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Kar S, Doshi SK, Sadhu A, Horton R, Osorio J, Ellis C, Stone J, Shah M, Dukkipati SR, Adler S, Nair DG, Kim J, Wazni O, Price MJ, Asch FM, Holmes DR, Shipley RD, Gordon NT, Allocco DJ, Reddy VY. Primary Outcome Evaluation of a Next-Generation Left Atrial Appendage Closure Device: Results From the PINNACLE FLX Trial. Circulation 2021; 143:1754-1762. [PMID: 33820423 DOI: 10.1161/circulationaha.120.050117] [Citation(s) in RCA: 185] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left atrial appendage (LAA) occlusion provides an alternative to oral anticoagulation for thromboembolic risk reduction in patients with nonvalvular atrial fibrillation. Since regulatory approval in 2015, the WATCHMAN device has been the only LAA closure device available for clinical use in the United States. The PINNACLE FLX study (Protection Against Embolism for Nonvalvular AF Patients: Investigational Device Evaluation of the Watchman FLX LAA Closure Technology) evaluated the safety and effectiveness of the next-generation WATCHMAN FLX LAA closure device in patients with nonvalvular atrial fibrillation in whom oral anticoagulation is indicated, but who have an appropriate rationale to seek a nonpharmaceutical alternative. METHODS This was a prospective, nonrandomized, multicenter US Food and Drug Administration study. The primary safety end point was the occurrence of one of the following events within 7 days after the procedure or by hospital discharge, whichever was later: death, ischemic stroke, systemic embolism, or device- or procedure-related events requiring cardiac surgery. The primary effectiveness end point was the incidence of effective LAA closure (peri-device flow ≤5 mm), as assessed by the echocardiography core laboratory at 12-month follow-up. RESULTS A total of 400 patients were enrolled. The mean age was 73.8±8.6 years and the mean CHA2DS2-VASc score was 4.2±1.5. The incidence of the primary safety end point was 0.5% with a 1-sided 95% upper CI of 1.6%, meeting the performance goal of 4.2% (P<0.0001). The incidence of the primary effectiveness end point was 100%, with a 1-sided 95% lower CI of 99.1%, again meeting the performance goal of 97.0% (P<0.0001). Device-related thrombus was reported in 7 patients, no patients experienced pericardial effusion requiring open cardiac surgery, and there were no device embolizations. CONCLUSIONS LAA closure with this next-generation LAA closure device was associated with a low incidence of adverse events and a high incidence of anatomic closure. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02702271.
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Affiliation(s)
- Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA (S.K.).,Bakersfield Heart Hospital, Bakersfield, CA (S.K.)
| | - Shephal K Doshi
- Providence, Saint Johns Health Center, Pacific Heart Institute, Santa Monica, CA (S.K.D.)
| | - Ashish Sadhu
- Phoenix Cardiovascular Research Group, AZ (A.S.)
| | | | - Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, AL (J.O.)
| | | | - James Stone
- North Mississippi Medical Center, Tupelo (J.S.)
| | - Manish Shah
- MedStar Health Medical Center, Washington, DC (M.S.)
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.R.D.)
| | | | - Devi G Nair
- St Bernard's Heart and Vascular Center, Jonesboro, AR (D.G.N.)
| | - Jamie Kim
- New England Heart and Vascular Institute at Catholic Medical Center, Manchester, NH (J.K.)
| | | | | | | | | | - Robert D Shipley
- Boston Scientific Corporation, Marlborough, MA (R.D.S., N.T.G., D.J.A.)
| | - Nicole T Gordon
- Boston Scientific Corporation, Marlborough, MA (R.D.S., N.T.G., D.J.A.)
| | - Dominic J Allocco
- Boston Scientific Corporation, Marlborough, MA (R.D.S., N.T.G., D.J.A.)
