1
|
Mondritzki T, Boehme P, White J, Park JW, Hoffmann J, Vogel J, Kolkhof P, Walsh S, Sandner P, Bischoff E, Dinh W, Hüser J, Truebel H. Remote Left Ventricular Hemodynamic Monitoring Using a Novel Intracardiac Sensor. Circ Cardiovasc Interv 2018; 11:e006258. [PMID: 29748220 DOI: 10.1161/circinterventions.117.006258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) remains the most common reason for hospital admission in patients aged >65 years. Despite modern drug therapy, mortality and readmission rates for patients hospitalized with HF remain high. This necessitates further research to identify early patients at risk for readmission to limit hospitalization by timely adjustment of medical therapy. Implantable devices can monitor left ventricular (LV) hemodynamics and remotely and continuously detect the early signs of decompensation to trigger interventions and reduce the risk of hospitalization for HF. Here, we report the first preclinical study validating a new batteryless and easy to implant LV-microelectromechanical system to assess LV performance. METHODS AND RESULTS A miniaturized implantable wireless pressure sensor was adapted for implantation in the LV apex. The LV-microelectromechanical system sensor was tested in a canine model of HF. The wireless pressure sensor measurements were compared with invasive left heart catheter-derived measurements at several time points. During different pharmacological challenge studies with dobutamine or vasopressin, the device was equally sensitive compared with invasive standard procedures. No adverse events or any observable reaction related to the implantation and application of the device for a period of 35 days was observed. CONCLUSIONS Our miniaturized wireless pressure sensor placed in the LV (LV-microelectromechanical system) has the potential to become a new telemetric tool to earlier identify patients at risk for HF decompensation and to guide the treatment of patients with HF.
Collapse
Affiliation(s)
- Thomas Mondritzki
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.) .,University of Witten/Herdecke, Germany (T.M., P.B., H.T.)
| | - Philip Boehme
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,University of Witten/Herdecke, Germany (T.M., P.B., H.T.)
| | - Jason White
- St Jude Medical (now Abbott), Atlanta, GA (J.W., J.W.P.)
| | - Jin Woo Park
- St Jude Medical (now Abbott), Atlanta, GA (J.W., J.W.P.)
| | - Jessica Hoffmann
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Julia Vogel
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Peter Kolkhof
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Stuart Walsh
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Peter Sandner
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,Hannover Medical School, Germany (P.S.)
| | - Erwin Bischoff
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Wilfried Dinh
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,Department of Cardiology, HELIOS Clinic Wuppertal, University Hospital Witten/Herdecke, Wuppertal, Germany (W.D.)
| | - Jörg Hüser
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.)
| | - Hubert Truebel
- From the Bayer AG, Wuppertal, Germany (T.M., P.B., J.H., J.V., P.K., S.W., P.S., E.B., W.D., J.H., H.T.).,University of Witten/Herdecke, Germany (T.M., P.B., H.T.)
| |
Collapse
|
3
|
Borges JP, da Silva Verdoorn K. Cardiac Ischemia/Reperfusion Injury: The Beneficial Effects of Exercise. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 999:155-179. [PMID: 29022263 DOI: 10.1007/978-981-10-4307-9_10] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cardiac ischemia reperfusion injury (IRI) occurs when the myocardium is revascularized after an episode of limited or absent blood supply. Many changes, including free radical production, calcium overload, protease activation, altered membrane lipids and leukocyte activation, contribute to IRI-induced myocardium damage. Aerobic exercise is the only countermeasure against IRI that can be sustained on a regular basis in clinical practice. Interestingly, both short-term (3-5 days) and long-term (several weeks) exercise increase myocardial tolerance, reduce infarct size area and arrhythmias induced by IRI. Exercise protects the heart against IRI in a biphasic manner. The early phase of cardioprotection occurs between 30 min and 3 h following an acute exercise bout, whilst the late phase is achieved within 24 h after the exercise bout and persists for several days. As for the exercise intensity, although controversial data exists, it is feasible that the amount of cardioprotection is proportional to exercise intensity and only achieved above a critical threshold. It is known that aerobic exercise produces a cardioprotective phenotype, however the mechanisms responsible for this phenomenon remain unclear. Apparently, aerobic exercise-induced preconditioning is dependent on several factors that work together to protect the heart. Altered nitric oxide (NO) signaling, increased levels of heat shock proteins (HSPs), enhanced function of ATP-sensitive potassium channels, increased activation of opioids system, and enhanced antioxidant capacity may contribute to exercise-induced cardioprotection. Much has been discovered from animal models involving exercise-induced cardioprotection against cardiac IRI, however translating these findings to clinical practice still represents the major challenge in this field.
Collapse
Affiliation(s)
- Juliana Pereira Borges
- Institute of Physical Education and Sports, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | | |
Collapse
|