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 machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".