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Leblanc AJ, Chen B, Dougherty PJ, Reyes RA, Shipley RD, Korzick DH, Muller-Delp JM. Divergent effects of aging and sex on vasoconstriction to endothelin in coronary arterioles. Microcirculation 2014. [PMID: 23198990 DOI: 10.1111/micc.12028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The risk for cardiovascular disease increases with advancing age; however, the chronological development of heart disease differs in males and females. The purpose of this study was to determine whether age-induced alterations in responses of coronary arterioles to the endogenous vasoconstrictor, endothelin, are sex-specific. METHODS Coronary arterioles were isolated from young and old male and female rats to assess vasoconstrictor responses to endothelin (ET), and ETa and ETb receptor inhibitors were used to assess receptor-specific signaling. RESULTS In intact arterioles from males, ET-induced vasoconstriction was reduced with age, whereas age increased vasoconstrictor responses to ET in intact arterioles from female rats. In intact arterioles from both sexes, blockade of either ETa or ETb eliminated age-related differences in responses to ET; however, denudation of arterioles from both sexes revealed age-related differences in ETa-mediated vasoconstriction. In arterioles from male rats, ETa receptor protein decreased, whereas ETb receptor protein increased with age. In coronary arterioles from females, neither ETa nor ETb receptor protein changed with age, suggesting age-related changes in ET signaling occur downstream of ET receptors. CONCLUSIONS Thus, aging-induced alterations in responsiveness of the coronary resistance vasculature to endothelin are sex-specific, possibly contributing to sexual dimorphism in the risk of cardiovascular disease with advancing age.
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Affiliation(s)
- Amanda J Leblanc
- Center for Cardiovascular and Respiratory Sciences, School of Medicine, West Virginia University, Morgantown, WV, USA
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Abstract
Impairment of flow-induced vasodilation in coronary resistance arterioles may contribute to the decline in coronary vasodilatory reserve that occurs with advancing age. This study investigated the effects of age on flow-induced signaling and activation of nitric oxide (NO)-mediated vasodilation in coronary resistance arterioles. Coronary arterioles were isolated from young (approximately 6 mo) and old (approximately 24 mo) male Fischer-344 rats to assess vasodilation to flow, vascular endothelial growth factor (VEGF), and ACh. Flow- and VEGF-induced vasodilation of coronary arterioles was impaired with age (P<or=0.05); however, ACh-induced vasodilation was preserved with age. NG-nitro-L-arginine methyl ester (L-NAME) (1x10(-5) M) eliminated vasodilation to flow, VEGF, and ACh, indicating dependence of these responses on NO. SU-1498, an inhibitor of vascular endothelial growth factor receptor 2 (VEGFR, also known as Flk-1), abolished age-related differences in flow-induced vasodilation. Flow-stimulated phosphorylation of Flk-1 in coronary arterioles from young but not old rats and Flk-1 protein was reduced in coronary arterioles from old rats compared with those from young rats. Flow stimulated phosphorylation of endothelial nitric oxide synthase (eNOS) in coronary arterioles from both young and old rats. VEGF induced phosphorylation of both protein kinase B (Akt) and eNOS in coronary arterioles. VEGF-induced phosphorylation of Akt, but not eNOS, was significantly reduced in arterioles from old rats compared with arterioles from young rats. Wortmannin, an inhibitor of phosphatidylinositol (PI) 3-kinase, eliminated age-related differences in both flow- and VEGF-induced vasodilation. These results indicate that impairment of Flk-1/PI3-kinase signaling contributes to the reduction of flow-induced vasodilation in coronary arterioles with advancing age.
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Affiliation(s)
- Amanda J LeBlanc
- Center for Interdisciplinary Research in Cardiovascular Sciences, Department of Physiology and Pharmacology, P.O. Box 9105, 1 Medical Center Dr., West Virginia University School of Medicine, Morgantown, WV 26506, USA
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Hein TW, Qamirani E, Shipley RD, Ren Y, Xu X, Kuo L. C‐reactive protein inhibits endothelium‐dependent prostacyclin synthase‐mediated dilation of coronary arterioles: role of peroxynitrite. FASEB J 2007. [DOI: 10.1096/fasebj.21.6.a1228-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Travis W. Hein
- Department of SurgeryScott and White Memorial Hospital/Texas A&M Health Science Center702 Southwest H.K. Dodgen LoopTempleTX76504
| | - Erion Qamirani
- Department of Systems Biology and Translational MedicineTexas A&M Health Science Center702 Southwest H.K. Dodgen LoopTempleTX76504
| | - Robert D. Shipley
- Department of Systems Biology and Translational MedicineTexas A&M Health Science Center702 Southwest H.K. Dodgen LoopTempleTX76504
| | - Yi Ren
- Department of Systems Biology and Translational MedicineTexas A&M Health Science Center702 Southwest H.K. Dodgen LoopTempleTX76504
| | - Xin Xu
- Department of Systems Biology and Translational MedicineTexas A&M Health Science Center702 Southwest H.K. Dodgen LoopTempleTX76504
| | - Lih Kuo
- Department of Systems Biology and Translational MedicineTexas A&M Health Science Center702 Southwest H.K. Dodgen LoopTempleTX76504
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LeBlanc AJ, Nichol K, Woodman CR, Shipley RD, Prisby RD, Muller‐Delp J. NOS expression and activity in cerebral resistance arteries: Effects of age and exercise training. FASEB J 2006. [DOI: 10.1096/fasebj.20.4.a812-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amanda Jo LeBlanc
