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Khalid SN, Mansoor T, Bilal MI, Ijaz SH, Fudim M, Greene SJ, Nambi V, Virani SS, Fonarow GC, Abramov D, Minhas AMK. Ongoing and future clinical trials of device therapies for patients with heart failure. Curr Probl Cardiol 2024; 49:102805. [PMID: 39159710 DOI: 10.1016/j.cpcardiol.2024.102805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 08/21/2024]
Abstract
Heart failure continues to pose a significant burden in terms of morbidity, mortality, and healthcare costs worldwide despite the implementation of guideline-directed medical therapy. Addressing this challenge and improving clinical outcomes for this patient population remains an urgent priority. Recognizing the limitations in current medical approaches and exploring strategies to overcome these limitations are crucial steps toward improving future outcomes. Various device-based interventions, such as Cardiac Resynchronization Therapy devices and Left Ventricular Assist Devices, have demonstrated notable benefits for individuals with heart failure. Our review is aimed at summarizing the ongoing research into new device therapies for heart failure, emphasizing their potential to overcome the current challenges in treatment. By utilizing Clinicaltrials.gov, an online repository, we conducted a comprehensive search for trials investigating emerging device therapies for patients dealing with heart failure.
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Affiliation(s)
| | - Taha Mansoor
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine.
| | | | | | - Marat Fudim
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Stephen J Greene
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Vijay Nambi
- Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Veterans Affair Medical Center
| | - Salim S Virani
- Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, Aga Khan University, Karachi; Texas Heart Institute, Houston, TX, Pakistan
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles CA, USA
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
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2
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Qian C, Ye F, Li J, Tseng P, Khine M. Wireless and Battery-Free Sensor for Interstitial Fluid Pressure Monitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:4429. [PMID: 39065827 PMCID: PMC11280719 DOI: 10.3390/s24144429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
Congestive heart failure (CHF) is a fatal disease with progressive severity and no cure; the heart's inability to adequately pump blood leads to fluid accumulation and frequent hospital readmissions after initial treatments. Therefore, it is imperative to continuously monitor CHF patients during its early stages to slow its progression and enable timely medical interventions for optimal treatment. An increase in interstitial fluid pressure (IFP) is indicative of acute CHF exacerbation, making IFP a viable biomarker for predicting upcoming CHF if continuously monitored. In this paper, we present an inductor-capacitor (LC) sensor for subcutaneous wireless and continuous IFP monitoring. The sensor is composed of inexpensive planar copper coils defined by a simple craft cutter, which serves as both the inductor and capacitor. Because of its sensing mechanism, the sensor does not require batteries and can wirelessly transmit pressure information. The sensor has a low-profile form factor for subcutaneous implantation and can communicate with a readout device through 4 layers of skin (12.7 mm thick in total). With a soft silicone rubber as the dielectric material between the copper coils, the sensor demonstrates an average sensitivity as high as -8.03 MHz/mmHg during in vitro simulations.
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Affiliation(s)
- Chengyang Qian
- Department of Biomedical Engineering, Henry Samueli School of Engineering, University of California Irvine, Irvine, CA 92697, USA (J.L.)
| | - Fan Ye
- Department of Electrical Engineering and Computer Science, Henry Samueli School of Engineering, University of California Irvine, Irvine, CA 92697, USA (P.T.)
| | - Junye Li
- Department of Biomedical Engineering, Henry Samueli School of Engineering, University of California Irvine, Irvine, CA 92697, USA (J.L.)
| | - Peter Tseng
- Department of Electrical Engineering and Computer Science, Henry Samueli School of Engineering, University of California Irvine, Irvine, CA 92697, USA (P.T.)
| | - Michelle Khine
- Department of Biomedical Engineering, Henry Samueli School of Engineering, University of California Irvine, Irvine, CA 92697, USA (J.L.)
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Filippini FB, Ribeiro HB, Bocchi E, Bacal F, Marcondes-Braga FG, Avila MS, Sturmer JD, Marchi MFDS, Kanhouche G, Freire AF, Cassar R, Abizaid AA, de Brito FS. Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure. Arq Bras Cardiol 2023; 120:e20220496. [PMID: 38126512 PMCID: PMC10773459 DOI: 10.36660/abc.20220496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 04/05/2023] [Accepted: 05/17/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Central Illustration : Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure Transcatheter devices for monitoring and treating advanced chronic heart failure patients. PA: pulmonary artery; LA: left atrium; AFR: atrial flow regulator; TASS: Transcatheter Atrial Shunt System; VNS: vagus nerve stimulation; BAT: baroreceptor activation therapy; RDN: renal sympathetic denervation; F: approval by the American regulatory agency (FDA); E: approval by the European regulatory agency (CE Mark). BACKGROUND Innovations in devices during the last decade contributed to enhanced diagnosis and treatment of patients with cardiac insufficiency. These tools progressively adapted to minimally invasive strategies with rapid, widespread use. The present article focuses on actual and future directions of device-related diagnosis and treatment of chronic heart failure.
