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Antonopoulos M, Bonios MJ, Dimopoulos S, Leontiadis E, Gouziouta A, Kogerakis N, Koliopoulou A, Elaiopoulos D, Vlahodimitris I, Chronaki M, Chamogeorgakis T, Drakos SG, Adamopoulos S. Advanced Heart Failure: Therapeutic Options and Challenges in the Evolving Field of Left Ventricular Assist Devices. J Cardiovasc Dev Dis 2024; 11:61. [PMID: 38392275 PMCID: PMC10888700 DOI: 10.3390/jcdd11020061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
Heart Failure is a chronic and progressively deteriorating syndrome that has reached epidemic proportions worldwide. Improved outcomes have been achieved with novel drugs and devices. However, the number of patients refractory to conventional medical therapy is growing. These advanced heart failure patients suffer from severe symptoms and frequent hospitalizations and have a dismal prognosis, with a significant socioeconomic burden in health care systems. Patients in this group may be eligible for advanced heart failure therapies, including heart transplantation and chronic mechanical circulatory support with left ventricular assist devices (LVADs). Heart transplantation remains the treatment of choice for eligible candidates, but the number of transplants worldwide has reached a plateau and is limited by the shortage of donor organs and prolonged wait times. Therefore, LVADs have emerged as an effective and durable form of therapy, and they are currently being used as a bridge to heart transplant, destination lifetime therapy, and cardiac recovery in selected patients. Although this field is evolving rapidly, LVADs are not free of complications, making appropriate patient selection and management by experienced centers imperative for successful therapy. Here, we review current LVAD technology, indications for durable MCS therapy, and strategies for timely referral to advanced heart failure centers before irreversible end-organ abnormalities.
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Affiliation(s)
- Michael Antonopoulos
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Michael J Bonios
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Stavros Dimopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Evangelos Leontiadis
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Aggeliki Gouziouta
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Nektarios Kogerakis
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Antigone Koliopoulou
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Dimitris Elaiopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Ioannis Vlahodimitris
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Maria Chronaki
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Themistocles Chamogeorgakis
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Stavros G Drakos
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Stamatis Adamopoulos
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
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Siruvallur Vasudevan V, Rajagopal K, Rame JE, Antaki JF. Trans-aortic Valvular Ejection Fraction for Monitoring Recovery of Patients with Ventricular Systolic Heart Failure. Ann Biomed Eng 2023; 51:2824-2836. [PMID: 37667085 DOI: 10.1007/s10439-023-03345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/06/2023] [Indexed: 09/06/2023]
Abstract
Durable mechanical circulatory support in the form of left ventricular (LV) assist device (LVAD) therapy is increasingly considered in the context of the recovery of native cardiac function. Progressive improvement in LV function may facilitate LVAD explantation and a resultant reduction in device-related risk. However, ascertaining LV recovery remains a challenge. In this study, we investigated the use of trans-aortic valvular flow rate and trans-LVAD flow rate to assess native LV systolic function using a well-established lumped parameter model of the mechanically assisted LV with pre-existing systolic dysfunction. Trans-aortic valvular ejection fraction (TAVEF) was specifically found to characterize the preload-independent contractility of the LV. It demonstrated excellent sensitivity to simulated pharmacodynamic stress tests and volume infusion tests. TAVEF may prove to be useful in the ascertainment of LV recovery in LVAD-supported LVs with pre-existing LV systolic dysfunction.
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Affiliation(s)
| | - Keshava Rajagopal
- Department of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jesus E Rame
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - James F Antaki
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA.
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Amrute JM, Lai L, Ma P, Koenig AL, Kamimoto K, Bredemeyer A, Shankar TS, Kuppe C, Kadyrov FF, Schulte LJ, Stoutenburg D, Kopecky BJ, Navankasattusas S, Visker J, Morris SA, Kramann R, Leuschner F, Mann DL, Drakos SG, Lavine KJ. Defining cardiac functional recovery in end-stage heart failure at single-cell resolution. NATURE CARDIOVASCULAR RESEARCH 2023; 2:399-416. [PMID: 37583573 PMCID: PMC10426763 DOI: 10.1038/s44161-023-00260-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/01/2023] [Indexed: 08/17/2023]
Abstract
Recovery of cardiac function is the holy grail of heart failure therapy yet is infrequently observed and remains poorly understood. In this study, we performed single-nucleus RNA sequencing from patients with heart failure who recovered left ventricular systolic function after left ventricular assist device implantation, patients who did not recover and non-diseased donors. We identified cell-specific transcriptional signatures of recovery, most prominently in macrophages and fibroblasts. Within these cell types, inflammatory signatures were negative predictors of recovery, and downregulation of RUNX1 was associated with recovery. In silico perturbation of RUNX1 in macrophages and fibroblasts recapitulated the transcriptional state of recovery. Cardiac recovery mediated by BET inhibition in mice led to decreased macrophage and fibroblast Runx1 expression and diminished chromatin accessibility within a Runx1 intronic peak and acquisition of human recovery signatures. These findings suggest that cardiac recovery is a unique biological state and identify RUNX1 as a possible therapeutic target to facilitate cardiac recovery.
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Affiliation(s)
- Junedh M. Amrute
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- These authors contributed equally: Junedh M. Amrute, Lulu Lai
| | - Lulu Lai
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
- These authors contributed equally: Junedh M. Amrute, Lulu Lai
| | - Pan Ma
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew L. Koenig
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenji Kamimoto
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
- Center for Regenerative Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrea Bredemeyer
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Thirupura S. Shankar
- Division of Cardiovascular Medicine & Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah Health & School of Medicine, Salt Lake City, UT, USA
| | - Christoph Kuppe
- Institute of Experimental Medicine and Systems Biology and Division of Nephrology, RWTH Aachen University, Aachen, Germany
| | - Farid F. Kadyrov
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Linda J. Schulte
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Dylan Stoutenburg
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Benjamin J. Kopecky
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Sutip Navankasattusas
- Division of Cardiovascular Medicine & Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah Health & School of Medicine, Salt Lake City, UT, USA
| | - Joseph Visker
- Division of Cardiovascular Medicine & Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah Health & School of Medicine, Salt Lake City, UT, USA
| | - Samantha A. Morris
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
- Center for Regenerative Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Rafael Kramann
- Institute of Experimental Medicine and Systems Biology and Division of Nephrology, RWTH Aachen University, Aachen, Germany
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Florian Leuschner
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg, Heidelberg, Germany
| | - Douglas L. Mann
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Stavros G. Drakos
- Division of Cardiovascular Medicine & Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah Health & School of Medicine, Salt Lake City, UT, USA
| | - Kory J. Lavine
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, USA
- Center for Regenerative Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Drakos SG, Badolia R, Makaju A, Kyriakopoulos CP, Wever-Pinzon O, Tracy CM, Bakhtina A, Bia R, Parnell T, Taleb I, Ramadurai DKA, Navankasattusas S, Dranow E, Hanff TC, Tseliou E, Shankar TS, Visker J, Hamouche R, Stauder EL, Caine WT, Alharethi R, Selzman CH, Franklin S. Distinct Transcriptomic and Proteomic Profile Specifies Patients Who Have Heart Failure With Potential of Myocardial Recovery on Mechanical Unloading and Circulatory Support. Circulation 2023; 147:409-424. [PMID: 36448446 PMCID: PMC10062458 DOI: 10.1161/circulationaha.121.056600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Extensive evidence from single-center studies indicates that a subset of patients with chronic advanced heart failure (HF) undergoing left ventricular assist device (LVAD) support show significantly improved heart function and reverse structural remodeling (ie, termed "responders"). Furthermore, we recently published a multicenter prospective study, RESTAGE-HF (Remission from Stage D Heart Failure), demonstrating that LVAD support combined with standard HF medications induced remarkable cardiac structural and functional improvement, leading to high rates of LVAD weaning and excellent long-term outcomes. This intriguing phenomenon provides great translational and clinical promise, although the underlying molecular mechanisms driving this recovery are largely unknown. METHODS To identify changes in signaling pathways operative in the normal and failing human heart and to molecularly characterize patients who respond favorably to LVAD unloading, we performed global RNA sequencing and phosphopeptide profiling of left ventricular tissue from 93 patients with HF undergoing LVAD implantation (25 responders and 68 nonresponders) and 12 nonfailing donor hearts. Patients were prospectively monitored through echocardiography to characterize their myocardial structure and function and identify responders and nonresponders. RESULTS These analyses identified 1341 transcripts and 288 phosphopeptides that are differentially regulated in cardiac tissue from nonfailing control samples and patients with HF. In addition, these unbiased molecular profiles identified a unique signature of 29 transcripts and 93 phosphopeptides in patients with HF that distinguished responders after LVAD unloading. Further analyses of these macromolecules highlighted differential regulation in 2 key pathways: cell cycle regulation and extracellular matrix/focal adhesions. CONCLUSIONS This is the first study to characterize changes in the nonfailing and failing human heart by integrating multiple -omics platforms to identify molecular indices defining patients capable of myocardial recovery. These findings may guide patient selection for advanced HF therapies and identify new HF therapeutic targets.
