Heart failure could be reversed with a new treatment that combines medication with the temporary use of an artificial heart pump, said researchers at the University of Utah Health.
The therapy, which involves implantation of a left ventricular assist device ( LVAD ), could: help reverse structural damage to the heart, eliminate the need for heart transplants, and prolong some patients’ lives, according to a press release issued by the Utah health center (U of U Health).
“For decades, heart transplantation and LVADs have been the therapeutic cornerstones of advanced heart failure,” said Stavros Drakos, MD , PhD, co-author of the recent study and director of cardiovascular research for the health center’s Division of Cardiology. “But this alternative approach is different. It appears to be a bridge to heart recovery without requiring transplantation or long-term use of an artificial heart pump.”
Living with heart failure
Heart failure is a chronic, progressive disease that affects about 6.2 million adults in the United States. It occurs when the heart does not pump blood as efficiently as needed, resulting in a lack of blood and oxygen in the rest of the body.
To compensate, the heart may enlarge and develop more muscle mass. It will pump faster to increase the output, while blood vessels narrow to increase blood pressure. Although these changes help the body to function, over time they cause the heart to wear out.
Eventually, the body and heart cannot keep up, and the patient might experience fatigue and shortness of breath. Most heart failure patients are encouraged to make lifestyle changes and take prescribed medications.
In the past, heart failure was not considered reversible. However, researchers at the Utah health center have been encouraged by the results of their recent study.
The study, which was conducted at six medical centers nationwide, appears in Circulation.
Helping the heart heal
Researchers followed 40 advanced heart failure patients aged 18 to 59, who all needed a LVAD to remain alive. Nineteen patients, who used the combined therapy, improved enough that the LVAD could be removed. Researchers found that 90% of these patients were alive one year after removal. After three years, 77% were still alive and doing well.
The LVAD is implanted in the chest, with the outside battery connected through a port in the skin. It can be used for a period of time to reduce the strain on a failing heart, allowing it to rest and fix damaged structures. This results in improved function, leading to its removal.
Steven Boyce, MD, a cardiothoracic surgeon at Adventist HealthCare White Oak Medical Center in Silver Spring, Md., explained that the LVAD decompresses the left ventricle. This results in less stress on the myocardium, the muscular tissue of the heart.
“Patients that suffer from non-ischemic cardiomyopathy would be the best candidates. If the heart muscle has been extensively replaced by scar tissue secondary to repeated infarctions, they are much less likely to benefit,” he said.
The treatment under investigation is a possible alternative to lifelong LVAD support or heart transplants, and puts less stress on the patient. Dr. Boyce said he has patients who are not candidates for a heart transplant and have been on LVADs for over 10 years.
The next step in the researchers’ plan is to break down why and in what manner the treatment works. Attention is focused on what are known as the metabolic pathways, the linked chemical reactions that take place within the cell. Some pathways create energy, and others require them.