Histopathologic correlates of myocardial improvement in patients supported by a left ventricular assist device

Segura, Ana Maria; Frazier, O.H.; Demirozu, Zumrut; Buja, L. Maximilian

doi:10.1016/j.carpath.2010.01.011

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Volume 20, Issue 3 , Pages 139-145, May 2011

Histopathologic correlates of myocardial improvement in patients supported by a left ventricular assist device

Ana Maria Segura
- Department of Cardiovascular Pathology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA
- Corresponding author. Cardiovascular Pathology, Texas Heart Institute at St. Luke's Episcopal Hospital, PO Box 20345, MC 1-283 Houston, TX 77225-0345, USA. Tel.: +1 832 355 7202; fax: +1 832 355 6812.
O.H. Frazier
- Department of Cardiovascular Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA
Zumrut Demirozu
- Department of Cardiovascular Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA
L. Maximilian Buja
- Department of Cardiovascular Pathology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, TX, USA

Received 27 October 2009; received in revised form 11 January 2010; accepted 25 January 2010. published online 26 February 2010.

Abstract

Background

Left ventricular assist devices unload the failing heart and improve hemodynamic function and tissue architecture. In some patients improvement allows for left ventricular assist device removal. We retrospectively compared histologic features in patients who were weaned off left ventricular assist device support with those who remained on support without evidence of clinical remission.

Methods

We graded left ventricular core samples taken at implantation on a scale we designed for evaluating severity and extent of fibrosis and hypertrophy. We correlated the grades with a computerized semiquantitative analysis of picrosirius-red and Masson's trichrome-stained sections. We evaluated interstitial (10×), perivascular (20×), and replacement (4×) fibrosis. Hypertrophy was assessed by myocyte diameter, cytoplasmic area, and nuclear/cytoplasmic ratio.

Results

All patients (N=17) underwent left ventricular assist device implantation for heart failure. In eight patients improvement allowed left ventricular assist device removal. The groups did not differ in age (24.1 vs. 25 years, P=.4) or mean time on left ventricular assist device support (506 vs. 414 days, P=.24). All mean measures showed significantly less hypertrophy in the left ventricular assist device-removal group than in the nonremoval group, respectively (cytoplasmic area, 58.00 vs. 77.18 μm², P=.021; myocyte diameter, 20.32 vs. 25.35 μm, P=.004; nuclear/cytoplasmic ratio, 11.04 vs. 8.69, P=.053). Although not statistically significant, the left ventricular assist device-removal group tended toward less overall fibrosis than the nonremoval group (11.57 vs. 13.24, P=.214).

Conclusions

Left ventricular assist device-removal patients had less hypertrophy and fibrosis overall than did nonremoval patients. These findings may help identify patients with a higher probability of left ventricular assist device removal and myocardial recovery.

Keywords: Heart-assist device, Hypertrophy, Myocardium, Myocyte, Remodeling, Transplantation