Myocardial Recovery After Left Ventricular Assist Device Weaning in Patients With Predominantly Toxic Cardiomyopathy: A Single-center Experience
Bibliographic record
Abstract
Background In some patients with left-ventricular assist devices (LVADs), unloading of the left ventricle (LV) and medical therapy may lead to improvement of LV systolic function, allowing for LVAD weaning. There are no guideline-directed parameters to help identify candidates for weaning and long-term outcomes remain imperfectly documented. We aimed to assess the clinical and echocardiographic characteristics of weaned patients and to evaluate their event-free survival following weaning. Methods Single-center retrospective study recruiting all patients who underwent second or third generation LVAD implantation between 2009-2021. Results 98 patients were included. Fourteen patients (14%) with LV recovery underwent LVAD weaning after 309 days of median support time. Heart failure etiologies in weaned patients included toxic (recreational drugs) (n=8, 57%), toxic (medication) (n = 2, 14%), ischemic (n=2, 14%) and idiopathic dilated cardiomyopathy (n=2, 14%). In unweaned patients, heart failure was mostly attributed to ischemic (n=35, 42%) and idiopathic dilated (n=27, 32%) cardiomyopathy. Three months after implantation, patients who were eventually weaned had higher LVEF (35 vs. 19%, p=0.001) and lower left ventricular end diastolic diameter (LVEDD) (52 vs. 60 mm, p=0.03) than unweaned patients. At last follow-up after weaning, mean LVEF was 44±6% and no death nor heart transplant had occurred. Conclusion LVADs can induce LV reverse remodeling leading to myocardial recovery in a significant proportion of patients, especially those with toxic and non-ischemic cardiomyopathies. Early reverse remodeling with decreasing LVEDD and improving LVEF at 3 months following implantation may suggest potential candidacy for LVAD weaning. Weaned patients maintain satisfactory LVEF recovery after weaning and have good long-term event-free survival.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".