Predictors of myocardial recovery following left ventricular assist device implantation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DENG Kailong , LIU Dingqian , LIU Junjiang , WANG Chunsheng ,  SUN Xiaoning

Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China;

Corresponding?author：

SUN Xiaoning, Email: Sun.xiaoning@zs-hospital.sh.cn

Keywords：

Ventricular remodeling; left ventricular assist device; heart failure; myocardial recovery; predictive factors; cardiac rehabilitation

DOI：

10.7507/1007-4848.202508036

Video：

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Objective To investigate the factors influencing myocardial recovery after left ventricular assist device (LVAD) implantation, aiming to identify patient characteristics associated with a higher potential for cardiac recovery and to inform clinical decision-making. Methods This retrospective study included consecutive patients with end-stage heart failure who underwent LVAD implantation at our institution between 2021 and June, 2025. Patients were categorized into three groups including a myocardial recovery group, an ongoing LVAD support group, and death group. Based on their postoperative outcomes, demographic, laboratory, and imaging data were compared among the groups. Multivariate logistic regression analysis was performed to identify independent predictors of myocardial recovery. Results A total of 57 patients who received an LVAD were included. Among them, 9 (15.8%) achieved myocardial recovery, 39 (68.4%) remained on LVAD support, and 9 (15.8%) died. Multivariate analysis identified younger age (OR=0.875, P=0.004) and a smaller preoperative left ventricular end-systolic diameter (LVESD) (OR=0.866, P=0.047) as independent predictors of myocardial recovery. Notably, all patients in the recovery group were male and had no prior implantation of an implantable cardioverter-defibrillator/cardiac resynchronization therapy defibrillator. Furthermore, a higher preoperative prealbumin level was significantly associated with survival (OR=1.018, P=0.024). Conclusion Younger age and a smaller preoperative LVESD are key predictors for myocardial recovery following LVAD implantation. Younger patients with a smaller LVESD exhibit a greater potential for functional recovery. Preoperative nutritional status, as indicated by prealbumin levels, may be a predictor of mortality.