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Affiliation(s)
- Stavros G. Drakos
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah, Intermountain Medical Center, Salt Lake VA Medical Center), Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Rachit Badolia
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
| | - Aman Makaju
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
| | - Christos P. Kyriakopoulos
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah, Intermountain Medical Center, Salt Lake VA Medical Center), Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Omar Wever-Pinzon
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah, Intermountain Medical Center, Salt Lake VA Medical Center), Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Christopher M. Tracy
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
| | - Anna Bakhtina
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
| | - Ryan Bia
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
| | - Timothy Parnell
- Bioinformatics Core, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Iosif Taleb
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah, Intermountain Medical Center, Salt Lake VA Medical Center), Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Dinesh K. A. Ramadurai
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
| | - Sutip Navankasattusas
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
| | - Elizabeth Dranow
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah, Intermountain Medical Center, Salt Lake VA Medical Center), Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Thomas C. Hanff
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah, Intermountain Medical Center, Salt Lake VA Medical Center), Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Eleni Tseliou
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah, Intermountain Medical Center, Salt Lake VA Medical Center), Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Thirupura S. Shankar
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
| | - Joseph Visker
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
| | - Rana Hamouche
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
| | - Elizabeth L. Stauder
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah, Intermountain Medical Center, Salt Lake VA Medical Center), Salt Lake City, Utah, United States
| | - William T. Caine
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah, Intermountain Medical Center, Salt Lake VA Medical Center), Salt Lake City, Utah, United States
| | - Rami Alharethi
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah, Intermountain Medical Center, Salt Lake VA Medical Center), Salt Lake City, Utah, United States
| | - Craig H. Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah, Intermountain Medical Center, Salt Lake VA Medical Center), Salt Lake City, Utah, United States
| | - Sarah Franklin
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Potential of Nuclear Imaging Techniques to Study the Oral Delivery of Peptides. Pharmaceutics 2022; 14:pharmaceutics14122809. [PMID: 36559303 PMCID: PMC9780892 DOI: 10.3390/pharmaceutics14122809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Peptides are small biomolecules known to stimulate or inhibit important functions in the human body. The clinical use of peptides by oral delivery, however, is very limited due to their sensitive structure and physiological barriers present in the gastrointestinal tract. These barriers can be overcome with chemical and mechanical approaches protease inhibitors, permeation enhancers, and polymeric encapsulation. Studying the success of these approaches pre-clinically with imaging techniques such as fluorescence imaging (IVIS) and optical microscopy is difficult due to the lack of in-depth penetration. In comparison, nuclear imaging provides a better platform to observe the gastrointestinal transit and quantitative distribution of radiolabeled peptides. This review provides a brief background on the oral delivery of peptides and states examples from the literature on how nuclear imaging can help to observe and analyze the gastrointestinal transit of oral peptides. The review connects the fields of peptide delivery and nuclear medicine in an interdisciplinary way to potentially overcome the challenges faced during the study of oral peptide formulations.
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Tseliou E, Lavine KJ, Wever-Pinzon O, Topkara VK, Meyns B, Adachi I, Zimpfer D, Birks EJ, Burkhoff D, Drakos SG. Biology of myocardial recovery in advanced heart failure with long-term mechanical support. J Heart Lung Transplant 2022; 41:1309-1323. [PMID: 35965183 DOI: 10.1016/j.healun.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022] Open
Abstract
Cardiac remodeling is an adaptive, compensatory biological process following an initial insult to the myocardium that gradually becomes maladaptive and causes clinical deterioration and chronic heart failure (HF). This biological process involves several pathophysiological adaptations at the genetic, molecular, cellular, and tissue levels. A growing body of clinical and translational investigations demonstrated that cardiac remodeling and chronic HF does not invariably result in a static, end-stage phenotype but can be at least partially reversed. One of the paradigms which shed some additional light on the breadth and limits of myocardial elasticity and plasticity is long term mechanical circulatory support (MCS) in advanced HF pediatric and adult patients. MCS by providing (a) ventricular mechanical unloading and (b) effective hemodynamic support to the periphery results in functional, structural, cellular and molecular changes, known as cardiac reverse remodeling. Herein, we analyze and synthesize the advances in our understanding of the biology of MCS-mediated reverse remodeling and myocardial recovery. The MCS investigational setting offers access to human tissue, providing an unparalleled opportunity in cardiovascular medicine to perform in-depth characterizations of myocardial biology and the associated molecular, cellular, and structural recovery signatures. These human tissue findings have triggered and effectively fueled a "bedside to bench and back" approach through a variety of knockout, inhibition or overexpression mechanistic investigations in vitro and in vivo using small animal models. These follow-up translational and basic science studies leveraging human tissue findings have unveiled mechanistic myocardial recovery pathways which are currently undergoing further testing for potential therapeutic drug development. Essentially, the field is advancing by extending the lessons learned from the MCS cardiac recovery investigational setting to develop therapies applicable to the greater, not end-stage, HF population. This review article focuses on the biological aspects of the MCS-mediated myocardial recovery and together with its companion review article, focused on the clinical aspects, they aim to provide a useful framework for clinicians and investigators.
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Affiliation(s)
- Eleni Tseliou
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, UT; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah Health, Salt Lake City, UT
| | - Kory J Lavine
- Division of Cardiology, Washington University School of Medicine, St Louis, MO
| | - Omar Wever-Pinzon
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, UT; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah Health, Salt Lake City, UT
| | - Veli K Topkara
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Bart Meyns
- Department of Cardiology and Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Iki Adachi
- Division of Cardiac Surgery, Texas Children's Hospital, Houston, TX
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Daniel Burkhoff
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY; Cardiovascular Research Foundation (CRF), New York, NY
| | - Stavros G Drakos
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, UT; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah Health, Salt Lake City, UT.
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Kurita N, Ogiwara E, Luo N, Kiang S, Karnik S, Smith PA, Nissim L, Fraser KH, Frazier OH, Wang Y. Dynamic Evaluation of an Active Axial Magnetic Levitated Bearing System in a Hemocompatibility Assessment Platform. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:2294-2297. [PMID: 36086211 DOI: 10.1109/embc48229.2022.9871132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To evaluate the hemocompatibility of individual components of our pediatric left ventricular assist device (LVAD), we proposed a hemocompatibility assessment platform (HAP) with a magnetic levitated bearing system. The HAP consists of a drive system utilizing a brushless direct current (BLDC) motor, passive magnetic bearings (PMB), and an active magnetically levitated bearing (AMB) to reduce the hemolysis generated by HAP itself. In this study, we designed and evaluated the performance of the AMB by measuring radial and axial displacements of the rotor resulting from radially destabilizing forces as well as the performance of the drive system when rotated at increasing speeds to 1,200 rotations per minute (rpm). The results show that, with radial disturbance, the AMB is capable of maintaining axial stability for the BLDC motor system. The AMB can control up to 1,200 rpm without any contact between the rotor and stator. Future work includes geometry optimization for the AMB structure and increase the capability to control stable high-speed rotation for the entire system. Clinical Relevance- This work furthers the development of the magnetic levitated bearing system for a hemocompatibility assessment platform that will be used to enhance and accelerate the development of adult and pediatric LVADs.
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LVAD as a Bridge to Remission from Advanced Heart Failure: Current Data and Opportunities for Improvement. J Clin Med 2022; 11:jcm11123542. [PMID: 35743611 PMCID: PMC9225013 DOI: 10.3390/jcm11123542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Left ventricular assist devices (LVADs) are an established treatment modality for advanced heart failure (HF). It has been shown that through volume and pressure unloading they can lead to significant functional and structural cardiac improvement, allowing LVAD support withdrawal in a subset of patients. In the first part of this review, we discuss the historical background, current evidence on the incidence and assessment of LVAD-mediated cardiac recovery, and out-comes including quality of life after LVAD support withdrawal. In the second part, we discuss current and future opportunities to promote LVAD-mediated reverse remodeling and improve our pathophysiological understanding of HF and recovery for the benefit of the greater HF population.
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9
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(Physiology of Continuous-flow Left Ventricular Assist Device Therapy. Translation of the document prepared by the Czech Society of Cardiology). COR ET VASA 2022. [DOI: 10.33678/cor.2022.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Ono M, Yamaguchi O, Ohtani T, Kinugawa K, Saiki Y, Sawa Y, Shiose A, Tsutsui H, Fukushima N, Matsumiya G, Yanase M, Yamazaki K, Yamamoto K, Akiyama M, Imamura T, Iwasaki K, Endo M, Ohnishi Y, Okumura T, Kashiwa K, Kinoshita O, Kubota K, Seguchi O, Toda K, Nishioka H, Nishinaka T, Nishimura T, Hashimoto T, Hatano M, Higashi H, Higo T, Fujino T, Hori Y, Miyoshi T, Yamanaka M, Ohno T, Kimura T, Kyo S, Sakata Y, Nakatani T. JCS/JSCVS/JATS/JSVS 2021 Guideline on Implantable Left Ventricular Assist Device for Patients With Advanced Heart Failure. Circ J 2022; 86:1024-1058. [PMID: 35387921 DOI: 10.1253/circj.cj-21-0880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Kenji Yamazaki
- Advanced Medical Research Institute, Hokkaido Cardiovascular Hospital
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Teruhiko Imamura
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Graduate School of Advanced Science and Engineering, Waseda University
| | - Miyoko Endo
- Department of Nursing, The University of Tokyo Hospital
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Koichi Kashiwa
- Department of Medical Engineering, The University of Tokyo Hospital
| | - Osamu Kinoshita
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Kaori Kubota
- Department of Transplantation Medicine, Osaka University Graduate School of Medicine
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroshi Nishioka
- Department of Clinical Engineering, National Cerebral and Cardiovascular Center
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center
| | - Takashi Nishimura
- Department of Cardiovascular and Thoracic Surgery, Ehime University Hospital
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Masaru Hatano
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Yumiko Hori
- Department of Nursing and Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Toru Miyoshi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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11
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Koga-Ikuta A, Fukushima S, Ishibashi-Ueda H, Tadokoro N, Kakuta T, Watanabe T, Fukushima N, Suzuki K, Fukui T, Fujita T. Immunocompetent cells in durable ventricular assist device-implanted non-ischaemic dilated cardiomyopathy. Gen Thorac Cardiovasc Surg 2022; 70:685-693. [PMID: 35229229 PMCID: PMC9300518 DOI: 10.1007/s11748-022-01773-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
Objective Because the presence of immunocompetent cells in the myocardium is associated with the pathological stage and/or myocardial viability, we explored relationships between functional recovery after left ventricular assist device implantation and the distribution of immunocompetent cells in non-ischaemic dilated cardiomyopathy patients. Methods We reviewed 50 consecutive dilated cardiomyopathy patients implanted with HeartMate II at our institute between April 2013 and December 2018 who were treated with optimal medical therapy during left ventricular assist device support. Patients were stratified by improvement of the left ventricular ejection fraction at 6 months after implantation: ≥ 10% increase (Gr ≥ 10%), 5–10% (Gr 5–10%), and ≤ 5% (Gr ≤ 5%). T cells and macrophages were evaluated in the apical myocardium after left ventricular assist device implantation. Results During left ventricular assist device support, 12 patients underwent heart transplantation and 2 patients died. Four patients with Gr ≤ 5% were readmitted because of congestive heart failure, but none with Gr ≥ 10%. Macrophages and T cells in the left ventricular myocardium with Gr ≥ 10% were significantly more present compared to those in other groups. Conclusions The distribution of immunocompetent cells in the left ventricular myocardium might predict myocardial viability of this pathology after implantation.