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Affiliation(s)
- Filippe Barcellos Filippini
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Alemão Oswaldo CruzSão PauloSPBrasil Hospital Alemão Oswaldo Cruz , São Paulo , SP – Brasil
| | - Henrique Barbosa Ribeiro
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Edimar Bocchi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Fernando Bacal
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Fabiana G. Marcondes-Braga
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Monica S. Avila
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Janine Daiana Sturmer
- Hospital Alemão Oswaldo CruzSão PauloSPBrasil Hospital Alemão Oswaldo Cruz , São Paulo , SP – Brasil
| | - Mauricio Felippi de Sá Marchi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Gabriel Kanhouche
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Antônio Fernando Freire
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Renata Cassar
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Alexandre A. Abizaid
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Fábio Sândoli de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
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Moerke C, Kloss M, Wulf K, Illner S, Kischkel S, Sombetzki M, Grabow N, Reisinger E, Öner A, Ince H. Evaluation of a Murine Model for Testing Antimicrobial Implant Materials in the Blood Circulation System. Biomedicines 2021; 9:1464. [PMID: 34680581 PMCID: PMC8533524 DOI: 10.3390/biomedicines9101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 01/08/2023] Open
Abstract
Medical device-related infections are becoming a steadily increasing challenge for the health care system regarding the difficulties in the clinical treatment. In particular, cardiovascular implant infections, catheter-related infections, as well as infective endocarditis are associated with high morbidity and mortality risks for the patients. Antimicrobial materials may help to prevent medical device-associated infections and supplement the currently available therapies. In this study, we present an easy-to-handle and simplified in vivo model to test antimicrobial materials in the bloodstream of mice. The model system is composed of the implantation of a bacteria-laden micro-stent scaffold into the murine tail vein. Our model enables the simulation of catheter-related infections as well as the development of infective endocarditis specific pathologies in combination with material testing. Furthermore, this in vivo model can cover two phases of the biofilm formation, including both the local tissue response to the bacterial biofilm and the systemic inflammatory response against circulating bacteria in the bloodstream that detached from a mature biofilm.
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Affiliation(s)
- Caroline Moerke
- Department of Cardiology, University Medical Center Rostock, 18057 Rostock, Germany; (C.M.); (A.Ö.)
| | - Marlen Kloss
- Division of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, 18057 Rostock, Germany; (M.K.); (M.S.); (E.R.)
| | - Katharina Wulf
- Institute for Biomedical Engineering, University Medical Center Rostock, 18119 Rostock, Germany; (K.W.); (S.I.); (S.K.); (N.G.)
| | - Sabine Illner
- Institute for Biomedical Engineering, University Medical Center Rostock, 18119 Rostock, Germany; (K.W.); (S.I.); (S.K.); (N.G.)
| | - Sabine Kischkel
- Institute for Biomedical Engineering, University Medical Center Rostock, 18119 Rostock, Germany; (K.W.); (S.I.); (S.K.); (N.G.)
| | - Martina Sombetzki
- Division of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, 18057 Rostock, Germany; (M.K.); (M.S.); (E.R.)
| | - Niels Grabow
- Institute for Biomedical Engineering, University Medical Center Rostock, 18119 Rostock, Germany; (K.W.); (S.I.); (S.K.); (N.G.)
| | - Emil Reisinger
- Division of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, 18057 Rostock, Germany; (M.K.); (M.S.); (E.R.)
| | - Alper Öner
- Department of Cardiology, University Medical Center Rostock, 18057 Rostock, Germany; (C.M.); (A.Ö.)
| | - Hüseyin Ince
- Department of Cardiology, University Medical Center Rostock, 18057 Rostock, Germany; (C.M.); (A.Ö.)
