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Lee RJ, Hinson A, Bauernschmitt R, Matschke K, Fang Q, Mann DL, Dowling R, Schiller N, Sabbah HN. The feasibility and safety of Algisyl-LVR™ as a method of left ventricular augmentation in patients with dilated cardiomyopathy: initial first in man clinical results. Int J Cardiol 2015; 199:18-24. [PMID: 26173169 DOI: 10.1016/j.ijcard.2015.06.111] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 06/08/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND A tissue engineering approach to augment the left ventricular wall has been suggested as a means to treat patients with advanced heart failure. This study evaluated the safety and feasibility of Algisyl-LVR™ as a method of left ventricular augmentation in patients with dilated cardiomyopathy undergoing open-heart surgery. METHODS AND RESULTS Eleven male patients (aged 44 to 74years) with advanced heart failure (NYHA class 3 or 4), a left ventricular ejection fraction (LVEF) of <40% and requiring conventional heart surgery received Algisyl-LVR delivered into the LV myocardial free wall. Serial echocardiography, assessment of NYHA class, Kansas City Cardiomyopathy Questionnaire (KCCQ) and 24-hour Holter monitoring were obtained at baseline, days 3 and 8 (for echocardiography and Holter monitoring), and at 3, 6, 12, 18 and 24months. A total of 9 (81.8%) patients completed 24months of follow-up. Two patients withdrew consent after day 8 and at the 3month visit. Operative mortality was 0% (n=10 with 30day follow-up). There were no adverse events attributed to Algisyl-LVR. Mean LVEF improved from 27.1 (±7.3) % at screening to a mean LVEF of 34.8 (±18.6) % 24months post-discharge. Improvements of NYHA class were corroborated with improvements in KCCQ summary scores. Holter monitor data showed a significant decrease in the episodes of nonsustained ventricular tachycardia following administration of Algisyl-LVR. CONCLUSIONS Administration of Algisyl-LVR to patients with advanced HF at the time of cardiac surgery is feasible and safe; warranting continued development of Algisyl-LVR as a potential therapy in patients with advanced HF.
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Affiliation(s)
- Randall J Lee
- Cardiovascular Research Institute, University of California-San Francisco, San Francisco, CA, USA; Department of Medicine, University of California-San Francisco, San Francisco, CA, USA; Institute for Regeneration Medicine, University of California-San Francisco, San Francisco, CA, USA.
| | | | - Robert Bauernschmitt
- Department for Thoracic and Cardiovascular Surgery, University of Ulm, Ulm, Germany
| | - Klaus Matschke
- Cardiovascular Surgery, University Hospital Dresden, Dresden, Germany
| | - Qi Fang
- Cardiovascular Research Institute, University of California-San Francisco, San Francisco, CA, USA; Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Douglas L Mann
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO, USA
| | | | - Nelson Schiller
- Cardiovascular Research Institute, University of California-San Francisco, San Francisco, CA, USA; Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Hani N Sabbah
- Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
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Scott JM, Esch BT, Lusina SJC, McKenzie DC, Koehle MS, Sheel AW, Warburton DE. Post-exercise hypotension and cardiovascular responses to moderate orthostatic stress in endurance-trained males. Appl Physiol Nutr Metab 2008; 33:246-53. [DOI: 10.1139/h07-173] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We tested the hypothesis that following an acute bout of exercise cardiovascular and cerebrovascular responses to lower-body negative pressure (LBNP) would be altered due to post-exercise hypotension (PEH). Ten healthy, male, endurance-trained athletes (mean age ± SD = 29.6 ± 5) were assessed for cardiovascular and cerebrovascular responses to LBNP following acute bouts of interval and continuous exercise. Mean arterial pressure (MAP), cardiac output, total peripheral resistance, heart rate variability, and total cerebral oxygen index were determined during a baseline LBNP session. These indices were also determined during two other LBNP sessions: following an acute bout of interval exercise, and following an acute bout of continuous exercise. Compared with baseline, MAP was reduced after both exercise conditions, similar to values previously reported (10 mmHg; p < 0.05 vs. pre-exercise). Total peripheral resistance was significantly reduced following both exercise bouts, and heart rate was significantly increased post-exercise (rest: 59.6 ± 11.2; interval: 77.8 ± 12.8; continuous: 80.3 ± 15.2 beats·min–1). Both cardiac output and stroke volume responses to LBNP following exercise were not altered when compared with baseline measurements. Tissue oxygenation during –40 mmHg (interval: 74.31% ± 7.82% vs. continuous: 69.13% ± 5.23%) was significantly lower than during normobaric pressure (interval: 77.14% ± 1.30% vs. continuous: 74.41% ± 0.94%). It appears from these observations that although young, endurance-trained males experience PEH following acute bouts of interval or continuous exercise, this hypotension does not alter the cardiovascular and cerebrovascular responses to a moderate orthostatic stress.
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Affiliation(s)
- Jessica M. Scott
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, Faculty of Medicine, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
| | - Ben T.A. Esch
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, Faculty of Medicine, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
| | - Sarah-Jane C. Lusina
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, Faculty of Medicine, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
| | - Donald C. McKenzie
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, Faculty of Medicine, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
| | - Michael S. Koehle
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, Faculty of Medicine, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
| | - A. William Sheel
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, Faculty of Medicine, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
| | - Darren E.R. Warburton
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
- School of Human Kinetics, Faculty of Medicine, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z3
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Esch BTA, Scott JM, Warburton DER. Construction of a lower body negative pressure chamber. ADVANCES IN PHYSIOLOGY EDUCATION 2007; 31:76-81. [PMID: 17327587 DOI: 10.1152/advan.00009.2006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Lower body negative pressure (LBNP) is an established and important technique used to physiologically stress the human body, particularly the cardiovascular system. LBNP is most often used to simulate gravitational stress, but it has also been used to simulate hemorrhage, alter preload, and manipulate baroreceptors. During experimentation, the consequences of LBNP and the reflex increases in heart rate and blood pressure can be manipulated and observed in a well-controlled manner, thus making LBNP an important research tool. Numerous laboratories have developed LBNP devices for use in research settings, and a few devices are commercially available. However, it is often difficult for new users to find adequately described design plans. Furthermore, many available plans require sophisticated and expensive materials and/or technical support. Therefore, we have created an affordable design plan for a LBNP chamber. The purpose of this article was to share our design template with others. In particular, we hope that this information will be of use in academic and research settings. Our pressure chamber has been stress tested to 100 mmHg below atmospheric pressure and has been used successfully to test orthostatic tolerance and physiological responses to -50 mmHg.
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Affiliation(s)
- Ben T A Esch
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, British Columbia, Canada
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