- Center for Interdisciplinary Research in Cardiovascular SciencesWest Virginia UniversityRoom #3060, 1 Medical Center DriveMorgantownWV26506
| | - Kathryn Nichol
- Physiology and BiophysicsUniversity of California Irvine1226 Gillespie Neuroscience Research FacilityIrvineCA92710
| | | | - Robert D. Shipley
- Texas A&M UniversitySystems Biology and Translation MedicineTempleTX76503
| | - Rhonda D Prisby
- Center for Interdisciplinary Research in Cardiovascular SciencesWest Virginia UniversityRoom #3060, 1 Medical Center DriveMorgantownWV26506
| | - Judy Muller‐Delp
- Center for Interdisciplinary Research in Cardiovascular SciencesWest Virginia UniversityRoom #3060, 1 Medical Center DriveMorgantownWV26506
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Zhang C, Hein TW, Wang W, Ren Y, Shipley RD, Kuo L. Activation of JNK and xanthine oxidase by TNF-α impairs nitric oxide-mediated dilation of coronary arterioles. J Mol Cell Cardiol 2006; 40:247-57. [PMID: 16413574 DOI: 10.1016/j.yjmcc.2005.11.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Revised: 11/01/2005] [Accepted: 11/28/2005] [Indexed: 11/19/2022]
Abstract
Elevated levels of tumor necrosis factor-alpha (TNF), a proinflammatory cytokine, are associated with coronary artery disease. However, it is unclear whether vasodilator function of coronary resistance arterioles is susceptible to TNF. Herein, we examined whether TNF can affect endothelium-dependent nitric oxide (NO)-mediated dilation of coronary arterioles to adenosine and whether inflammatory signaling pathways such as mitogen-activated protein kinases, ceramide sphingolipids, and oxidative stress are involved in the TNF-mediated effect. To eliminate confounding influences associated with in vivo preparations, coronary arterioles from porcine heart were isolated and pressurized without flow for in vitro study. Intraluminal treatment with TNF (1 ng/ml, 90 min) significantly attenuated the NO release and vasodilation to adenosine. This inhibitory effect was not observed in denuded vessels or in the presence of NO synthase inhibitor l-NMMA. Histochemical data showed that superoxide production and JNK phosphorylation in arteriolar endothelial cells was enhanced by TNF. Administration of superoxide scavenger or inhibitors of ceramide-activated protein kinase (dimethylaminopurine), JNK (SP600125 and dicumarol), and xanthine oxidase (allopurinol) reduced superoxide production as well as restored NO release and vasodilation to adenosine. Conversely, the effects of TNF were insensitive to inhibitors of p38 (SB203580), ERK (PD98059), NAD(P)H oxidase (apocynin), or mitochondrial respiratory chain (rotenone). These data indicate that TNF inhibits endothelium-dependent NO-mediated dilation of coronary arterioles by ceramide-induced activation of JNK and subsequent production of superoxide via xanthine oxidase. Because myocardial ischemia augments adenosine production and elevates TNF level, inhibiting adenosine-stimulated endothelial release of NO by TNF could contribute to inadequate regulation of coronary blood flow during the development of ischemic heart disease.
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Affiliation(s)
- Cuihua Zhang
- Department of Medical Physiology, Cardiovascular Research Institute, College of Medicine, The Texas A&M University System Health Science Center, 702 Southwest H.K. Dodgen Loop, Temple, TX 76504, USA
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Shipley RD, Muller-Delp JM. Aging decreases vasoconstrictor responses of coronary resistance arterioles through endothelium-dependent mechanisms. Cardiovasc Res 2005; 66:374-83. [PMID: 15820206 DOI: 10.1016/j.cardiores.2004.11.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Revised: 10/15/2004] [Accepted: 11/03/2004] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Aging decreases coronary blood flow and maximal reserve capacity. Impaired blood flow capacity may be related to an increased vasoconstrictor capacity of coronary resistance vessels. This study tested the hypothesis that aging increases the vasoconstrictor responsiveness of coronary arterioles isolated from myocardium of young (4 months) and old (24 months) Fischer 344 rats. METHODS Isolated coronary arterioles were cannulated and pressurized (60 cm H2O) via hydrostatic pressure reservoirs. RESULTS Contrary to our hypothesis, aging decreased responsiveness of coronary arterioles to endothelin (ET, 1 x 10(-11)-3 x 10(-8) M), potassium chloride (KCl, 10-100 mM), and pressure-induced myogenic responses (0-140 cm H2O). Removal of the endothelium from coronary arterioles increased vasoconstriction to all agonists; however, age-related KCl vasoconstrictor response differences remained, suggesting that K+ channel activity and/or the relative contribution of specific K+ channels to maintenance of vascular smooth muscle membrane potential may change with age. Removal of the endothelium, in addition to increasing responsiveness, eliminated aging-induced differences in ET- and pressure-induced vasoconstriction. L-NAME (10(-5)) incubation resulted in a greater enhancement of spontaneous tone in arterioles from old rats compared to those of young rats. ETB (BQ-788, 3 x 10(-8)) receptor blockade eliminated the age-associated differences. CONCLUSION Collectively, these data suggest an age-associated increase in endothelial modulation of coronary resistance vessel constriction. This enhanced endothelial attenuation of coronary arteriolar constriction appears to result from increased basal release of nitric oxide. These alterations of coronary vascular reactivity may contribute to age-induced redistribution of coronary blood flow and diminished cardiac function.