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Affiliation(s)
- Ayumi Koga-Ikuta
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Cardiovascular Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | | | - Naoki Tadokoro
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takashi Kakuta
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takurya Watanabe
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Norihide Fukushima
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ken Suzuki
- Translational Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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12
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Rosenbaum AN, Antaki JF, Behfar A, Villavicencio MA, Stulak J, Kushwaha SS. Physiology of Continuous-Flow Left Ventricular Assist Device Therapy. Compr Physiol 2021; 12:2731-2767. [PMID: 34964115 DOI: 10.1002/cphy.c210016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The expanding use of continuous-flow left ventricular assist devices (CF-LVADs) for end-stage heart failure warrants familiarity with the physiologic interaction of the device with the native circulation. Contemporary devices utilize predominantly centrifugal flow and, to a lesser extent, axial flow rotors that vary with respect to their intrinsic flow characteristics. Flow can be manipulated with adjustments to preload and afterload as in the native heart, and ascertainment of the predicted effects is provided by differential pressure-flow (H-Q) curves or loops. Valvular heart disease, especially aortic regurgitation, may significantly affect adequacy of mechanical support. In contrast, atrioventricular and ventriculoventricular timing is of less certain significance. Although beneficial effects of device therapy are typically seen due to enhanced distal perfusion, unloading of the left ventricle and atrium, and amelioration of secondary pulmonary hypertension, negative effects of CF-LVAD therapy on right ventricular filling and function, through right-sided loading and septal interaction, can make optimization challenging. Additionally, a lack of pulsatile energy provided by CF-LVAD therapy has physiologic consequences for end-organ function and may be responsible for a series of adverse effects. Rheological effects of intravascular pumps, especially shear stress exposure, result in platelet activation and hemolysis, which may result in both thrombotic and hemorrhagic consequences. Development of novel solutions for untoward device-circulatory interactions will facilitate hemodynamic support while mitigating adverse events. © 2021 American Physiological Society. Compr Physiol 12:1-37, 2021.
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Affiliation(s)
- Andrew N Rosenbaum
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - James F Antaki
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.,VanCleve Cardiac Regenerative Medicine Program, Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sudhir S Kushwaha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
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13
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Karnik S, Smith PA, Ogiwara E, Fraser CD, Frazier OH, Kurita N, Fraser KH, Wang Y. Hemocompatibility Assessment Platform Drive System Design: Trade-off between Motor Performance and Hemolysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5539-5542. [PMID: 34892379 DOI: 10.1109/embc46164.2021.9630400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Left ventricular assist devices (LVADs) have long been used to treat adults with heart failure, but LVAD options for pediatric patients with heart failure are lacking. Despite the urgent need for long-term, implantable pediatric LVADs, design challenges such as hemolysis, pump thrombosis, and bleeding persist. We have developed a Hemocompatibility Assessment Platform (HAP) to identify blood trauma from individual LVAD components. A HAP would aid in refining pump components before in vivo testing, thereby preventing unnecessary animal sacrifice and reducing development time and cost. So that the HAP does not confound hemolysis data, the HAP drive system consists of an enlarged air-gap motor coupled to a magnetic levitation system. Although it is known that an enlarged air gap motor will have diminished performance, while the larger gap in the motor will cause less blood damage, the trade-offs are not fully characterized. Therefore, in this study we evaluated these trade-offs to determine an optimal rotor diameter for the HAP drive motor. The motor performance was characterized with an experimental method by determining the torque constant for the HAP drive motor with varied rotor diameters. The torque threshold was set as 10 mNm to achieve a nominal current of 3.5A. Hemolysis in the HAP drive motor gap was estimated by calculating scalar shear stress generated in the HAP motor gap analytically and numerically. A design criterion of 30 Pa was selected for scalar shear stress to achieve minimal hemolysis and platelet activation in the HAP drive system.Clinical Relevance- We evaluated a Hemocompatibility Assessment Platform for developing LVAD prototypes that can best balance motor performance and hemocompatibility. This design method can assist with optimizing the drive system during the research stage and illustrates how motor geometry can be tuned to reduce blood trauma.
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14
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Shah P, Psotka M, Taleb I, Alharethi R, Shams MA, Wever-Pinzon O, Yin M, Latta F, Stehlik J, Fang JC, Diao G, Singh R, Ijaz N, Kyriakopoulos CP, Zhu W, May CW, Cooper LB, Desai SS, Selzman CH, Kfoury A, Drakos SG. Framework to Classify Reverse Cardiac Remodeling With Mechanical Circulatory Support: The Utah-Inova Stages. Circ Heart Fail 2021; 14:e007991. [PMID: 33947201 PMCID: PMC8137588 DOI: 10.1161/circheartfailure.120.007991] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Variable definitions and an incomplete understanding of the gradient of reverse cardiac remodeling following continuous flow left ventricular assist device (LVAD) implantation has limited the field of myocardial plasticity. We evaluated the continuum of LV remodeling by serial echocardiographic imaging to define 3 stages of reverse cardiac remodeling following LVAD. METHODS The study enrolled consecutive LVAD patients across 4 study sites. A blinded echocardiographer evaluated the degree of structural (LV internal dimension at end-diastole [LVIDd]) and functional (LV ejection fraction [LVEF]) change after LVAD. Patients experiencing an improvement in LVEF ≥40% and LVIDd ≤6.0 cm were termed responders, absolute change in LVEF of ≥5% and LVEF <40% were termed partial responders, and the remaining patients with no significant improvement in LVEF were termed nonresponders. RESULTS Among 358 LVAD patients, 34 (10%) were responders, 112 (31%) partial responders, and the remaining 212 (59%) were nonresponders. The use of guideline-directed medical therapy for heart failure was higher in partial responders and responders. Structural changes (LVIDd) followed a different pattern with significant improvements even in patients who had minimal LVEF improvement. With mechanical unloading, the median reduction in LVIDd was -0.6 cm (interquartile range [IQR], -1.1 to -0.1 cm; nonresponders), -1.1 cm (IQR, -1.8 to -0.4 cm; partial responders), and -1.9 cm (IQR, -2.9 to -1.1 cm; responders). Similarly, the median change in LVEF was -2% (IQR, -6% to 1%), 9% (IQR, 6%-14%), and 27% (IQR, 23%-33%), respectively. CONCLUSIONS Reverse cardiac remodeling associated with durable LVAD support is not an all-or-none phenomenon and manifests in a continuous spectrum. Defining 3 stages across this continuum can inform clinical management, facilitate the field of myocardial plasticity, and improve the design of future investigations.
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Affiliation(s)
- Palak Shah
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Mitchell Psotka
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Iosif Taleb
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah,Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, Utah
| | - Rami Alharethi
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah
| | - Mortada A. Shams
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia,Division of Cardiology, George Washington University, Washington DC
| | - Omar Wever-Pinzon
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah,Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael Yin
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah,Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, Utah
| | - Federica Latta
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia,Department of Cardiology, University of Brescia, Italy, Brescia, Italy
| | - Josef Stehlik
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah
| | - James C. Fang
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah
| | - Guoqing Diao
- Department of Biostatistics and Bioinformatics, George Washington University, Washington DC
| | - Ramesh Singh
- Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Naila Ijaz
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Christos P. Kyriakopoulos
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah,Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, Utah
| | - Wei Zhu
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Christopher W. May
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Lauren B. Cooper
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah
| | - Shashank S. Desai
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah
| | - Craig H. Selzman
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah,Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, Utah
| | - Abdallah Kfoury
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah
| | - Stavros G. Drakos
- Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program (University of Utah Health & School of Medicine, Intermountain Medical Center & Salt Lake VA Medical Center), Salt Lake City, Utah,Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, Utah
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15
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Dandel M, Javier MFDM, Javier Delmo EM, Loebe M, Hetzer R. Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure. Cardiovasc Diagn Ther 2021; 11:226-242. [PMID: 33708495 DOI: 10.21037/cdt-20-288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although complete myocardial recovery after ventricular assist device (VAD) implantation is rather seldom, systematic search for recovery is worthwhile because for recovered patients weaning from VADs is feasible and can provide survival benefits with long-term freedom from heart failure (HF) recurrence, even if a chronic cardiomyopathy was the primary cause for the drug-refractory HF necessitating left ventricular (LVAD) or biventricular support (as bridge-to-transplantation or definitive therapy) and even if recovery remains incomplete. LVAD patients explanted for myoacardial recovery compared to those transplanted from LVAD support showed similar survival rates and a significant proportion of explanted patients can achieve cardiac and physical functional capacities that are within the normal range of healthy controls. In apparently sufficiently recovered patients, a major challenge remains still the pre-explant prediction of the weaning success which is meanwhile reliably possible for experienced clinicians. In weaning candidates, the combined use of certain echocardiography and right heart catheterization parameters recorded before VAD explantation can predict post-weaning cardiac stability with good accuracy. However, in the absence of standardization or binding recommendations, the protocols for assessment of native cardiac improvement and also the weaning criteria differ widely among centers. Currently there are still only few larger studies on myocardial recovery assessment after VAD implantation. Therefore, the weaning practice relies mostly on small case series, local practice patterns, and case reports, and the existing knowledge, as well as the partially differing recommendations which are based mainly on expert opinions, need to be periodically systematised. Addressing these shortcomings, our review aims to summarize the evidence and expert opinion on the evaluation of cardiac recovery during mechanical ventricular support by paying special attention to the reliability of the methods and parameters used for assessment of myocardial recovery and the challenges met in both evaluation of recovery and weaning decision making.