1.	Yuzefpolskaya M, Schroeder SE, Houston BA, et al. The society of thoracic surgeons Intermacs 2022 annual report: focus on the 2018 heart transplant allocation system. Ann Thorac Surg, 2023, 115(2): 311-327.
2.	Wang X, Zhou X, Chen H, et al. Long-term outcomes of a novel fully magnetically levitated ventricular assist device for the treatment of advanced heart failure in China. J Heart Lung Transplant, 2024, 43(11): 1806-1815.
3.	Derks W, Rode J, Collin S, et al. A latent cardiomyocyte regeneration potential in human heart disease. Circulation, 2025, 151(3): 245-256.
4.	Pan S, Aksut B, Wever-Pinzon OE, et al. Incidence and predictors of myocardial recovery on long-term left ventricular assist device support: results from the United Network for Organ Sharing database. J Heart Lung Transplant, 2015, 34(12): 1624-1629.
5.	Topkara VK, Garan AR, Fine B, et al. Myocardial recovery in patients receiving contemporary left ventricular assist devices: results from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Circ Heart Fail, 2016, 9(7): e003157.
6.	Itagaki S, Moss N, Toyoda N, et al. Incidence, outcomes, and opportunity for left ventricular assist device weaning for myocardial recovery. JACC Heart Fail, 2024, 12(5): 893-901.
7.	Shah P, Psotka M, Taleb I, et al. Framework to classify reverse cardiac remodeling with mechanical circulatory support: the Utah-Inova stages. Circ Heart Fail, 2021, 14(5): e007991.
8.	Olsen C, Mandawat A, Sun JL, et al. Recovery of left ventricular function is associated with improved outcomes in LVAD recipients. J Heart Lung Transplant, 2022, 41(8): 1055-1062.
9.	Saeed D, Feldman D, Banayosy AE, et al. The 2023 international society for heart and lung transplantation guidelines for mechanical circulatory support: a 10-year update. J Heart Lung Transplant, 2023, 42(7): e1-e222.
10.	中華醫學會心血管病學分會, 中國醫師協會心血管內科醫師分會, 中國醫師協會心力衰竭專業委員會, 等. 中國心力衰竭診斷和治療指南2024. 中華心血管病雜志, 2024, 52(3): 235-275.Chinese Society of Cardiology of Chinese Medical Association, Chinese College of Cardiovascular Physicians, Chinese Heart Failure Association, et al. Chinese guidelines for the diagnosis and treatment of heart failure 2024. Chin J Cardiol, 2024, 52(3): 235-275.
11.	Parikh M, Shah S, Basu R, et al. Transcriptomic signatures of end-stage human dilated cardiomyopathy hearts with and without left ventricular assist device support. Int J Mol Sci, 2022, 23(4): 2050.
12.	Antonides CFJ, Schoenrath F, de By T, et al. Outcomes of patients after successful left ventricular assist device explantation: a EUROMACS study. ESC Heart Fail, 2020, 7(3): 1085-1094.
13.	Diakos NA, Taleb I, Kyriakopoulos CP, et al. Circulating and myocardial cytokines predict cardiac structural and functional improvement in patients with heart failure undergoing mechanical circulatory support. J Am Heart Assoc, 2021, 10(20): e020238.
14.	Akkawi AR, Yamaguchi A, Shimamura J, et al. Age is a predictor of in-hospital outcomes for left ventricular assist device implantation: a nationwide analysis. J Pers Med, 2024, 14(3): 236.
15.	Kenigsberg BB, Majure DT, Sheikh FH, et al. Sex-associated differences in cardiac reverse remodeling in patients supported by contemporary left ventricular assist devices. J Card Fail, 2020, 26(6): 494-504.
16.	Wever-Pinzon O, Drakos SG, McKellar SH, et al. Cardiac recovery during long-term left ventricular assist device support. J Am Coll Cardiol, 2016, 68(14): 1540-1553.
