NEUROHORMONAL CHANGES AFTER IMPLANTATION OF A LEFT-VENTRICULAR ASSISTSYSTEM

In patients with left ventricular dysfunction, neurohormonal levels ar e valuable indicators of the severity of heart disease and prognosis. For patients with severe left ventricular dysfunction, left ventricula r assist systems (LVAS) are effective as short-term bridges to heart t ransplantation and are currently being investigated for long-term use. Unknown, however, are the effects of mechanical unloading of the left ventricle on neurohormone levels during the initial weeks after LVAS implantation, and whether these changes are similar to the neurohormon al level decreases observed after cardiac transplantation. This study was undertaken to determine the effect of LVAS support on plasma norep inephrine (PNE) levels during the initial weeks after device implantat ion. The PNE levels in five consecutive patients with left ventricular dysfunction were measured within 1 week after LVAS implantation and e very week thereafter for 5 weeks. Significant decreases in PNE levels were observed after 3 weeks of LVAS support. After 5 weeks of LVAS sup port, PNE levels had decreased to near normal. For patients with sever e left ventricular dysfunction, the improved prognosis after LVAS supp ort may be due in part to the normalization of neurohormonal levels. T he findings indicate that PNE levels may be of value in determining wh ether a patient can be weaned from LVAS support.