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Affiliation(s)
- Michael Dandel
- Department of Cardiology, Cardio Centrum Berlin, Berlin, Germany
| | | | | | - Matthias Loebe
- Thoracic Transplant and Mechanical Support, Miami Transplant Institute, Memorial Jackson Health System, University of Miami, Miami, Florida, USA
| | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
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16
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Briasoulis A, Inampudi C, Hatzis G, Asleh R. Management of Patients with Heart Failure: Focus on New Pharmaceutical and Device Options. Curr Med Chem 2020; 27:4522-4535. [DOI: 10.2174/0929867326666190523083747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/06/2018] [Accepted: 02/19/2019] [Indexed: 01/14/2023]
Abstract
Hospitalization rates and survival of patients with Heart Failure (HF) have improved.
However, 5-year mortality rates remain high and the prevalence of the disease is rising likely due to
aging of the population and advances in diagnosis and treatment of other acute and chronic cardiovascular
diseases. Over the past three decades the therapeutic armamentarium of heart failure has improved
substantially with development of medications targeting neuro-hormonal activation and devices
preventing sudden cardiac death and improving cardiac synchrony. Recently, inhibition of angiotensin
receptors and neprilysin as well as sinoatrial pacemaker modulating f-current, have been
found safe and effective strategies that improve HF hospitalization rates and/or mortality. Antidiabetic
agents inhibiting sodium-glucose co-transporters 2, result in natriuresis and osmotic diuresis
and may further improve HF related outcomes. Furthermore, emerging therapies such as cardiac myosin
activators, soluble guanylate cyclase stimulators and non-steroidal mineralocorticoid receptor
antagonists are undergoing investigation in phase II and III studies of HF patients. Finally, rapid evolution
of in the management of advanced HF has occurred with the application of second and third
generation continuous flow left ventricular assist devices in clinical practice. Ongoing clinical studies
will validate the safety and efficacy of emerging therapeutic strategies in HF population underrepresented
in previous clinical trials.
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Affiliation(s)
- Alexandros Briasoulis
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Chakradhari Inampudi
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Georgios Hatzis
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Rabea Asleh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN, United States
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17
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Cardiac regeneration as an environmental adaptation. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2020; 1867:118623. [DOI: 10.1016/j.bbamcr.2019.118623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/02/2019] [Accepted: 12/10/2019] [Indexed: 12/15/2022]
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18
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Tonna JE, McKellar SH, Selzman CH, Drakos S, Koliopoulou AG, Taleb I, Stoddard GJ, Stehlik J, Welt FGP, Fair JF, Stoddard K, Youngquist ST. Exploratory analysis of myocardial function after extracorporeal cardiopulmonary resuscitation vs conventional cardiopulmonary resuscitation. BMC Res Notes 2020; 13:137. [PMID: 32143688 PMCID: PMC7060522 DOI: 10.1186/s13104-020-04982-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/26/2020] [Indexed: 02/27/2023] Open
Abstract
Objective Ventricular unloading is associated with myocardial recovery. We sought to evaluate the association of extracorporeal cardiopulmonary resuscitation (ECPR) on myocardial function after cardiac arrest. We conducted a retrospective exploratory analysis, comparing ejection fraction (EF) after adult cardiac arrest, between ECPR and conventional CPR. Results Among 1119 cases of cardiac arrest, 116 had an echocardiogram post-return of spontaneous circulation (ROSC) and were included. Thirty-eight patients had ≥ 2 echocardiograms. ECPR patients had differences in age, hypertension and chronic heart failure. ECPR patients had a lower EF post-ROSC (24% vs 45%; p < 0.01) and were more likely to undergo percutaneous coronary intervention (25% vs 3%; p < 0.01). In multivariate analysis, only ECPR use (β-coeff: 10.4 [95% CI 3.68–17.13]; p < 0.01) independently predicted improved myocardial function. In this exploratory study, EF after cardiac arrest may be more likely to improve among ECPR patients than CCPR patients. Our methodology should be replicated to confirm or refute the validity of our findings.
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Affiliation(s)
- Joseph E Tonna
- Division of Emergency Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA. .,Division of Cardiothoracic Surgery, University of Utah School of Medicine, 30 N 1900 E, 3C127, Salt Lake City, UT, 84132, USA.
| | - Stephen H McKellar
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, 30 N 1900 E, 3C127, Salt Lake City, UT, 84132, USA
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, 30 N 1900 E, 3C127, Salt Lake City, UT, 84132, USA
| | - Stavros Drakos
- Division of Cardiology, University of Utah School of Medicine, Salt Lake City, USA
| | - Antigone G Koliopoulou
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, 30 N 1900 E, 3C127, Salt Lake City, UT, 84132, USA
| | - Iosif Taleb
- Division of Cardiology, University of Utah School of Medicine, Salt Lake City, USA
| | - Gregory J Stoddard
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, USA
| | - Josef Stehlik
- Division of Cardiology, University of Utah School of Medicine, Salt Lake City, USA
| | - Frederick G P Welt
- Division of Cardiology, University of Utah School of Medicine, Salt Lake City, USA
| | - James F Fair
- Division of Emergency Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | | | - Scott T Youngquist
- Division of Emergency Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
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19
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Gender Differences in Outcomes After Implantation of Left Ventricular Assist Devices. Ann Thorac Surg 2020; 109:780-786. [DOI: 10.1016/j.athoracsur.2019.07.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/22/2019] [Accepted: 07/09/2019] [Indexed: 01/06/2023]
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20
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Smith PA, Wang Y, Bieritz SA, Sampaio LC, Metcalfe RW, Cohn WE, Frazier OH. Hemodynamic Evaluation of an Intra-Atrial Blood Pump on a Pulsatile Mock Circulatory Loop. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:4508-4511. [PMID: 30441353 DOI: 10.1109/embc.2018.8513133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An intra-atrial pump (IAP) was proposed that would be affixed to the atrial septum to support the compromised left ventricle (LV) without harming the ventricular tissue in patients with early-stage heart failure. The IAP is designed to operate in parallel with the LV, drawing blood from the left atrium and unloading the LV. In previous hydraulic studies, different blade geometries were tested for the IAP; however, it is important to know how the blade geometry affects the IAP's hemodynamic performance in the human cardiovascular system. In this study, a mock circulatory loop (MCL) with physiological response was used to evaluate the hemodynamic effects of IAP blade geometry and connection configuration in the human cardiovascular system. In a $2 \times 2$ study, two different blade geometries (with steep vs flat pressure/flow curves) were tested in two different connection configurations: the proposed configuration (left atrium to aorta) and the conventional configuration for LVADs (LV to aorta). We found that atrial cannulation is feasible and creates a beneficial hemodynamic environment, although it is inferior to the one created by ventricular cannulation. The steepgradient pump performed better than the flat-gradient pump in atrial insertion.
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21
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Expanding the Scope of Multimodality Imaging in Durable Mechanical Circulatory Support. JACC Cardiovasc Imaging 2019; 13:1069-1081. [PMID: 31542528 DOI: 10.1016/j.jcmg.2019.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/13/2019] [Accepted: 05/24/2019] [Indexed: 01/01/2023]
Abstract
An increasing number of patients transition to advanced-stage heart failure refractory to medical therapy. Left ventricular assist systems (LVAS) provide a bridge to candidates awaiting heart transplantation and extended device durability allows permanent implantation referred to as destination therapy. Noninvasive imaging plays a pivotal role in the optimal management of patients implanted with durable mechanical circulatory support (MCS) devices. Several advances require an updated perspective of multi-modality imaging in contemporary LVAS management. First, there has been substantial evolution of devices such as the introduction of the fully magnetically levitated HeartMate 3 pump (Abbott, Abbott Park, Illinois). Second, imaging beyond the device, of the peripheral system, is increasingly recognized as clinically relevant. Third, U.S. Food and Drug Administration recalls have called attention to LVAS complications beyond pump thrombosis that are amenable to imaging-based diagnosis. Fourth, there is increased availability of multimodality imaging, such as computed tomography and positron emission tomography, at many centers across the world. In this review, the authors provide a practical and contemporary approach to multi-modality imaging of current-generation durable MCS devices. As the use of LVAS and other novel MCS devices increases globally, it is critical for clinicians caring for LVAS patients to understand the roles of various imaging modalities in patient evaluation and management.
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See Hoe LE, Bartnikowski N, Wells MA, Suen JY, Fraser JF. Hurdles to Cardioprotection in the Critically Ill. Int J Mol Sci 2019; 20:E3823. [PMID: 31387264 PMCID: PMC6695809 DOI: 10.3390/ijms20153823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease is the largest contributor to worldwide mortality, and the deleterious impact of heart failure (HF) is projected to grow exponentially in the future. As heart transplantation (HTx) is the only effective treatment for end-stage HF, development of mechanical circulatory support (MCS) technology has unveiled additional therapeutic options for refractory cardiac disease. Unfortunately, despite both MCS and HTx being quintessential treatments for significant cardiac impairment, associated morbidity and mortality remain high. MCS technology continues to evolve, but is associated with numerous disturbances to cardiac function (e.g., oxidative damage, arrhythmias). Following MCS intervention, HTx is frequently the destination option for survival of critically ill cardiac patients. While effective, donor hearts are scarce, thus limiting HTx to few qualifying patients, and HTx remains correlated with substantial post-HTx complications. While MCS and HTx are vital to survival of critically ill cardiac patients, cardioprotective strategies to improve outcomes from these treatments are highly desirable. Accordingly, this review summarizes the current status of MCS and HTx in the clinic, and the associated cardiac complications inherent to these treatments. Furthermore, we detail current research being undertaken to improve cardiac outcomes following MCS/HTx, and important considerations for reducing the significant morbidity and mortality associated with these necessary treatment strategies.
