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El Farissi M, Pijls NHJ, Good R, Engström T, Keeble TR, Beleslin B, De Bruyne B, Fröbert O, Erlinge D, Teeuwen K, Eerdekens R, Demandt JPA, Mangion K, Lonborg J, Setz-Pels W, Karamasis G, Wijnbergen I, Vlaar PJ, de Vos A, Brueren GR, Oldroyd K, Berry C, Tonino PAL, Van't Veer M, Otterspoor LC. A randomised trial of selective intracoronary hypothermia during primary PCI. EUROINTERVENTION 2024; 20:e740-e749. [PMID: 38887884 PMCID: PMC11165355 DOI: 10.4244/eij-d-23-01042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/04/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND While experimental data suggest that selective intracoronary hypothermia decreases infarct size, studies in patients with ST-elevation myocardial infarction (STEMI) are lacking. AIMS We investigated the efficacy of selective intracoronary hypothermia during primary percutaneous coronary intervention (PCI) to decrease infarct size in patients with STEMI. METHODS In this multicentre randomised controlled trial, 200 patients with large anterior wall STEMI were randomised 1:1 to selective intracoronary hypothermia during primary PCI or primary PCI alone. Using an over-the-wire balloon catheter for infusion of cold saline and a pressure-temperature wire to monitor the intracoronary temperature, the anterior myocardium distal to the occlusion was selectively cooled to 30-33°C for 7-10 minutes before reperfusion (occlusion phase), immediately followed by 10 minutes of cooling after reperfusion (reperfusion phase). The primary endpoint was infarct size as a percentage of left ventricular mass on cardiovascular magnetic resonance imaging after 3 months. RESULTS Selective intracoronary hypothermia was performed in 94/100 patients randomised to cooling. Distal coronary temperature decreased by 6°C within 43 seconds (interquartile range [IQR] 18-113). The median duration of the occlusion phase and reperfusion phase were 8.2 minutes (IQR 7.2-9.0) and 9.1 minutes (IQR 8.2-10.0), respectively. The infarct size at 3 months was 23.1±12.5% in the selective intracoronary hypothermia group and 21.6±12.2% in the primary PCI alone group (p=0.43). The left ventricular ejection fraction at 3 months in each group were 49.1±10.2% and 50.1±10.4%, respectively (p=0.53). CONCLUSIONS Selective intracoronary hypothermia during primary PCI in patients with anterior wall STEMI was feasible and safe but did not decrease infarct size compared with standard primary PCI. (ClinicalTrials.gov: NCT03447834).
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Affiliation(s)
- Mohamed El Farissi
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Richard Good
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Thomas Engström
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Branko Beleslin
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Ole Fröbert
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Rob Eerdekens
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Jesse P A Demandt
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Kenneth Mangion
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Jakob Lonborg
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Wikke Setz-Pels
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Grigoris Karamasis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Inge Wijnbergen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Pieter Jan Vlaar
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Annemiek de Vos
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Guus R Brueren
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Keith Oldroyd
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Colin Berry
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Marcel Van't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Luuk C Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
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Pei Z, Qiu J, Zhao Y, Song S, Wang R, Luo W, Cai X, Liu B, Chen H, Yin J, Weng X, Wu Y, Li C, Shen L, Ge J. A novel intracoronary hypothermia device reduces myocardial reperfusion injury in pigs. Chin Med J (Engl) 2024:00029330-990000000-00988. [PMID: 38445387 DOI: 10.1097/cm9.0000000000003033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Hypothermia therapy has been suggested to attenuate myocardial necrosis; however, the clinical implementation as a valid therapeutic strategy has failed, and new approaches are needed to translate into clinical applications. This study aimed to assess the feasibility, safety, and efficacy of a novel selective intracoronary hypothermia (SICH) device in mitigating myocardial reperfusion injury. METHODS This study comprised two phases. The first phase of the SICH was performed in a normal porcine model for 30 minutes ( n = 5) to evaluate its feasibility. The second phase was conducted in a porcine myocardial infarction (MI) model of myocardial ischemia/reperfusion was performed by balloon occlusion of the left anterior descending coronary artery for 60 minutes and maintained for 42 days. Pigs in the hypothermia group ( n = 8) received hypothermia intervention onset reperfusion for 30 minutes and controls ( n = 8) received no intervention. All animals were followed for 42 days. Cardiac magnetic resonance analysis (5 and 42 days post-MI) and a series of biomarkers/histological studies were performed. RESULTS The average time to lower temperatures to a steady state was 4.8 ± 0.8 s. SICH had no impact on blood pressure or heart rate and was safely performed without complications by using a 3.9 F catheter. Interleukin-6 (IL-6), tumor necrosis factor-α, C-reactive protein (CRP), and brain natriuretic peptide (BNP) were lower at 60 min post perfusion in pigs that underwent SICH as compared with the control group. On day 5 post MI/R, edema, intramyocardial hemorrhage, and microvascular obstruction were reduced in the hypothermia group. On day 42 post MI/R, the infarct size, IL-6, CRP, BNP, and matrix metalloproteinase-9 were reduced, and the ejection fraction was improved in pigs that underwent SICH. CONCLUSIONS The SICH device safely and effectively reduced the infarct size and improved heart function in a pig model of MI/R. These beneficial effects indicate the clinical potential of SICH for treatment of myocardial reperfusion injury.