17.	Guo Z, Liu X, Cheng X, et al. Combination of left ventricular end-diastolic diameter and QRS duration strongly predicts good response to and prognosis of cardiac resynchronization therapy. Cardiol Res Pract, 2020, 2020: 1257578.
18.	Gyoten T, Amiya E, Saito A, et al. Predictors of long-term success after successful explantation of continuous flow left ventricular assist device support. Interact Cardiovasc Thorac Surg, 2024, 38(6): ivae091.
19.	Gokhale S, Malesz A, Masha L. Ventricular arrhythmias and sudden cardiac death in left ventricular assist device patients without implantable cardioverter defibrillators. ASAIO J, 2024, 70(9): 773-777.
20.	Hall D, Chhana RA, Yang BQ, et al. The impact of preoperative right ventricular dysfunction and ventricular arrhythmias on left ventricular assist device outcomes. ASAIO J, 2025, 71(9): 736-743.
21.	Birks EJ, Drakos SG, Patel SR, et al. Prospective multicenter study of myocardial recovery using left ventricular assist devices (RESTAGE-HF [remission from stage D heart failure]): medium-term and primary end point results. Circulation, 2020, 142(21): 2016-2028.
22.	Chou BP, Critsinelis A, Lamba HK, et al. Continuous-flow left ventricular assist device support in patients with ischemic versus nonischemic cardiomyopathy. Tex Heart Inst J, 2021, 48(4): e7241.
23.	Moayedifar R, Celik M, Karner B, et al. Prognostic significance of albumin in modern left ventricular assist device therapy: relevance in the HeartMate 3 era? J Clin Med, 2025, 14(17): 6193.
24.	Niklewski T, Jurkiewicz M, Szczurek-Wasilewicz W, et al. Preoperative albumin-bilirubin (ALBI) score is the strongest predictor of mortality after LVAD implantation. Biomedicines, 2025, 13(10): 2449.
25.	Shi R, Li Z, Duan X, et al. Association between malnutrition risk and the prognosis of geriatric heart failure patients undergoing left ventricular assist device implantation. J Nutr Health Aging, 2024, 28(12): 100382.
26.	Rame JE, Pagani FD, Kiernan MS, et al. Evolution of late right heart failure with left ventricular assist devices and association with outcomes. J Am Coll Cardiol, 2021, 78(23): 2294-2308.
27.	Roth R, H?ckh M, Schnick T, et al. Transcriptional signature of cardiac myocyte recovery in mice and human reveals persistent upregulation of epigenetic factors. Epigenetics, 2025, 20(1): 2506625.
28.	Kaye DM, Wang XS, Koay YC, et al. Mechanical unloading is accompanied by reverse metabolic remodelling in the failing heart: identification of a novel citraconate-mediated pathway. Eur J Heart Fail, 2025, 27(7): 1342-1352.
29.	Kawai Y, Farag JA, Nishiga M, et al. Comprehensive analysis of myocardial reverse remodeling following HeartWare ventricular assist device implantation. Clin Transplant, 2025, 39(8): e70245.
30.	Biggs RM, Zhang Y, Silverman DN, et al. Persistent fibrosis in heart failure with a reduced ejection fraction linked to phenotypic differences in human cardiac fibroblast populations. J Am Heart Assoc, 2025, 14(8): e039747.
31.	Costantino S, Paneni F. Long-lasting metabolic impairment in the failing heart: epigenetic memories at play. Epigenetics, 2025, 20(1): 2515430.
32.	Shi A, Gan SQ, Liu SY, et al. Life experiences and coping strategies after left ventricular assist device implantation as destination therapy in China: a descriptive phenomenological inquiry. BMJ Open, 2025, 15(9): e097409.