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Affiliation(s)
- Louise E See Hoe
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia.
- Faculty of Medicine, University of Queensland, Chermside 4032, Australia.
| | - Nicole Bartnikowski
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia
- Science and Engineering Faculty, Queensland University of Technology, Chermside 4032, Australia
| | - Matthew A Wells
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia
- School of Medical Science, Griffith University, Southport 4222, Australia
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia
- Faculty of Medicine, University of Queensland, Chermside 4032, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia
- Faculty of Medicine, University of Queensland, Chermside 4032, Australia
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Salutary Effects of the PULVAD, a Novel Implantable Counterpulsation Assist Device, on Cardiac Mechanoenergetics. ASAIO J 2019; 65:473-480. [DOI: 10.1097/mat.0000000000000838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Bonios MJ, Koliopoulou A, Wever-Pinzon O, Taleb I, Stehlik J, Xu W, Wever-Pinzon J, Catino A, Kfoury AG, Horne BD, Nativi-Nicolau J, Adamopoulos SN, Fang JC, Selzman CH, Bax JJ, Drakos SG. Cardiac Rotational Mechanics As a Predictor of Myocardial Recovery in Heart Failure Patients Undergoing Chronic Mechanical Circulatory Support: A Pilot Study. Circ Cardiovasc Imaging 2019; 11:e007117. [PMID: 29653930 DOI: 10.1161/circimaging.117.007117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/22/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Impaired qualitative and quantitative left ventricular (LV) rotational mechanics predict cardiac remodeling progression and prognosis after myocardial infarction. We investigated whether cardiac rotational mechanics can predict cardiac recovery in chronic advanced cardiomyopathy patients. METHODS AND RESULTS Sixty-three patients with advanced and chronic dilated cardiomyopathy undergoing implantation of LV assist device (LVAD) were prospectively investigated using speckle tracking echocardiography. Acute heart failure patients were prospectively excluded. We evaluated LV rotational mechanics (apical and basal LV twist, LV torsion) and deformational mechanics (circumferential and longitudinal strain) before LVAD implantation. Cardiac recovery post-LVAD implantation was defined as (1) final resulting LV ejection fraction ≥40%, (2) relative LV ejection fraction increase ≥50%, (iii) relative LV end-systolic volume decrease ≥50% (all 3 required). Twelve patients fulfilled the criteria for cardiac recovery (Rec Group). The Rec Group had significantly less impaired pre-LVAD peak LV torsion compared with the Non-Rec Group. Notably, both groups had similarly reduced pre-LVAD LV ejection fraction. By receiver operating characteristic curve analysis, pre-LVAD peak LV torsion of 0.35 degrees/cm had a 92% sensitivity and a 73% specificity in predicting cardiac recovery. Peak LV torsion before LVAD implantation was found to be an independent predictor of cardiac recovery after LVAD implantation (odds ratio, 0.65 per 0.1 degrees/cm [0.49-0.87]; P=0.014). CONCLUSIONS LV rotational mechanics seem to be useful in selecting patients prone to cardiac recovery after mechanical unloading induced by LVADs. Future studies should investigate the utility of these markers in predicting durable cardiac recovery after the explantation of the cardiac assist device.
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Affiliation(s)
- Michael J Bonios
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Antigone Koliopoulou
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Omar Wever-Pinzon
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Iosif Taleb
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Josef Stehlik
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Weining Xu
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - James Wever-Pinzon
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Anna Catino
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Abdallah G Kfoury
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Benjamin D Horne
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Jose Nativi-Nicolau
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Stamatis N Adamopoulos
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - James C Fang
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Craig H Selzman
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Jeroen J Bax
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.)
| | - Stavros G Drakos
- Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.).
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Abstract
Mechanical unloading with left ventricular assist device (LVAD) support can lead to clinically meaningful reversal of stress-related compensatory mechanisms. However, true assessment of left ventricular ejection fraction (LVEF) is not possible, whereas the left ventricle is unloaded by LVAD therapy making identification of patients with myocardial recovery even more challenging. We introduce our new protocol, the "reverse ramp test" for HeartWare HVAD, HeartMate II, and HeartMate 3. The reverse ramp is transthoracic echo (TTE) and right heart catheterization (RHC)-based protocol with LVAD turn down steps to minimal support allowing for a more accurate assessment of myocardial function.
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Eisen HJ. Left Ventricular Assist Devices (LVADS): History, Clinical Application and Complications. Korean Circ J 2019; 49:568-585. [PMID: 31243930 PMCID: PMC6597447 DOI: 10.4070/kcj.2019.0161] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022] Open
Abstract
Congestive heart failure is a major cause of morbidity and mortality as well as a major health care cost in the developed world. Despite the introduction of highly effective heart failure medical therapies and simple devices such as cardiac resynchronization therapy that reduce mortality, improve cardiac function and quality of life, there remains a large number of patients who do not respond to these therapies or whose heart failure progresses despite optimal therapy. For these patients, cardiac transplantation is an option but is limited by donor availability as well as co-morbidities which may limit survival post-transplant. For these patients, left ventricular assist devices (LVADs) offer an alternative that can improve survival as well as exercise tolerance and quality of life. These devices have continued to improve as technology has improved with substantially improved durability of the devices and fewer post-implant complications. Pump thrombosis, stroke, gastrointestinal bleeding and arrhythmias post-implant have become less common with the newest devices, making destination therapy where ventricular assist device are implanted permanently in patients with advanced heart failure, a reality and an appropriate option for many patients. This may offer an opportunity for long term survival in many patients. As the first of the totally implantable devices are introduced and go to clinical trials, LVADs may be introduced that may truly be alternatives to cardiac transplantation in selected patients. Post-implant right ventricular failure remains a significant complication and better ways to identify patients at risk as well as to manage this complication must be developed.
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Affiliation(s)
- Howard J Eisen
- Heart and Vascular Institute, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA.
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Eric Wu L, Tansley G, John Fraser F, Shaun Gregory D. In-Vitro Evaluation of Cardiac Energetics and Coronary Flow with Volume Displacement and Rotary Blood Pumps. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:5277-5281. [PMID: 30441528 DOI: 10.1109/embc.2018.8513158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bridge to recovery with left ventricular assist device (LVAD) support has been more prominent with volume displacement pumps (VDPs) than with rotary blood pumps (RBPs), which may be due to VDPs providing greater ventricular unloading and coronary artery flow. To compare ventricular unloading and coronary flow of VDPs and RBPs in a repeatable environment, a physiologic coronary circulation was added to a pre-existing mock circulatory loop. In this study, a physiologic coronary circulation, mimicking a healthy or diseased auto-regulatory response was implemented in a mock circulatory loop. Using the mock circulation loop, a VDP with original (Björk-Shiley) and then replacement (jellyfish) valves was operated in clinically recommended modes and compared to full and partial assist RBP operating at constant speed and rapid speed modulated modes. The Björk-Shiley VDP resulted in increased pressure-volume area, which resulted in greater coronary artery flow when compared to the improved jellyfish valves. Full assist RBP support reduced left ventricular stroke work, pressure-volume area and coronary flow compared to partial assist, whilst the effect of speed modulation modes was not as significant. Of all LVAD operating modes, the counter-pulsed VDP with jellyfish valves demonstrated the greatest reduction in pressure-volume area and improved coronary flow. This study provides a basis for further investigation into RBP speed modulation profiles to match the improved haemodynamic performance of VDPs.
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28
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Luc JGY, Tchantchaleishvili V. Update on Stem Cell-Based Therapy and Mechanical Cardiac Support: A North American Perspective. Artif Organs 2018; 42:866-870. [PMID: 30328627 DOI: 10.1111/aor.13334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Wright PT, Sanchez-Alonso JL, Lucarelli C, Alvarez-Laviada A, Poulet CE, Bello SO, Faggian G, Terracciano CM, Gorelik J. Partial Mechanical Unloading of the Heart Disrupts L-Type Calcium Channel and Beta-Adrenoceptor Signaling Microdomains. Front Physiol 2018; 9:1302. [PMID: 30283354 PMCID: PMC6157487 DOI: 10.3389/fphys.2018.01302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/29/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction: We investigated the effect of partial mechanical unloading (PMU) of the heart on the physiology of calcium and beta-adrenoceptor-cAMP (βAR-cAMP) microdomains. Previous studies have investigated PMU using a model of heterotopic-heart and lung transplantation (HTHAL). These studies have demonstrated that PMU disrupts the structure of cardiomyocytes and calcium handling. We sought to understand these processes by studying L-Type Calcium Channel (LTCC) activity and sub-type-specific βAR-cAMP signaling within cardiomyocyte membrane microdomains. Method: We utilized an 8-week model of HTHAL, whereby the hearts of syngeneic Lewis rats were transplanted into the abdomens of randomly assigned cage mates. A pronounced atrophy was observed in hearts after HTHAL. Cardiomyocytes were isolated via enzymatic perfusion. We utilized Förster Resonance Energy Transfer (FRET) based cAMP-biosensors and scanning ion conductance microscopy (SICM) based methodologies to study localization of LTCC and βAR-cAMP signaling. Results: β2AR-cAMP responses measured by FRET in the cardiomyocyte cytosol were reduced by PMU (loaded 28.51 ± 7.18% vs. unloaded 10.84 ± 3.27% N,n 4/10-13 mean ± SEM ∗p < 0.05). There was no effect of PMU on β2AR-cAMP signaling in RII_Protein Kinase A domains. β1AR-cAMP was unaffected by PMU in either microdomain. Consistent with this SICM/FRET analysis demonstrated that β2AR-cAMP was specifically reduced in t-tubules (TTs) after PMU (loaded TT 0.721 ± 0.106% vs. loaded crest 0.104 ± 0.062%, unloaded TT 0.112 ± 0.072% vs. unloaded crest 0.219 ± 0.084% N,n 5/6-9 mean ± SEM ∗∗p < 0.01, ∗∗∗p < 0.001 vs. loaded TT). By comparison β1AR-cAMP responses in either TT or sarcolemmal crests were unaffected by the PMU. LTCC occurrence and open probability (Po) were reduced by PMU (loaded TT Po 0.073 ± 0.011% vs. loaded crest Po 0.027 ± 0.006% N,n 5/18-26 mean ± SEM ∗p < 0.05) (unloaded TT 0.0350 ± 0.003% vs. unloaded crest Po 0.025 N,n 5/20-30 mean ± SEM NS #p < 0.05 unloaded vs. loaded TT). We discovered that PMU had reduced the association between Caveolin-3, Junctophilin-2, and Cav1.2. Discussion: PMU suppresses’ β2AR-cAMP and LTCC activity. When activated, the signaling of β2AR-cAMP and LTCC become more far-reaching after PMU. We suggest that a situation of ‘suppression/decompartmentation’ is elicited by the loss of refined cardiomyocyte structure following PMU. As PMU is a component of modern device therapy for heart failure this study has clinical ramifications and raises important questions for regenerative medicine.
