Identifying and Facilitating Ventricular Recovery on Mechanical Support

描述(申请人提供)：机械左心室辅助装置(LVAD)通常是严重心力衰竭患者的救命工具。虽然LVAD通常被用作移植的桥梁，但接受LVAD的患者中有一个重要的亚群已经恢复了左心功能，从而成功地取出了装置。由于复杂的卸载效应，常规的临床手段很难或不可能评估LVAD患者的左心功能。因此，我们开发了使用在线数字超声心动图和无创动脉压测量左心功能的新方法(前负荷调整的最大功率)。我们将这些方法应用于53名精选的LVAD患者，并在14名成功摘除LVAD的患者中确定了左心室恢复。这项提案使用了一个由3个LVAD专家中心组成的多中心联盟：匹兹堡大学，它将领导所有方面，宾夕法尼亚州立大学-好时，和马里兰大学。匹兹堡大学的团队由心脏成像、心力衰竭和临床人工心脏计划以及卡内基梅隆大学的生物工程专家组成。目的#1将验证这样一个假设，即我们的新的负荷非依赖性左心室功能测量方法可以可靠地识别175-200名左室肥厚患者的左心室恢复情况。我们将比较常规临床峰值运动、氧耗量和右心导管术的预测能力，以完善LVAD摘除的选择标准。具体的AIMS#2和AIMS#3将测试可以促进LVAD上的LV恢复的假设：AIM#2将使用体外和体内动物实验来改进和测试用于同步LVEAD操作的反馈控制器，以实现最佳负荷以促进LV恢复。目的#3将在一项前瞻性的多中心随机临床试验中测试这一策略，在该试验中，LVAD同步自适应重新加载将与常规的异步LVAD手术进行比较。 Layer摘要：使用左心辅助装置(LVAD)的机械支持可以挽救患者生命 严重心力衰竭患者，通常作为移植的桥梁。虽然患者在接受LVAD期间可能会有心脏恢复，而且装置可以移除，但使用常规方法很难进行评估。我们将使用新的非侵入性心脏测试来识别LVAD的心脏恢复情况，并开发一种独特的控制系统来促进心脏恢复。

DESCRIPTION (provided by applicant): The mechanical left ventricular assist device (LVAD) is often life-saving for patients with severe heart failure. Although LVAD is typically used as a bridge to transplantation, an important subset of patients on LVAD have recovery of LV function leading to successful removal of the device. Assessment of LV function by routine clinical means is difficult or impossible on LVAD due to complex unloading effects. Accordingly, we have developed novel load-independent measures of LV function (preload adjusted maximal power) using on-line digital echocardiography and non-invasive arterial pressure. We have applied these methods to 53 selected LVAD patients, and identified LV recovery in 14 who had successful LVAD removal. This proposal uses a multi-center consortium of 3 expert LVAD centers: the University of Pittsburgh, which will lead all aspects, Penn State-Hershey, and the University of Maryland. The University of Pittsburgh team is a collaboration of cardiac imaging, heart failure and the clinical Artificial Heart Program along with bioengineering experts at Carnegie Mellon University. Aim # 1 will test the hypothesis that our novel load independent LV functional measures can reliably identify LV recovery in a series of 175-200 LVAD patients. The predictive power of routine clinical peak exercise oxygen consumption and right heart catheterization will be compared to refine selection criteria for LVAD removal. Specific Aims # 2 and #3 will test the hypothesis that LV recovery on LVAD can be facilitated: Aim #2 will use in vitro and in vivo animal experiments to refine and test a feedback controller for Synchronized LVAD operation for optimal loading to facilitate LV recovery. Aim #3 will test this strategy in a prospective multi-center randomized clinical trial where LVAD Synchronized Adaptive Reloading will be compared to routine Asynchronous LVAD operation. Lay Summary: Mechanical support with a left ventricular assist device (LVAD) can be life-saving for Patients with severe heart failure, usually as a bridge to transplantation. Although patients may have cardiac recovery while on LVAD and the device can be removed, it is difficult to assess using routine means. We will use novel non-invasive cardiac testing to identify recovery of the heart on LVAD and develop a unique control system to facilitate cardiac recovery.