the predicting recovery of own cardiac function.
Methods: Twenty-two sections from 11 patients (male to female = 10:1, mean age at LVAD implantation = 27 ± 9 years old) whose LVAD were able to be removed in our institute from 1994 to 2007 were reviewed (group A). We compared 68 sections from 13 patients (male to female = 12:1, mean age at LVAD implantation = 33 ± 13 years old) who could not wean from LVAD (group B). All myocardial specimens were sampled simultaneously at the time of LVAD implantation and stained by hematoxylin-eosin, Masson’s trichrome method, periodic acid-Schiff’s staining (PAS), a way to observe glycogen, and Tenascin-C (T-C) immunochemistry of labeling extracellular matrix glycoprotein. Myocardial PAS and T-C staining as well as fragmentation of cardiomyocytes, interstitial fibrosis, edema, wall thickening of intramural arterioles, were semiquantitated in grade 0 to 3, and cardiomyocytes diameters were also measured from light microscopy.
Results: PAS graded significantly higher in group A(p < 0.0015, group A; 2.5 ± 0.7, group B; 1.4 ± 0.8 respectively). T-C grading was markedly lower in group A (p < 0.0001, 0.9 ± 1.0, 2.6 ± 0.6). Degree of interstitial fibrosis(p < 0.0009, 2.2 ± 0.8, 2.8 ± 0.5), edema(p < 0.0001, 1.5 ± 0.9, 2.7 ± 0.6), and intramural wall thickening of arterioles(p = 0.0014, 1.2 ± 0.7, 1.6 ± 0.6) were also statistically lower in group A. Degree of myocardial fragmentation and mean diameters of cardiomyocytes diameters were no difference in two groups. These data might have relation to myocardial hibernation.
Conclusions: Histopathological analysis is important for the assessment of end-stage heart failure in patients with LVAD, especially the degree of hibernation reflected by additional PAS and T-C staining would be good predictive markers for the removal of LVAD.