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Scialla S, Martuscelli G, Nappi F, Singh SSA, Iervolino A, Larobina D, Ambrosio L, Raucci MG. Trends in Managing Cardiac and Orthopaedic Device-Associated Infections by Using Therapeutic Biomaterials. Polymers (Basel) 2021; 13:1556. [PMID: 34066192 PMCID: PMC8151391 DOI: 10.3390/polym13101556] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/23/2022] Open
Abstract
Over the years, there has been an increasing number of cardiac and orthopaedic implanted medical devices, which has caused an increased incidence of device-associated infections. The surfaces of these indwelling devices are preferred sites for the development of biofilms that are potentially lethal for patients. Device-related infections form a large proportion of hospital-acquired infections and have a bearing on both morbidity and mortality. Treatment of these infections is limited to the use of systemic antibiotics with invasive revision surgeries, which had implications on healthcare burdens. The purpose of this review is to describe the main causes that lead to the onset of infection, highlighting both the biological and clinical pathophysiology. Both passive and active surface treatments have been used in the field of biomaterials to reduce the impact of these infections. This includes the use of antimicrobial peptides and ionic liquids in the preventive treatment of antibiotic-resistant biofilms. Thus far, multiple in vivo studies have shown efficacious effects against the antibiotic-resistant biofilm. However, this has yet to materialize in clinical medicine.
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Affiliation(s)
- Stefania Scialla
- Institute of Polymers, Composites and Biomaterials of National Research Council (IPCB-CNR), 80125 Naples, Italy; (S.S.); (D.L.)
| | - Giorgia Martuscelli
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 81100 Naples, Italy;
| | - Francesco Nappi
- Centre Cardiologie du Nord de Saint-Denis, Department of Cardiac Surgery, 93200 Paris, France; (F.N.); (A.I.)
| | | | - Adelaide Iervolino
- Centre Cardiologie du Nord de Saint-Denis, Department of Cardiac Surgery, 93200 Paris, France; (F.N.); (A.I.)
| | - Domenico Larobina
- Institute of Polymers, Composites and Biomaterials of National Research Council (IPCB-CNR), 80125 Naples, Italy; (S.S.); (D.L.)
| | - Luigi Ambrosio
- Institute of Polymers, Composites and Biomaterials of National Research Council (IPCB-CNR), 80125 Naples, Italy; (S.S.); (D.L.)
| | - Maria Grazia Raucci
- Institute of Polymers, Composites and Biomaterials of National Research Council (IPCB-CNR), 80125 Naples, Italy; (S.S.); (D.L.)
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Oseran AS, Afari ME, Barrett CD, Lewis GD, Thomas SS. Beyond the stethoscope: managing ambulatory heart failure during the COVID-19 pandemic. ESC Heart Fail 2021; 8:999-1006. [PMID: 33506638 PMCID: PMC8006709 DOI: 10.1002/ehf2.13201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/08/2020] [Accepted: 01/02/2021] [Indexed: 12/15/2022] Open
Abstract
There have been nearly 70 million cases of COVID‐19 worldwide, with over 1.5 million deaths at the time of this publication. This global pandemic has mandated dramatic changes in healthcare delivery with a particular focus on social distancing in order to reduce viral transmission. Heart failure patients are among the highest utilizers of health care and are at increased risk for COVID‐related vulnerabilities. Effectively managing this complex and resource‐intensive patient population from a distance presents new and unique challenges. Here, we review relevant data on telemedicine and remote monitoring strategies for heart failure patients and provide a framework to help providers treat this population during the COVID‐19 pandemic. This includes (i) dedicated pre‐visit contact and planning (i.e. confirm clinical appropriateness, presence of compatible technology, and patient comfort); (ii) utilization of virtual clinic visits (use of telehealth platforms, a video‐assisted exam, self‐reported vital signs, and weights); and (iii) use of existing remote heart failure monitoring sensors when applicable (CardioMEMS, Optivol, and HeartLogic). While telemedicine and remote monitoring strategies are not new, these technologies are emerging as an important tool for the effective management of heart failure patients during the COVID‐19 pandemic. In general, these strategies appear to be safe; however, additional data will be needed to determine their effectiveness with respect to both process and outcomes measures.