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Affiliation(s)
- Zhiqiang Pei
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Jin Qiu
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi 030009, China
| | - Yongchao Zhao
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Shuai Song
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Rui Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Wei Luo
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Xingxing Cai
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 201322, China
| | - Bin Liu
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi 030009, China
| | - Han Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Jiasheng Yin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Xinyu Weng
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Yizhe Wu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Li Shen
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
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Li L, Li L, Cao C, Guo F, Wang A, Lin L, Liu Z, Meng H, Zhang P, Xin G, Liu J, Ren J, Fu J. Investigation of the active ingredients of Shuangshen Ningxin Fomula and the mechanism underlying their protective effects against myocardial ischemia-reperfusion injury by mass spectrometric imaging. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 123:155184. [PMID: 37951149 DOI: 10.1016/j.phymed.2023.155184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/20/2023] [Accepted: 11/02/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Traditional Chinese medicine, particularly Shuangshen Ningxin Capsule (SSNX), has been studied intensely. SSNX includes total ginseng saponins (from Panax ginseng Meyer), total phenolic acids from Salvia miltiorrhiza Bunge, and total alkaloids from Corydalis yanhusuo W. T. Wang. It has been suggested to protect against myocardial ischemia by a mechanism that has not been fully elucidated. METHODS The composition and content of SSNX were determined by UHPLC-Q-TOFQ-TOF / MS. Then, a rat model of myocardial ischemia-reperfusion injury was established, and the protective effect of SSNX was measured. The protective mechanism was investigated using spatial metabolomics. RESULTS We found that SSNX significantly improved left ventricular function and ameliorated pathological damages in rats with myocardial ischemia-reperfusion injury. Using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), the protective mechanism of SSNX was examined by comparing the monomer components of drugs targeted in myocardial tissue with the distribution of myocardial energy metabolism-related molecules and phospholipids. Interestingly, some lipids display inconsistent content distribution in the myocardial ischemia risk and non-risk zones. These discrepancies reflect the degree of myocardial injury in different regions. CONCLUSION These findings suggest that SSNX protects against myocardial ischemia-reperfusion injury by correcting abnormal myocardial energy metabolism, changing the levels and distribution patterns of phospholipids, and stabilizing the structure of the myocardial cell membrane. MALDI-TOF MS can detect the spatial distribution of small molecule metabolites in the myocardium and can be used in pharmacological research.
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Affiliation(s)
- Lingmei Li
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China; Kunshan Hospital of Traditional Chinese Medicine, Jiangsu 215300, China
| | - Lei Li
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Ce Cao
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Fan Guo
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Aoao Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Li Lin
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Zixin Liu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Hongxu Meng
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Peng Zhang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Gaojie Xin
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Jianxun Liu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China.
| | - Junguo Ren
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China.
| | - Jianhua Fu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Beijing Key Laboratory of Chinese Materia Pharmacology, China Academy of Chinese Medical Sciences, Beijing 100091, China.
