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Zhu Z, Zhu J, Yu J, Xu K, Tang Y, Fang Y, Gu S, Su X, Ding F, Ali WB, Modine T, Zhang R. Percutaneous Ventricular Restoration Prevents Left Ventricular Remodeling Post Myocardial Infarction: One-Year Evaluation of the Heartech First-in-man Study. J Card Fail 2022; 28:604-613. [DOI: 10.1016/j.cardfail.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
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Zhu Z, Yu J, Xu K, Tang Y, Fang Y, Gu J, Gu S, Ding F, Modine T, Zhang R. First-in-man study of Heartech® percutaneous left ventricular partitioning device for treatment of heart failure postmyocardial infarction. Catheter Cardiovasc Interv 2019; 94:845-853. [PMID: 31231944 DOI: 10.1002/ccd.28366] [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: 01/11/2019] [Revised: 04/26/2019] [Accepted: 05/28/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This first-in-man (FIM) study aimed to determine the safety and efficacy of the Heartech® left ventricular partitioning device (LVPD) in patients with chronic heart failure (HF) postmyocardial infarction. METHODS Sixteen patients were enrolled from three cardiac intervention centers in China. All patients underwent percutaneous ventricular restoration (PVR) procedures with implantation of the Heartech® LVPD. Safety and immediate success rates were recorded. Major adverse cardiovascular and cerebrovascular events (MACCEs) including all-cause mortality, myocardial infarction, stroke, emergent or selective surgery or interventional therapy, renal failure requiring hemodialysis, and major bleeding were recorded. Efficacy features included functional status, echocardiographic characteristics, life quality characteristics including peak oxygen consumption of cardiopulmonary exercise testing (CPET), European five-dimensional health scale (EQ-5D), 6-min walk test (6MWT) at baseline and during follow-up (NCT02938637). RESULTS The device success rate was 93.75% (15 successes in 16 patients) with 100% safety. During follow-up of 36 ± 4.5 days, no MACCEs were found. The left ventricular end-systolic volume index decreased significantly (LVESVi, 72.47 ± 22.77 mL/m2 vs. 50.13 ± 13.36 mL/m2 , p < .001) as did left ventricular end diastolic volume index (LVEDVi, 106.27 ± 28.01 mL/m2 vs. 83.20 ± 16.87 mL/m2 , p = .001). Left ventricular ejection fraction (LVEF, 32.47 ± 6.98% vs. 40.41 ± 6.15, p < .001), 6MWT (383.13 ± 108.70 vs. 453.47 ± 88.24, p < 0.001) and EQ-5D (65.93 ± 11.25 vs. 78.67 ± 8.35, p < .001) improved significantly. CONCLUSIONS Heartech® LVPD appeared to be safe and effective for treatment of HF postmyocardial infarction.
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Affiliation(s)
- Zhengbin Zhu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Cardiovascular Research institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiwei Yu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Xu
- Department of Cardiology, The General Hospital of Shenyang Military, Shenyang, Liaoning, China
| | - Yimin Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Yuehua Fang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Cardiovascular Research institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianing Gu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengjia Gu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Cardiovascular Research institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Thomas Modine
- Shanghai Jiao Tong University, Shanghai, China.,Institut Coeur Poumon, CHRU de Lille, Lille, Nord, France
| | - Ruiyan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Cardiovascular Research institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hendriks T, Schurer RAJ, Al Ali L, van den Heuvel AFM, van der Harst P. Left ventricular restoration devices post myocardial infarction. Heart Fail Rev 2018; 23:871-883. [PMID: 29770903 PMCID: PMC6208878 DOI: 10.1007/s10741-018-9711-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Even in the era of percutaneous reperfusion therapy, left ventricular (LV) remodeling after myocardial infarction (MI) leading to heart failure remains a major health concern. Contractile dysfunction of the infarcted myocardium results in an increased pressure load, leading to maladaptive reshaping of the LV. Several percutaneous transcatheter procedures have been developed to deliver devices that restore LV shape and function. The purposes of this review are to discuss the spectrum of transcatheter devices that are available or in development for attenuation of adverse LV remodeling and to critically examine the available evidence for improvement of functional status and cardiovascular outcomes.
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Affiliation(s)
- Tom Hendriks
- University of Groningen, University Medical Center Groningen, Department of Cardiology, 9700RB, Groningen, The Netherlands
| | - Remco A J Schurer
- University of Groningen, University Medical Center Groningen, Department of Cardiology, 9700RB, Groningen, The Netherlands
| | - Lawien Al Ali
- University of Groningen, University Medical Center Groningen, Department of Cardiology, 9700RB, Groningen, The Netherlands
| | - Ad F M van den Heuvel
- University of Groningen, University Medical Center Groningen, Department of Cardiology, 9700RB, Groningen, The Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen, Department of Cardiology, 9700RB, Groningen, The Netherlands.
