Exploratory Study on the Mechanism of Left Ventricular Function Recovery After Left Ventricular Assist Device Implantation in Pediatric Dilated Cardiomyopathy

This study investigated factors associated with left ventricular (LV) recovery in pediatric dilated cardiomyopathy (DCM) following left ventricular assist device (LVAD) implantation, using single-cell multiomics analysis. Twenty-five pediatric DCM patients who underwent bridge-to-transplant LVAD (BTT-LVAD) implantation at our institution were categorized as either recovery (R) cases, defined by successful LVAD explantation with sustained stability on medical therapy, or non-recovery (NR) cases, defined by the need for transplantation or death. Single-nucleus RNA (snRNA) sequencing and chromatin accessibility analyses were conducted on six subcases (three from each group). Candidate genes and pathways identified were further validated through histological and serological assessments in all cases. Pseudobulk analysis revealed higher expression of NPPB, MYL7, and PCDH9 in cardiomyocytes from the R group, with NPPB exhibiting the highest baseline expression and corresponding changes in chromatin accessibility. Gene Ontology analysis highlighted pathways regulating apoptosis. Serum BNP, a protein product of NPPB, was significantly elevated in the R group at the time of LVAD implantation and correlated with a higher proportion of non-apoptotic cells.