1. Yuzefpolskaya M, Schroeder SE, Houston BA, et al. The society of thoracic surgeons Intermacs 2022 annual report: focus on the 2018 heart transplant allocation system. Ann Thorac Surg, 2023, 115(2): 311-327.
2. Wang X, Zhou X, Chen H, et al. Long-term outcomes of a novel fully magnetically levitated ventricular assist device for the treatment of advanced heart failure in China. J Heart Lung Transplant, 2024, 43(11): 1806-1815.
3. Derks W, Rode J, Collin S, et al. A latent cardiomyocyte regeneration potential in human heart disease. Circulation, 2025, 151(3): 245-256.
4. Pan S, Aksut B, Wever-Pinzon OE, et al. Incidence and predictors of myocardial recovery on long-term left ventricular assist device support: results from the United Network for Organ Sharing database. J Heart Lung Transplant, 2015, 34(12): 1624-1629.
5. Topkara VK, Garan AR, Fine B, et al. Myocardial recovery in patients receiving contemporary left ventricular assist devices: results from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Circ Heart Fail, 2016, 9(7): e003157.
6. Itagaki S, Moss N, Toyoda N, et al. Incidence, outcomes, and opportunity for left ventricular assist device weaning for myocardial recovery. JACC Heart Fail, 2024, 12(5): 893-901.
7. Shah P, Psotka M, Taleb I, et al. Framework to classify reverse cardiac remodeling with mechanical circulatory support: the Utah-Inova stages. Circ Heart Fail, 2021, 14(5): e007991.
8. Olsen C, Mandawat A, Sun JL, et al. Recovery of left ventricular function is associated with improved outcomes in LVAD recipients. J Heart Lung Transplant, 2022, 41(8): 1055-1062.
9. Saeed D, Feldman D, Banayosy AE, et al. The 2023 international society for heart and lung transplantation guidelines for mechanical circulatory support: a 10-year update. J Heart Lung Transplant, 2023, 42(7): e1-e222.
10. 中華醫學會心血管病學分會, 中國醫師協會心血管內科醫師分會, 中國醫師協會心力衰竭專業委員會, 等. 中國心力衰竭診斷和治療指南2024. 中華心血管病雜志, 2024, 52(3): 235-275.Chinese Society of Cardiology of Chinese Medical Association, Chinese College of Cardiovascular Physicians, Chinese Heart Failure Association, et al. Chinese guidelines for the diagnosis and treatment of heart failure 2024. Chin J Cardiol, 2024, 52(3): 235-275.
11. Parikh M, Shah S, Basu R, et al. Transcriptomic signatures of end-stage human dilated cardiomyopathy hearts with and without left ventricular assist device support. Int J Mol Sci, 2022, 23(4): 2050.
12. Antonides CFJ, Schoenrath F, de By T, et al. Outcomes of patients after successful left ventricular assist device explantation: a EUROMACS study. ESC Heart Fail, 2020, 7(3): 1085-1094.
13. Diakos NA, Taleb I, Kyriakopoulos CP, et al. Circulating and myocardial cytokines predict cardiac structural and functional improvement in patients with heart failure undergoing mechanical circulatory support. J Am Heart Assoc, 2021, 10(20): e020238.
14. Akkawi AR, Yamaguchi A, Shimamura J, et al. Age is a predictor of in-hospital outcomes for left ventricular assist device implantation: a nationwide analysis. J Pers Med, 2024, 14(3): 236.
15. Kenigsberg BB, Majure DT, Sheikh FH, et al. Sex-associated differences in cardiac reverse remodeling in patients supported by contemporary left ventricular assist devices. J Card Fail, 2020, 26(6): 494-504.
16. Wever-Pinzon O, Drakos SG, McKellar SH, et al. Cardiac recovery during long-term left ventricular assist device support. J Am Coll Cardiol, 2016, 68(14): 1540-1553.
17. Guo Z, Liu X, Cheng X, et al. Combination of left ventricular end-diastolic diameter and QRS duration strongly predicts good response to and prognosis of cardiac resynchronization therapy. Cardiol Res Pract, 2020, 2020: 1257578.
18. Gyoten T, Amiya E, Saito A, et al. Predictors of long-term success after successful explantation of continuous flow left ventricular assist device support. Interact Cardiovasc Thorac Surg, 2024, 38(6): ivae091.
19. Gokhale S, Malesz A, Masha L. Ventricular arrhythmias and sudden cardiac death in left ventricular assist device patients without implantable cardioverter defibrillators. ASAIO J, 2024, 70(9): 773-777.
20. Hall D, Chhana RA, Yang BQ, et al. The impact of preoperative right ventricular dysfunction and ventricular arrhythmias on left ventricular assist device outcomes. ASAIO J, 2025, 71(9): 736-743.
21. Birks EJ, Drakos SG, Patel SR, et al. Prospective multicenter study of myocardial recovery using left ventricular assist devices (RESTAGE-HF [remission from stage D heart failure]): medium-term and primary end point results. Circulation, 2020, 142(21): 2016-2028.
22. Chou BP, Critsinelis A, Lamba HK, et al. Continuous-flow left ventricular assist device support in patients with ischemic versus nonischemic cardiomyopathy. Tex Heart Inst J, 2021, 48(4): e7241.
23. Moayedifar R, Celik M, Karner B, et al. Prognostic significance of albumin in modern left ventricular assist device therapy: relevance in the HeartMate 3 era? J Clin Med, 2025, 14(17): 6193.
24. Niklewski T, Jurkiewicz M, Szczurek-Wasilewicz W, et al. Preoperative albumin-bilirubin (ALBI) score is the strongest predictor of mortality after LVAD implantation. Biomedicines, 2025, 13(10): 2449.
25. Shi R, Li Z, Duan X, et al. Association between malnutrition risk and the prognosis of geriatric heart failure patients undergoing left ventricular assist device implantation. J Nutr Health Aging, 2024, 28(12): 100382.
26. Rame JE, Pagani FD, Kiernan MS, et al. Evolution of late right heart failure with left ventricular assist devices and association with outcomes. J Am Coll Cardiol, 2021, 78(23): 2294-2308.
27. Roth R, H?ckh M, Schnick T, et al. Transcriptional signature of cardiac myocyte recovery in mice and human reveals persistent upregulation of epigenetic factors. Epigenetics, 2025, 20(1): 2506625.
28. Kaye DM, Wang XS, Koay YC, et al. Mechanical unloading is accompanied by reverse metabolic remodelling in the failing heart: identification of a novel citraconate-mediated pathway. Eur J Heart Fail, 2025, 27(7): 1342-1352.
29. Kawai Y, Farag JA, Nishiga M, et al. Comprehensive analysis of myocardial reverse remodeling following HeartWare ventricular assist device implantation. Clin Transplant, 2025, 39(8): e70245.
30. Biggs RM, Zhang Y, Silverman DN, et al. Persistent fibrosis in heart failure with a reduced ejection fraction linked to phenotypic differences in human cardiac fibroblast populations. J Am Heart Assoc, 2025, 14(8): e039747.
31. Costantino S, Paneni F. Long-lasting metabolic impairment in the failing heart: epigenetic memories at play. Epigenetics, 2025, 20(1): 2515430.
32. Shi A, Gan SQ, Liu SY, et al. Life experiences and coping strategies after left ventricular assist device implantation as destination therapy in China: a descriptive phenomenological inquiry. BMJ Open, 2025, 15(9): e097409.

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