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Affiliation(s)
- Peter T Wright
- Myocardial Function, National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine, Hammersmith Hospital, London, United Kingdom
| | - Jose L Sanchez-Alonso
- Myocardial Function, National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine, Hammersmith Hospital, London, United Kingdom
| | - Carla Lucarelli
- Myocardial Function, National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine, Hammersmith Hospital, London, United Kingdom.,Department of Cardiac Surgery, School of Medicine, University of Verona, Verona, Italy
| | - Anita Alvarez-Laviada
- Myocardial Function, National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine, Hammersmith Hospital, London, United Kingdom
| | - Claire E Poulet
- Myocardial Function, National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine, Hammersmith Hospital, London, United Kingdom
| | - Sean O Bello
- Myocardial Function, National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine, Hammersmith Hospital, London, United Kingdom
| | - Giuseppe Faggian
- Department of Cardiac Surgery, School of Medicine, University of Verona, Verona, Italy
| | - Cesare M Terracciano
- Myocardial Function, National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine, Hammersmith Hospital, London, United Kingdom
| | - Julia Gorelik
- Myocardial Function, National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine, Hammersmith Hospital, London, United Kingdom
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Combining Stem Cell Therapy for Advanced Heart Failure and Ventricular Assist Devices: A Review. ASAIO J 2018. [DOI: 10.1097/mat.0000000000000782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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31
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Medvedofsky D, Mor-Avi V, Sayer G, Addetia K, Kruse E, Adatya S, Kim G, Weinert L, Yamat M, Ota T, Jeevanandam V, Uriel N, Lang RM. Residual native left ventricular function optimization using quantitative 3D echocardiographic assessment of rotational mechanics in patients with left ventricular assist devices. Echocardiography 2018; 35:1606-1615. [DOI: 10.1111/echo.14101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Diego Medvedofsky
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | - Victor Mor-Avi
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | - Gabriel Sayer
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | - Karima Addetia
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | - Eric Kruse
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | - Sirtaz Adatya
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | - Gene Kim
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | - Lynn Weinert
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | - Megan Yamat
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | - Takeyoshi Ota
- Department of Surgery; University of Chicago Medical Center; Chicago Illinois
| | | | - Nir Uriel
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
| | - Roberto M. Lang
- Department of Medicine; University of Chicago Medical Center; Chicago Illinois
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The Effect of Left Ventricular Assist Device Therapy on Cardiac Biomarkers: Implications for the Identification of Myocardial Recovery. Curr Heart Fail Rep 2018; 15:250-259. [DOI: 10.1007/s11897-018-0399-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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33
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Sustained Cardiac Recovery Hinges on Timing and Natural History of Underlying Condition. Am J Med Sci 2018; 356:47-55. [DOI: 10.1016/j.amjms.2018.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/14/2017] [Accepted: 02/21/2018] [Indexed: 01/12/2023]
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Di Franco S, Amarelli C, Montalto A, Loforte A, Musumeci F. Biomaterials and heart recovery: cardiac repair, regeneration and healing in the MCS era: a state of the "heart". J Thorac Dis 2018; 10:S2346-S2362. [PMID: 30123575 PMCID: PMC6081365 DOI: 10.21037/jtd.2018.01.85] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 01/12/2018] [Indexed: 01/31/2023]
Abstract
Regenerative medicine is an emerging interdisciplinary field of scientific research that, supported by tissue engineering is, nowadays, a valuable and reliable solution dealing with the actual organs shortage and the unresolved limits of biological or prosthetic materials used in repair and replacement of diseased or damaged human tissues and organs. Due to the improvements in design and materials, and to the changing of clinical features of patients treated for valvular heart disease the distance between the ideal valve and the available prostheses has been shortened. We will then deal with the developing of new tools aiming at replacing or repair cardiac tissues that still represent an unmet clinical need for the surgeons and indeed for their patients. In the effort of improving treatment for the cardiovascular disease (CVD), scientists struggle with the lack of self-regenerative capacities of finally differentiated cardiovascular tissues. In this context, using several converging technological approaches, regenerative medicine moves beyond traditional transplantation and replacement therapies and can restore tissue impaired function. It may also play an essential role in surgery daily routine, leading to produce devices such as injectable hydrogels, cardiac patches, bioresorbable stents and vascular grafts made by increasingly sophisticated biomaterial scaffolds; tailored devices promptly fabricated according to surgeon necessity and patient anatomy and pathology will hopefully represent a daily activity in the next future. The employment of these devices, still far from the in vitro reproduction of functional organs, has the main aim to achieve a self-renewal process in damaged tissues simulating endogenous resident cell populations. In this field, the collaboration and cooperation between cardiothoracic surgeons and bioengineers appear necessary to modify these innovative devices employed in preclinical studies according to the surgeon's needs.
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Affiliation(s)
- Sveva Di Franco
- Department of Anaesthesiology and Critical Care Medicine, L. Vanvitelli University, Naples, Italy
| | - Cristiano Amarelli
- Department of Cardiovascular Surgery and Transplants, Monaldi Hospital, Azienda dei Colli, Naples, Italy
| | - Andrea Montalto
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Antonio Loforte
- Department of Cardiovascular Surgery and Transplantation, S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Francesco Musumeci
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
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Isovolumic loading of the failing heart by intraventricular placement of a spring expander attenuates cardiac atrophy after heterotopic heart transplantation. Biosci Rep 2018; 38:BSR20180371. [PMID: 29743195 PMCID: PMC6019382 DOI: 10.1042/bsr20180371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/20/2018] [Accepted: 04/30/2018] [Indexed: 12/21/2022] Open
Abstract
Cardiac atrophy is the most common complication of prolonged application of the left ventricle (LV) assist device (LVAD) in patients with advanced heart failure (HF). Our aim was to evaluate the course of unloading-induced cardiac atrophy in rats with failing hearts, and to examine if increased isovolumic loading obtained by intraventricular implantation of an especially designed spring expander would attenuate this process. Heterotopic abdominal heart transplantation (HTx) was used as a rat model of heart unloading. HF was induced by volume overload achieved by creation of the aorto-caval fistula (ACF). The degree of cardiac atrophy was assessed as the weight ratio of the heterotopically transplanted heart (HW) to the control heart. Isovolumic loading was increased by intraventricular implantation of a stainless steel three-branch spring expander. The course of cardiac atrophy was evaluated on days 7, 14, 21, and 28 after HTx Seven days unloading by HTx in failing hearts sufficed to substantially decrease the HW (-59 ± 3%), the decrease progressed when measured on days 14, 21, and 28 after HTx Implantation of the spring expander significantly reduced the decreases in whole HW at all the time points (-39 ± 3 compared with -59 ± 3, -52 ± 2 compared with -69 ± 3, -51 ± 2 compared with -71 ± 2, and -44 ± 2 compared with -71 ± 3%, respectively; P<0.05 in each case). We conclude that the enhanced isovolumic heart loading obtained by implantation of the spring expander attenuates the development of unloading-induced cardiac atrophy in the failing rat heart.
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Briasoulis A, Inampudi C, Akintoye E, Adegbala O, Asleh R, Alvarez P, Bhama J. Regional Variation in Mortality, Major Complications, and Cost After Left Ventricular Assist Device Implantation in the United States (2009 to 2014). Am J Cardiol 2018; 121:1575-1580. [PMID: 29731117 DOI: 10.1016/j.amjcard.2018.02.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/14/2018] [Accepted: 02/26/2018] [Indexed: 11/26/2022]
Abstract
The objective of this analysis was to provide evidence on regional differences in outcomes, cost and disposition among patients who undergo continuous-flow LVAD implantation. Using data from the National Inpatient Sample and US Census Bureau, annual national estimates in utilization, in-hospital mortality, major complications, cost, length of stay (LOS), and disposition were estimated for years 2009 to 2014. Main outcomes and complications were identified using patient safety indicators and International Classification of Diseases-Ninth Revision, Clinical Modification codes. We analyzed a total of 3,572 (weighted = 17,552) patients with LVAD implants among the 4 Census regions of the United States. The patient population in the Southern region was younger with higher percentage of African-Americans. Overall, the comorbidity burden was higher in the Midwest. The risk-adjusted rate of in-hospital mortality did not differ significantly among the geographical regions (p = 0.8). With the exception of cardiac tamponade rates which were higher in the Northeast and West, all other post-operative complications did not differ between regions. LOS was higher in the Northeast (median 32 days) and lower in the South (median 27 days). The cost analysis suggested higher median cost in the West (median $246,292) and lowest in the Northeast region (median $192,604). Finally, higher percentages of patients were transferred to an extended care facility in the Northeast, whereas more patients were discharged to home in the Western region. We identified region disparities in LOS, cost and disposition but not in-hospital mortality and complications, among patients who underwent LVAD implantation between 2009 and 2014.