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Affiliation(s)
- Andrew S Oseran
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Maxwell E Afari
- Cardiac Service Line, Maine Medical Center, Portland, ME, USA
| | - Conor D Barrett
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Gregory D Lewis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Sunu S Thomas
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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Vuckovic KM, Bierle RS, Ryan CJ. Navigating Symptom Management in Heart Failure: The Crucial Role of the Critical Care Nurse. Crit Care Nurse 2021; 40:55-63. [PMID: 32236426 DOI: 10.4037/ccn2020685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
High-acuity, progressive care, and critical care nurses often provide care for patients with heart failure during an exacerbation of acute disease or at the end of life. Identifying and managing heart failure symptoms is complex and requires early recognition and early intervention. Because symptoms of heart failure are not disease specific, patients may not respond to them appropriately, resulting in treatment delays. This article reviews the complexities and issues surrounding the patient's ability to recognize heart failure symptoms and the critical care nurse's role in facilitating early intervention. It outlines the many barriers to symptom recognition and response, including multimorbidities, age, symptom intensity, symptom escalation, and health literacy. The influence of self-care on heart failure management is also described. The critical care nurse plays a crucial role in teaching heart failure patients to identify and respond appropriately to their symptoms, thus promoting early intervention.
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Affiliation(s)
- Karen M Vuckovic
- Karen M. Vuckovic is an advanced practice registered nurse, Division of Cardiology, University of Illinois Hospital and Health Sciences System, and a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois. Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Monument Health Heart and Vascular Institute, Rapid City, South Dakota. Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| | - Rebecca Schuetz Bierle
- Karen M. Vuckovic is an advanced practice registered nurse, Division of Cardiology, University of Illinois Hospital and Health Sciences System, and a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois. Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Monument Health Heart and Vascular Institute, Rapid City, South Dakota. Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| | - Catherine J Ryan
- Karen M. Vuckovic is an advanced practice registered nurse, Division of Cardiology, University of Illinois Hospital and Health Sciences System, and a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois. Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Monument Health Heart and Vascular Institute, Rapid City, South Dakota. Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
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Carmona-Rubio A, Gonzalez-Bonilla HM, Jacob MS. Implementing CardioMEMS Monitoring and Interventions into Clinical Practice. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00822-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Volterrani M, Spoletini I, Angermann C, Rosano G, Coats AJ. Implantable devices for heart failure monitoring: the CardioMEMS™ system. Eur Heart J Suppl 2019; 21:M50-M53. [PMID: 31908617 PMCID: PMC6937499 DOI: 10.1093/eurheartj/suz265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Several devices have been developed for heart failure (HF) treatment and monitoring. Among device-based monitoring tools, CardioMEMS™ has received growing research attention. This document reflects the key points of an ESC consensus meeting on implantable devices for monitoring in HF, with a particular focus on CardioMEMS™.
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Affiliation(s)
- Maurizio Volterrani
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Ilaria Spoletini
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Christiane Angermann
- Department of Medicine I, Cardiology and Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany
| | - Giuseppe Rosano
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Andrew Js Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
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Grassi G, Quarti-Trevano F, Esler MD. Sympathetic activation in congestive heart failure: an updated overview. Heart Fail Rev 2019; 26:173-182. [PMID: 31832833 DOI: 10.1007/s10741-019-09901-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Conclusive evidence demonstrates that the sympathetic nervous system activation is a hallmark of congestive heart failure. This has been shown via a variety of biochemical, neurophysiological, and neuroimaging approaches for studying human sympathetic neural function. The sympathetic activation appears to be an early phenomenon in the clinical course of the disease, closely related to its severity and potentiated by the concomitant presence of other comorbidities, such as obesity, diabetes mellitus, metabolic syndrome, hypertension, and renal failure. The adrenergic overdrive in heart failure is associated with other sympathetic abnormalities, such as the downregulation of beta-adrenergic adrenoreceptors at cardiac level, and exerts unfavorable consequences on the cardiovascular system. These include the endothelial dysfunction, the development of left ventricular hypertrophy, the atherosclerosis development, as well as the generation of atrial and ventricular arrhythmias, and, at very extreme levels of sympathetic activation, the occurrence of microscopic myocardial necrosis. Given the close direct independent relationships detected in heart failure between sympathetic activation and mortality, the adrenergic overdrive has become a target of neuromodulatory therapeutic interventions, which include non-pharmacological, pharmacological, and device-based interventions. For some of these approaches (specifically bilateral renal nerves ablation and carotid baroreceptor stimulation), additional studies are needed to better define their impact on the clinical course of the disease.
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Affiliation(s)
- Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Italy.
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Italy
| | - Murray D Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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11
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Luedde M, Spehlmann ME, Frey N. Progress in heart failure treatment in Germany. Clin Res Cardiol 2018; 107:105-113. [DOI: 10.1007/s00392-018-1317-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/27/2018] [Indexed: 12/29/2022]
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