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Jung KT, Bapat A, Kim YK, Hucker WJ, Lee K. Therapeutic hypothermia for acute myocardial infarction: a narrative review of evidence from animal and clinical studies. Korean J Anesthesiol 2022; 75:216-230. [PMID: 35350095 PMCID: PMC9171548 DOI: 10.4097/kja.22156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/21/2022] Open
Abstract
Myocardial infarction (MI) is the leading cause of death from coronary heart disease and requires immediate reperfusion therapy with thrombolysis, primary percutaneous coronary intervention, or coronary artery bypass grafting. However, myocardial reperfusion therapy is often accompanied by cardiac ischemia/reperfusion (I/R) injury, which leads to myocardial injury with detrimental consequences. The causes of I/R injury are unclear, but are multifactorial, including free radicals, reactive oxygen species, calcium overload, mitochondria dysfunction, inflammation, and neutrophil-mediated vascular injury. Mild hypothermia has been introduced as one of the potential inhibitors of myocardial I/R injury. Although animal studies have demonstrated that mild hypothermia significantly reduces or delays I/R myocardium damage, human trials have not shown clinical benefits in acute MI (AMI). In addition, the practice of hypothermia treatment is increasing in various fields such as surgical anesthesia and intensive care units. Adequate sedation for anesthetic procedures and protection from body shivering has become essential during therapeutic hypothermia. Therefore, anesthesiologists should be aware of the effects of therapeutic hypothermia on the metabolism of anesthetic drugs. In this paper, we review the existing data on the use of therapeutic hypothermia for AMI in animal models and human clinical trials to better understand the discrepancy between perceived benefits in preclinical animal models and the absence thereof in clinical trials thus far.
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Affiliation(s)
- Ki Tae Jung
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology and Pain Medicine, College of Medicine and Medical School, Chosun University, Gwangju, Korea
| | - Aneesh Bapat
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - William J. Hucker
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Kichang Lee
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
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Abella BS, Otterspoor L, Nichol G, Martin JL. ST-Elevation Myocardial Infarction Track. Ther Hypothermia Temp Manag 2021; 11:65-70. [PMID: 33819429 DOI: 10.1089/ther.2021.29091.bab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Benjamin S Abella
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Pennsylvania, USA
| | - Luuk Otterspoor
- Heart Centre Eindhoven, Catharina Hospital, Eindhoven, Netherlands
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, Washington, USA
| | - Jack L Martin
- ICON plc., North Wales, Pennsylvania, USA.,Sharpe-Strumia Research Foundation, Bryn Mawr, Pennsylvania, USA
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Bashtawi Y, Almuwaqqat Z. Therapeutic Hypothermia in STEMI. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 29:77-84. [PMID: 32807668 DOI: 10.1016/j.carrev.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/16/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
Abstract
In this review article we tried to find an answer to the question, should local coronary hypothermia be a part of the early reperfusion strategy in patients with STEMI to prevent reperfusion injury, no-reflow phenomenon, and to reduce the infarct size and mortality. Hypothermia can save cardiomyocytes if achieved in a timely fashion before reperfusion. Intracoronary hypothermia can be adjunct to PCI by lessening ischemia/reperfusion injury on cardiomyocytes and reduction in infarct size. Reperfusion induced Calcium overload, generation of ROS and subsequent activation of Mitochondrial permeability transition pore (MPT) are major contributors to reperfusion injury. Hypothermia reduces calcium loading of the cell and maintains cellular energy and tissue level glucose which can scavenger ROS. Hypothermia reduces MPT activation and thus reduces infarct size. Systemic cooling trials failed to reduce infarct size, perhaps because the target temperature was not reached fast enough, and it was associated with systemic side effects. The need for rapid induction of hypothermia to <35 °C with the ethical concern of delaying reperfusion while cooling the patient and the inconsistency of endovascular cooling results lead to a belief that endovascular cooling may exceed the acceptable level of invasiveness in the context of other novels cardioprotective, regenerative and reperfusion therapies. Clinical trials showed the safety and feasibility of novel intracoronary hypothermia with rapid induction and maintenance of hypothermia using routine PCI equipment ahead of reperfusion. Two phases of cooling were applied without significant delay in the door to balloon time. Cooling of the coronary artery leads to cooling of its dependant myocardium without affecting adjacent myocardium. Heat transfer occurred by heat conduction during the occlusion phase and heat convention during the reperfusion phase. Fine-tuning of saline temperature and infusion rate helped to improve the protocol. The best duration of hypothermia before and after reperfusion is not known and needs further investigation. A balance between the undoubted cardioprotective effects of hypothermia with iatrogenic prolongation of ischemia time needs to be established. A reduction in infarct size was observed but needs to be validated with large randomized trials. Furthermore, it might be possible to augment the cardioprotective effects of intracoronary hypothermia by combination with other cardioprotective approaches such as antioxidant drugs and afterload reducing agents.