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Briasoulis A, Inampudi C, Akintoye E, Adegbala O, Alvarez P, Bhama J. Trends in Utilization, Mortality, Major Complications, and Cost After Left Ventricular Assist Device Implantation in the United States (2009 to 2014). Am J Cardiol 2018. [PMID: 29525059 DOI: 10.1016/j.amjcard.2018.01.041] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The utilization of contemporary continuous-flow left ventricular assist device (CF-LVADs) has increased, accounting for >90% of implants from 2009 to 2014. The present study aimed to identify the annual national estimates in utilization, in-hospital mortality, and major complications with CF-LVAD using data from the National Inpatient Sample, the largest all-payer inpatient data set in the United States, and the US Census Bureau, for the years 2009 to 2014. Participants included all adult patients who received CF-LVADs from 2009 to 2014. End points included in-hospital mortality, in-hospital complications, length of stay, cost, and disposition at the time of discharge. A total of 3,572 (weighted = 17,552) patients with left ventricular assist device (LVAD) implants were analyzed. LVAD implants increased significantly, with average annual change (%) of +12.6% (p <0.001). Rates of in-hospital mortality decreased by average annual rate of -5.3% (p = 0.02). The rates of major complications including ischemic stroke, major bleeding, and cardiac tamponade did not change significantly over the study period. However, we found a significant decrease in postoperative infections (p = 0.001) and respiratory complications (p = 0.03). Although the length of stay and disposition patterns did not change over time, we found a significant decrease in cost of hospitalization (p = 0.001). In conclusion, from 2009 to 2014, utilization of LVADs increased with concomitant decrease in in-hospital mortality rates, without significant changes in major complications.
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Affiliation(s)
- Alexandros Briasoulis
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Chakradhari Inampudi
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Emmanuel Akintoye
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Oluwole Adegbala
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Paulino Alvarez
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jay Bhama
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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38
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Early Recognition of Heart Failure: A Call for Action. J Card Fail 2018; 24:310-312. [DOI: 10.1016/j.cardfail.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 11/24/2022]
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39
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Lee SE, Nguyen C, Yoon J, Chang HJ, Kim S, Kim CH, Li D. Three-dimensional Cardiomyocytes Structure Revealed By Diffusion Tensor Imaging and Its Validation Using a Tissue-Clearing Technique. Sci Rep 2018; 8:6640. [PMID: 29703900 PMCID: PMC5923209 DOI: 10.1038/s41598-018-24622-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/06/2018] [Indexed: 01/30/2023] Open
Abstract
We characterized the microstructural response of the myocardium to cardiovascular disease using diffusion tensor imaging (DTI) and performed histological validation by intact, un-sectioned, three-dimensional (3D) histology using a tissue-clearing technique. The approach was validated in normal (n = 7) and ischemic (n = 8) heart failure model mice. Whole heart fiber tracking using DTI in fixed ex-vivo mouse hearts was performed, and the hearts were processed with the tissue-clearing technique. Cardiomyocytes orientation was quantified on both DTI and 3D histology. Helix angle (HA) and global HA transmurality (HAT) were calculated, and the DTI findings were confirmed with 3D histology. Global HAT was significantly reduced in the ischemic group (DTI: 0.79 ± 0.13°/% transmural depth [TD] and 3D histology: 0.84 ± 0.26°/%TD) compared with controls (DTI: 1.31 ± 0.20°/%TD and 3D histology: 1.36 ± 0.27°/%TD, all p < 0.001). On direct comparison of DTI with 3D histology for the quantitative assessment of cardiomyocytes orientation, significant correlations were observed in both per-sample (R2 = 0.803) and per-segment analyses (R2 = 0.872). We demonstrated the capability and accuracy of DTI for mapping cardiomyocytes orientation by comparison with the intact 3D histology acquired by tissue-clearing technique. DTI is a promising tool for the noninvasive characterization of cardiomyocytes architecture.
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Affiliation(s)
- Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, 03722, South Korea
- Integrative Cardiovascular Imaging Center, Yonsei University Health System, Seoul, 03722, South Korea
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Christopher Nguyen
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Jongjin Yoon
- Departement of Pharmacology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, 03722, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, 03722, South Korea.
- Integrative Cardiovascular Imaging Center, Yonsei University Health System, Seoul, 03722, South Korea.
| | - Sekeun Kim
- Integrative Cardiovascular Imaging Center, Yonsei University Health System, Seoul, 03722, South Korea
- Graduate School of Biomedical Engineering, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Chul Hoon Kim
- Departement of Pharmacology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, 03722, Korea
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
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Unkovic P, Basuray A. Heart Failure with Recovered EF and Heart Failure with Mid-Range EF: Current Recommendations and Controversies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:35. [PMID: 29616374 DOI: 10.1007/s11936-018-0628-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW This review explores key features and potential management controversies in two emerging populations in heart failure: heart failure with recovered ejection fraction (HF-recovered EF) and heart failure with mid-range ejection fraction (HFmrEF). RECENT FINDINGS While HF-recovered EF patients have better outcomes than heart failure with reduced ejection fraction (HFrEF), they continue to have symptoms, persistent biomarker elevations, and abnormal outcomes suggesting a continued disease process. HFmrEF patients appear to have features of HFrEF and heart failure with preserved ejection fraction (HFpEF), but have a high prevalence of ischemic heart disease and may represent a transitory phase between the HFrEF and HFpEF. Management strategies have insufficient data to warrant standardization at this time. HF-recovered EF and HFmrEF represent new populations with unmet needs and expose the pitfalls of an EF basis for heart failure classification.
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41
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Chera HH, Nagar M, Chang NL, Morales-Mangual C, Dous G, Marmur JD, Ihsan M, Madaj P, Rosen Y. Overview of Impella and mechanical devices in cardiogenic shock. Expert Rev Med Devices 2018; 15:293-299. [DOI: 10.1080/17434440.2018.1456334] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hymie Habib Chera
- Division of Cardiology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Menachem Nagar
- Division of Cardiology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Nai-Lun Chang
- Division of Cardiology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - George Dous
- Division of Cardiology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Jonathan D. Marmur
- Division of Cardiology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Muhammad Ihsan
- Division of Cardiology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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42
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Pokorný M, Mrázová I, Malý J, Pirk J, Netuka I, Vaňourková Z, Doleželová Š, Červenková L, Maxová H, Melenovský V, Šochman J, Sadowski J, Červenka L. Effects of increased myocardial tissue concentration of myristic, palmitic and palmitoleic acids on the course of cardiac atrophy of the failing heart unloaded by heterotopic transplantation. Physiol Res 2018; 67:13-30. [PMID: 29137478 DOI: 10.33549/physiolres.933637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The present experiments were performed to evaluate if increased heart tissue concentration of fatty acids, specifically myristic, palmitic and palmitoleic acids that are believed to promote physiological heart growth, can attenuate the progression of unloading-induced cardiac atrophy in rats with healthy and failing hearts. Heterotopic abdominal heart transplantation (HT(x)) was used as a model for heart unloading. Cardiac atrophy was assessed from the ratio of the native- to-transplanted heart weight (HW). The degree of cardiac atrophy after HT(x) was determined on days 7, 14, 21 and 28 after HT(x) in recipients of either healthy or failing hearts. HT(x) of healthy hearts resulted in 23+/-3, 46+/-3, 48+/-4 and 46+/-4 % HW loss at the four time-points. HT(x) of the failing heart resulted in even greater HW losses, of 46+/-4, 58+/-3, 66+/-2 and 68+/-4 %, respectively (P<0.05). Activation of "fetal gene cardiac program" (e.g. beta myosin heavy chain gene expression) and "genes reflecting cardiac remodeling" (e.g. atrial natriuretic peptide gene expression) after HT(x) was greater in failing than in healthy hearts (P<0.05 each time). Exposure to isocaloric high sugar diet caused significant increases in fatty acid concentrations in healthy and in failing hearts. However, these increases were not associated with any change in the course of cardiac atrophy, similarly in healthy and post-HT(x) failing hearts. We conclude that increasing heart tissue concentrations of the fatty acids allegedly involved in heart growth does not attenuate the unloading-induced cardiac atrophy.
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Affiliation(s)
- M Pokorný
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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43
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Tang HM, Fung MC, Tang HL. Detecting Anastasis In Vivo by CaspaseTracker Biosensor. J Vis Exp 2018. [PMID: 29443051 DOI: 10.3791/54107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Anastasis (Greek for "rising to life") is a recently discovered cell recovery phenomenon whereby dying cells can reverse late-stage cell death processes that are generally assumed to be intrinsically irreversible. Promoting anastasis could in principle rescue or preserve injured cells that are difficult to replace such as cardiomyocytes or neurons, thereby facilitating tissue recovery. Conversely, suppressing anastasis in cancer cells, undergoing apoptosis after anti-cancer therapies, may ensure cancer cell death and reduce the chances of recurrence. However, these studies have been hampered by the lack of tools for tracking the fate of cells that undergo anastasis in live animals. The challenge is to identify the cells that have reversed the cell death process despite their morphologically normal appearance after recovery. To overcome this difficulty, we have developed Drosophila and mammalian CaspaseTracker biosensor systems that can identify and permanently track the anastatic cells in vitro or in vivo. Here, we present in vivo protocols for the generation and use of the CaspaseTracker dual biosensor system to detect and track anastasis in Drosophila melanogaster after transient exposure to cell death stimuli. While conventional biosensors and protocols can label cells actively undergoing apoptotic cell death, the CaspaseTracker biosensor can permanently label cells that have recovered after caspase activation - a hallmark of late-stage apoptosis, and simultaneously identify active apoptotic processes. This biosensor can also track the recovery of the cells that attempted other forms of cell death that directly or indirectly involved caspase activity. Therefore, this protocol enables us to continuously track the fate of these cells and their progeny, facilitating future studies of the biological functions, molecular mechanisms, physiological and pathological consequences, and therapeutic implications of anastasis. We also discuss the appropriate controls to distinguish cells that undergo anastasis from those that display non-apoptotic caspase activity in vivo.