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Dhakal BP, Oliveira GH. Percutaneous Ventricular Restoration with a Partitioning Device for Ischemic Heart Failure Treatment. Curr Heart Fail Rep 2017; 14:87-99. [PMID: 28236161 DOI: 10.1007/s11897-017-0326-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF THE REVIEW Percutaneous ventricular restoration with a ventricular partitioning device (VPD) is a novel minimally invasive procedure designed to restore the left ventricular (LV) shape by isolating the infarcted and aneurysmal LV apex from remainder of the cavity in heart failure patients with severely reduced LV ejection fraction. In this review, we perform an in-depth analysis of the design and purpose of the VPD and review the available clinical data, with special attention to hemodynamics, outcomes, and complications. RECENT FINDINGS PARACHUTE trials have shown >90% procedural success rate of VPD implant. Heart failure patients had improvement in hemodynamics (reduction in LV volumes and increase in LV ejection fraction) and functional status (6-min walking distance and quality of life scores) after the VPD implant. Optimal implant position is necessary to obtain a good clinical outcome. Percutaneous VPD implantation has thus far been a safe intervention capable of improving surrogate markers of heart failure but there is still a need to develop more durable devices with a long-lasting hemodynamics effect.
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Affiliation(s)
- Bishnu P Dhakal
- Harrington Heart and Vascular Institute, Division of Heart Failure and Cardiac Transplant, Department of Medicine University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Mailstop LKS 5038, Cleveland, OH, 44106, USA
| | - Guilherme H Oliveira
- Harrington Heart and Vascular Institute, Division of Heart Failure and Cardiac Transplant, Department of Medicine University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Mailstop LKS 5038, Cleveland, OH, 44106, USA.
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Del Trigo M, Rodés-Cabau J. Transcatheter Structural Heart Interventions for the Treatment of Chronic Heart Failure. Circ Cardiovasc Interv 2015; 8:e001943. [DOI: 10.1161/circinterventions.114.001943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Maria Del Trigo
- From the Quebec Heart & Lung Institute, Quebec City, Quebec, Canada
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Liu S, Ngo DTM, Chong CR, Amarasekera AT, Procter NEK, Licari G, Dautov RF, Stewart S, Chirkov YY, Horowitz JD. Suppression of neutrophil superoxide generation by BNP is attenuated in acute heart failure: a case for 'BNP resistance'. Eur J Heart Fail 2015; 17:475-83. [PMID: 25684282 DOI: 10.1002/ejhf.242] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/18/2014] [Accepted: 01/09/2015] [Indexed: 11/08/2022] Open
Abstract
AIMS The release of the B-type natriuretic peptide (BNP) is increased in heart failure (HF), a condition associated with oxidative stress. BNP is known to exert anti-inflammatory effects including suppression of neutrophil superoxide (O2(-)) release. However, BNP-based restoration of homeostasis in HF is inadequate, and the equivocal clinical benefit of a recombinant BNP, nesiritide, raises the possibility of attenuated response to BNP. We therefore tested the hypothesis that BNP-induced suppression of neutrophil O2(-) generation is impaired in patients with acute HF. METHODS AND RESULTS We have recently characterized suppression of neutrophil O2(-) generation (PMA- or fMLP-stimulated neutrophil burst) by BNP as a measure of its physiological activity. In the present study, BNP response was compared in neutrophils of healthy subjects (n = 29) and HF patients (n = 45). Effects of BNP on fMLP-induced phosphorylation of the NAD(P)H oxidase subunit p47phox were also evaluated. In acute HF patients, the suppressing effect of BNP (1 µmol/L) on O2(-) generation was attenuated relative to that in healthy subjects (P < 0.05 for both PMA and fMLP). Analogously, BNP inhibited p47phox phosphorylation in healthy subjects but not in HF patients (P < 0.05). However, O2(-)-suppressing effects of the cell-permeable cGMP analogue (8-pCPT-cGMP) were preserved in acute HF. Conventional HF treatment for 5 weeks partially restored neutrophil BNP responsiveness (n = 25, P < 0.05), despite no significant decrease in plasma NT-proBNP levels. CONCLUSIONS BNP inhibits neutrophil O2(-) generation by suppressing NAD(P)H oxidase assembly. This effect is impaired in acute HF patients, with partial recovery during treatment.
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Affiliation(s)
- Saifei Liu
- Department of Cardiology and Clinical Pharmacology, Basil Hetzel Institute, The Queen Elizabeth Hospital, The University of Adelaide, South Australia, Australia
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Kapur NK, Paruchuri V. Interventions for failing vessels, valves, and now … ventricles: the parachute device. Catheter Cardiovasc Interv 2014; 83:631-2. [PMID: 24532330 DOI: 10.1002/ccd.25398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/12/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
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