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Affiliation(s)
- Yazan Bashtawi
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan.
| | - Zakaria Almuwaqqat
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, United States of America
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Merrill TL, Mitchell JE, Merrill DR, Gorman JH, Gorman RC, Gillespie MJ. Myocardial tissue salvage is correlated with ischemic border region temperature at reperfusion. Catheter Cardiovasc Interv 2019; 96:E593-E601. [PMID: 31478608 DOI: 10.1002/ccd.28480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Our pilot study investigated the association between region-specific myocardial tissue temperature and tissue salvage using a novel tri-lumen cooling catheter to provide rapid localized cooling directly to the heart in an open-chest porcine model of ischemia-reperfusion. BACKGROUND Therapeutic hypothermia remains a promising strategy to limit reperfusion injury following myocardial ischemia. METHODS Large swine underwent 60 min of coronary occlusion followed by 3 hr of reperfusion. Prior to inducing ischemia, six temperature probes were placed directly on the heart, monitoring myocardial temperatures in different locations. Hemodynamic parameters and core temperature were also collected. Approximately 15 min prior to reperfusion, the cooling catheter was inserted via femoral artery and the distal tip advanced proximal to the occluded coronary vessel under fluoroscopic guidance. Autologous blood was pulled from the animal via femoral sheath and delivered through the central lumen of the cooling catheter, delivering at 50 ml/min, 27°C at the distal tip. Cooling was continued for an additional 25 min after reperfusion followed by a 5-min controlled rewarming. Hearts were excised and assessed for infarct size per area at risk. RESULTS Although cooling catheter performance was consistent throughout the study (38 W), the resulting tissue cooling was not. Our results show a correlation between myocardial tissue salvage and ischemic border region (IBR) temperature at the time of reperfusion (R2 = 0.59, p = 0.027). IBR tissue is the tissue located at the boundary between healthy and ischemic tissues. CONCLUSIONS Our findings suggest that localized, rapid, short-term myocardial tissue cooling has the potential to limit reperfusion injury in humans.
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Affiliation(s)
- Thomas L Merrill
- Department of Mechanical Engineering and Biomedical Engineering, Rowan University, Glassboro, New Jersey.,Catheter Development, Focal Cool, LLC, Mullica Hill, New Jersey
| | | | | | - Joseph H Gorman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert C Gorman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew J Gillespie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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8
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A predictive computational model to estimate myocardial temperature during intracoronary hypothermia in acute myocardial infarction. Med Eng Phys 2019; 68:65-75. [DOI: 10.1016/j.medengphy.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 11/20/2022]
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9
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Wang YS, Zhang J, Li YF, Chen BR, Khurwolah MR, Tian YF, Shi HJ, Yang ZJ, Wang LS. A pilot clinical study of adjunctive therapy with selective intracoronary hypothermia in patients with ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2018; 92:E433-E440. [PMID: 30265431 DOI: 10.1002/ccd.27864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/31/2018] [Accepted: 08/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We aimed to assess the effect of selective intracoronary hypothermia on outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). BACKGROUND Intracoronary hypothermia, the feasibility and safety of which has been validated in humans, induced by selective trans-coronary infusion of saline at different temperatures can reduce infarct size (IS) prior to reperfusion in animal models of STEMI. METHODS Sixty STEMI patients presenting with thrombolysis in myocardial infarction (TIMI) flow grade 0/1 were randomized after coronary artery angiography. Intracoronary hypothermia was induced by selective trans-coronary infusion of saline at 4°C to the endangered myocardium in the 30 patients. The primary endpoint, absolute IS expressed as IS/myocardium at risk (MaR), was assessed by cardiac magnetic resonance imaging at day 7 post-PPCI in 50 patients. Clinical follow-up was undertaken at day 30 after procedure. RESULTS Intracoronary hypothermia was successfully performed in hypothermia group, without increase in arrhythmia or hemodynamic instability. The mean temperature reduction of 5.8 ± 1.1°C in distal coronary artery was achieved before reperfusion. Mean IS/MaR was predominantly reduced in the hypothermia group (44.85 ± 5.89% vs. 50.69 ± 10.75%, P = 0.022), especially in the anterior STEMI subgroup (46.12 ± 7.54% vs. 55.27 ± 11.175%, P = 0.023). The clinical events appeared no statistical difference between the two groups at the 30-day follow-up. CONCLUSION The statistical difference in IS/MaR by intracoronary hypothermia as adjunctive therapy to PPCI is an important observation and warrants a larger pivotal trial fully powered for efficacy.