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Affiliation(s)
- Ho Man Tang
- Institute for Basic Biomedical Sciences, Johns Hopkins University School of Medicine; School of Life Sciences, Chinese University of Hong Kong;
| | - Ming Chiu Fung
- School of Life Sciences, Chinese University of Hong Kong;
| | - Ho Lam Tang
- Department of Neurosurgery, Johns Hopkins University School of Medicine;
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44
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Diakos NA, Passi S, Taleb I, Kfoury AG, Drakos SG. Regional myocardial structural characteristics in ischemic and non-ischemic cardiomyopathy: Left ventricle versus right and apex versus base. J Heart Lung Transplant 2018; 37:166-169. [DOI: 10.1016/j.healun.2017.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 07/10/2017] [Accepted: 07/26/2017] [Indexed: 11/26/2022] Open
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Cai AW, Islam S, Hankins SR, Fischer W, Eisen HJ. Mechanical Circulatory Support in the Treatment of Advanced Heart Failure. Am J Transplant 2017; 17:3020-3032. [PMID: 28643428 DOI: 10.1111/ajt.14403] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 01/25/2023]
Abstract
According to the Centers for Disease Control, heart failure (HF) remains a pervasive condition with high morbidity and mortality, affecting 5.8 million people in the United States and 23 million worldwide. For patients with refractory end-stage HF, heart transplantation is the "gold standard" for definitive treatment. However, the demand for heart transplantation has consistently exceeded the availability of donor hearts, with approximately 2331 orthotopic heart transplantations performed in the United States in 2015 despite an estimated 100 000 to 250 000 patients with New York Heart Association class IIIB or IV symptoms that are refractory to medical treatment, making such patients potential transplant candidates. As such, the need for mechanical circulatory support (MCS) to treat patients with end-stage HF has become paramount. In this review, we focus on the history, advancements, and current use of durable MCS device therapy in the treatment of advanced heart failure.
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Affiliation(s)
- A W Cai
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - S Islam
- Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA
| | - S R Hankins
- Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA
| | - W Fischer
- Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA
| | - H J Eisen
- Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA
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46
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Rossing K, Gustafsson F. Medical and mechanical unloading in advanced heart failure: hope for cardiac recovery? Eur J Heart Fail 2017; 20:175-177. [PMID: 29164755 DOI: 10.1002/ejhf.1081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/15/2017] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kasper Rossing
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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47
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Catino AB, Ferrin P, Wever-Pinzon J, Horne BD, Wever-Pinzon O, Kfoury AG, McCreath L, Diakos NA, McKellar S, Koliopoulou A, Bonios MJ, Al-Sarie M, Taleb I, Dranow E, Fang JC, Drakos SG. Clinical and histopathological effects of heart failure drug therapy in advanced heart failure patients on chronic mechanical circulatory support. Eur J Heart Fail 2017; 20:164-174. [PMID: 29094485 DOI: 10.1002/ejhf.1018] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/27/2017] [Accepted: 08/28/2017] [Indexed: 01/22/2023] Open
Abstract
AIMS Adjuvant heart failure (HF) drug therapy in patients undergoing chronic mechanical circulatory support (MCS) is often used in conjunction with a continuous-flow left ventricular assist device (LVAD), but its potential impact is not well defined. The objective of the present study was to examine the effects of conventional HF drug therapy on myocardial structure and function, peripheral organ function and the incidence of adverse events in the setting of MCS. METHODS AND RESULTS Patients with chronic HF requiring LVAD support were prospectively enrolled. Paired myocardial tissue samples were obtained prior to LVAD implantation and at transplantation for histopathology. The Meds group comprised patients treated with neurohormonal blocking therapy (concurrent beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and aldosterone antagonist), and the No Meds group comprised patients on none of these. Both the Meds (n = 37) and No Meds (n = 44) groups experienced significant improvements in cardiac structure and function over the 6 months following LVAD implantation. The degree of improvement was greater in the Meds group, including after adjustment for baseline differences. There were no differences between the two groups in arrhythmias, end-organ injury, or neurological events. In patients with high baseline pre-LVAD myocardial fibrosis, treatment with HF drug therapy was associated with a reduction in fibrosis. CONCLUSIONS Clinical and histopathological evidence showed that adjuvant HF drug therapy was associated with additional favourable effects on the structure and function of the unloaded myocardium that extended beyond the beneficial effects attributed to LVAD-induced unloading alone. Adjuvant HF drug therapy did not influence the incidence of major post-LVAD adverse events during the follow-up period.
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Affiliation(s)
- Anna B Catino
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Peter Ferrin
- Nora Eccles Harrison Cardiovascular Research and Training Institution (CVRTI), Salt Lake City, UT, USA
| | - James Wever-Pinzon
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Benjamin D Horne
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Omar Wever-Pinzon
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Abdallah G Kfoury
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Lauren McCreath
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA.,Nora Eccles Harrison Cardiovascular Research and Training Institution (CVRTI), Salt Lake City, UT, USA
| | - Nikolaos A Diakos
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA.,Nora Eccles Harrison Cardiovascular Research and Training Institution (CVRTI), Salt Lake City, UT, USA
| | - Stephen McKellar
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Antigone Koliopoulou
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Michael J Bonios
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Mohammad Al-Sarie
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Iosif Taleb
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Elizabeth Dranow
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - James C Fang
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Stavros G Drakos
- Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Divisions of Cardiovascular Medicine and Cardiovascular Surgery, University of Utah Health Sciences Center, Salt Lake VA Medical Center, Intermountain Medical Center, Salt Lake City, UT, USA.,Nora Eccles Harrison Cardiovascular Research and Training Institution (CVRTI), Salt Lake City, UT, USA.,Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
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48
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Particle image velocimetry tests on pediatric 45-cc and 30-cc ventricle assist devices: effects of heart rate on VAD operation. Int J Artif Organs 2017; 40:558-562. [PMID: 28708210 PMCID: PMC6159851 DOI: 10.5301/ijao.5000618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study investigated flow analysis inside pediatric ventricle assist devices (VADs) designed and manufactured at the Foundation for Cardiac Surgery Development (FRK), Zabrze, Poland. The main goal of the experiment was to define the minimal heart rate admissible in clinical practice. METHODS The flow was directed by mechanical, single-disc valves developed at the Lodz University of Technology, Institute of Turbomachinery in Lodz, Poland. VAD operation conditions under different heart rates were analyzed. Measurements were performed on Religa PED pediatric VADs (45 cm3 and 30 cm3) with a particle image velocimetry (PIV) system. RESULTS Due to the PIV method used, the measurements were made without interference of the measuring system onto the flow structure in the investigated channel, as the measurement procedure is noninvasive. During the investigations conducted in different measurement planes, the majority of the flow volume in the chamber was observable. CONCLUSIONS The measurements at different heart rates demonstrated a significant influence of this parameter on the flow nature in the heart ventricle. Additionally, it was found that the heart rate affected the operation of heart valves in the VAD.
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49
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Advancing the science of myocardial recovery with mechanical circulatory support: A Working Group of the National, Heart, Lung, and Blood Institute. J Thorac Cardiovasc Surg 2017. [DOI: 10.1016/j.jtcvs.2017.03.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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50
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Wever-Pinzon J, Selzman CH, Stoddard G, Wever-Pinzon O, Catino A, Kfoury AG, Diakos NA, Reid BB, McKellar S, Bonios M, Koliopoulou A, Budge D, Kelkhoff A, Stehlik J, Fang JC, Drakos SG. Impact of Ischemic Heart Failure Etiology on Cardiac Recovery During Mechanical Unloading. J Am Coll Cardiol 2017; 68:1741-1752. [PMID: 27737740 DOI: 10.1016/j.jacc.2016.07.756] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Small-scale studies focused mainly on nonischemic cardiomyopathy (NICM) have shown that a subset of left ventricular assist device (LVAD) patients can achieve significant improvement of their native heart function, but the impact of ischemic cardiomyopathy (ICM) has not been specifically investigated. Many patients with acute myocardial infarction are discharged from their index hospitalization without heart failure (HF), only to return much later with overt HF syndrome, mainly caused by chronic remodeling of the noninfarcted region of the myocardium. OBJECTIVES This study sought to prospectively investigate the effect of ICM HF etiology on LVAD-associated improvement of cardiac structure and function using NICM as control. METHODS Consecutive patients (n = 154) with documented chronic and dilated cardiomyopathy (ICM, n = 61; NICM, n = 93) requiring durable support with continuous-flow LVAD were prospectively evaluated with serial echocardiograms and right heart catheterizations. RESULTS In patients supported with LVAD for at least 6 months, we found that 5% of subjects with ICM and 21% of subjects with NICM achieved left ventricular ejection fraction ≥40% (p = 0.034). LV end-diastolic and end-systolic volumes and diastolic function were significantly and similarly improved in patients with ICM and NICM. CONCLUSIONS LVAD-associated unloading for 6 months resulted in a substantial improvement in myocardial structure, and systolic and diastolic function in 1 in 20 ICM and 1 in 5 NICM patients. These specific incidence and timeline findings may provide guidance in clinical practice and research design for sequencing and prioritizing advanced HF and heart transplantation therapeutic options in patients with ICM and NICM.
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Affiliation(s)
- James Wever-Pinzon
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Craig H Selzman
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; University of Utah Molecular Medicine Program, Salt Lake City, Utah
| | - Greg Stoddard
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Omar Wever-Pinzon
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Anna Catino
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Abdallah G Kfoury
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Nikolaos A Diakos
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; University of Utah Molecular Medicine Program, Salt Lake City, Utah
| | - Bruce B Reid
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Stephen McKellar
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; University of Utah Molecular Medicine Program, Salt Lake City, Utah
| | - Michael Bonios
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Antigone Koliopoulou
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Deborah Budge
- University of Utah Molecular Medicine Program, Salt Lake City, Utah
| | - Aaron Kelkhoff
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Josef Stehlik
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - James C Fang
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Stavros G Drakos
- Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Health Sciences Center, Intermountain Medical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; University of Utah Molecular Medicine Program, Salt Lake City, Utah.
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