Impact of Cardiac Fibrosis and Collagens on Right Ventricular Failure and Acute Kidney Injury in Patients after Continuous-Flow Left Ventricular Assist Devices

Objectives: Cardiac fibrosis plays an essential role in cardiac reverse remodeling during left ventricular assisted device (LVAD) support. However, the impact on cardiac fibrosis and related collagens at the time of LVAD implantation on clinical outcomes remains unclear.

Methods: A total of 34 patients receiving a third-generation LVAD were included and apical left ventricular tissue was obtained from the LVAD insertion site. Cardiac fibrosis was evaluated via Elastica-van Gieson staining and expressions of Collagen I (Col1a1) and Collagen III (Col3a1) mRNA were detected by RT-qPCR.

Result: Eighteen patients developed right ventricular failure (RVF) and 14 of them received right ventricular assisted device (RVAD) support. 22 patients developed acute kidney injury (AKI), 12 needed (temporary) new-onset renal replacement therapy (RRT). Higher expression of Col1a1 was significantly associated with increased incidences of RVF (76.5 vs. 29.4%, p = 0.015), RVAD support (64.7 vs. 17.6%, p = 0.013), and stage 3 AKI (58.8 vs. 17.6%, p = 0.032). Patients with higher Col1a1 expression were more prone to RRT (52.9 vs. 17.6%, p = 0.071). Receiver operating characteristic curves showed that Col1a1 had good predictive effects on RVF (area under the curve [AUC], 0.806, p = 0.002), RVAD support (AUC = 0.789, p = 0.005), stage 3 AKI (AUC = 0.740, p = 0.020), and RRT (AUC = 0.731, p = 0.028). Moreover, patients with higher Col1a1 had longer postoperative duration of mechanical ventilation, duration of ICU stays, and hospital length of stay (all p < 0.05). Cardiac fibrosis, Col3a1, and Col1a1/Col3a1 shared similar results or trends with Col1a1.

Conclusion: Fibrosis and related collagens in the apical left ventricular tissue at the time of LVAD implantation are associated with increased risk of RVF, RVAD implantation, and worse renal function. Col1a1 is a stable indicator for poor prognosis.

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Artikel online veröffentlicht:
19. Februar 2021