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Affiliation(s)
- Yong-Sheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Fei Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bing-Rui Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mohammad Reeaze Khurwolah
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yun-Fan Tian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao-Jie Shi
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhi-Jian Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lian-Sheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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10
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McGarvey M, Ali O, Iqbal MB, Ilsley C, Wong J, Di Mario C, Redwood S, Patterson T, Pennell DJ, Rogers P, Dalby M. A feasibility and safety study of intracoronary hemodilution during primary coronary angioplasty in order to reduce reperfusion injury in myocardial infarction. Catheter Cardiovasc Interv 2018. [PMID: 28636165 DOI: 10.1002/ccd.27136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES We designed a pilot study to evaluate safety and feasibility of an inexpensive and simple approach to intracoronary hemodilution during primary angioplasty (PPCI) to reduce reperfusion injury. INTRODUCTION Early revascularization in acute myocardial infarction decreases infarct size and improves outcomes. However, abrupt restoration of coronary flow results in myocardial reperfusion injury and increased final infarct size. Dilution of coronary blood during revascularization may help reduce this damage. If proved effective, such an approach would need to be simple and suitable for widespread adoption. METHODS Ten patients presenting with STEMI underwent intracoronary dilution with room temperature Hartmann's solution delivered through the guiding catheter during primary angioplasty (PPCI). Infusion of perfusate began prior to crossing the occluded artery with the guidewire, continuing until 10 min after completion of the balloon and stenting procedure. Infusion was briefly interrupted for contrast injection and pressure monitoring. The outcome measures were safety, including intracoronary temperature reduction and volume of intracoronary perfusate infused, and technical feasibility. RESULTS There were no significant symptomatic, hemodynamic, ECG ST/T segment or rhythm changes observed during perfusate administration. The median (interquartile range) volume of perfusate administered was 550 mL (350-725 mL) and the median intracoronary temperature reduction observed was 3.4°Celsius. Myocardial salvage was 0.54 (0.43-0.65). CONCLUSIONS Transcatheter intracoronary hemodilution with room temperature perfusate during PPCI is feasible and appears safe. Such a strategy is simple and inexpensive, with potential to be widely applied. Further mechanistic and subsequent outcome powered studies are required to evaluate whether this strategy can reduce reperfusion injury in STEMI.
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Affiliation(s)
- Michael McGarvey
- Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, and Imperial College London, United Kingdom
| | - Omar Ali
- Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, and Imperial College London, United Kingdom
| | - M Bilal Iqbal
- Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, and Imperial College London, United Kingdom
| | - Charles Ilsley
- Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, and Imperial College London, United Kingdom
| | - Joyce Wong
- Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, and Imperial College London, United Kingdom
| | - Carlo Di Mario
- Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, and Imperial College London, United Kingdom
| | - Simon Redwood
- Department of Cardiology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Tiffany Patterson
- Department of Cardiology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Dudley J Pennell
- Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, and Imperial College London, United Kingdom
| | - Paula Rogers
- Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, and Imperial College London, United Kingdom
| | - Miles Dalby
- Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, and Imperial College London, United Kingdom
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Otterspoor LC, van Nunen LX, van ‘t Veer M, Johnson NP, Pijls NH. Intracoronary Hypothermia Before Reperfusion to Reduce Reperfusion Injury in Acute Myocardial Infarction: A Novel Hypothesis and Technique. Ther Hypothermia Temp Manag 2017; 7:199-205. [DOI: 10.1089/ther.2017.0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Luuk C. Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Marcel van ‘t Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Nils P. Johnson
- Division of Cardiology, Weatherhead PET Center, McGovern Medical School, UTHealth and Memorial Hermann Hospital, Houston, Texas
| | - Nico H.J. Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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12
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Saunderson CE, Chowdhary A, Brogan RA, Batin PD, Gale CP. In an era of rapid STEMI reperfusion with Primary Percutaneous Coronary Intervention is there a role for adjunct therapeutic hypothermia? A structured literature review. Int J Cardiol 2016; 223:883-890. [DOI: 10.1016/j.ijcard.2016.08.226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
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