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Affiliation(s)
- Robert D Shipley
- Department of Health and Kinesiology, Texas A & M University, College Station, Texas 77843, USA
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Shipley RD, Kim SJ, Muller-Delp JM. Time course of flow-induced vasodilation in skeletal muscle: contributions of dilator and constrictor mechanisms. Am J Physiol Heart Circ Physiol 2005; 288:H1499-507. [PMID: 15576446 DOI: 10.1152/ajpheart.00489.2004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to determine the time course of flow-induced vasodilation in soleus and gastrocnemius muscle arterioles and the mechanisms that underlie vasodilatory responses to an increase in intraluminal flow. Vasodilation was assessed during 20 min of continuous exposure to intraluminal flow. Both soleus and gastrocnemius muscle arterioles dilated in response to flow, although the magnitude of vasodilation was greater in arterioles from the gastrocnemius muscle. Neither blockade of nitric oxide synthase with NG-nitro-l-arginine methyl ester (l-NAME) nor blockade of cyclooxygenase with indomethacin inhibited the initial vasodilation (0–2 min) in arterioles from either muscle. In contrast, vasodilation to sustained exposure to flow (2–20 min) was eliminated by treatment with l-NAME in arterioles from both muscles. Both depolarization with 40 mM KCl and blockade of Ca2+-activated K+channels inhibited the initial flow-induced dilation, and the inhibition was greater in gastrocnemius muscle arterioles than soleus muscle arterioles. In the presence of l-NAME, prolonged exposure to flow resulted in constriction in soleus and gastrocnemius muscle arterioles. This constriction was abolished by endothelin receptor blockade. These results indicate that the time course and magnitude of flow-induced vasodilation differs between arterioles from soleus and gastrocnemius muscles. The immediate response to increased flow is greater in gastrocnemius muscle arterioles and involves activation of K+channels. In arterioles from both soleus and gastrocnemius muscles, vasodilation to sustained flow exposure occurs primarily through production of nitric oxide. In the absence of nitric oxide, sustained exposure to flow results in pronounced constriction that is mediated by endothelin.
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Affiliation(s)
- Robert D Shipley
- Dept. of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA
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Saville WJA, Sofaly CD, Reed SM, Dubey JP, Oglesbee MJ, Lacombe VA, Keene RO, Gugisberg KM, Swensen SW, Shipley RD, Chiang YW, Chu HJ, Ng T. An equine protozoal myeloencephalitis challenge model testing a second transport after inoculation with Sarcocystis neurona sporocysts. J Parasitol 2005; 90:1406-10. [PMID: 15715237 DOI: 10.1645/ge-128r] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Previous challenge studies performed at Ohio State University involved a transport-stress model where the study animals were dosed with Sarcocystis neurona sporocysts on the day of arrival. This study was to test a second transportation of horses after oral inoculation with S. neurona sporocysts. Horses were assigned randomly to groups: group 1, transported 4 days after inoculation (DAI); group 2, at 11 DAI; group 3, at 18 DAI; and group 4, horses were not transported a second time (controls). An overall neurologic score was determined on the basis of a standard numbering system used by veterinarians. All scores are out of 5, which is the most severely affected animal. The mean score for the group 1 horses was 2.42; group 2 horses was 2.5; group 3 horses was 2.75; and group 4 horses was 3.25. Because the group 4 horses did not have a second transport, they were compared with all other groups. Statistically different scores were present between group 4 and groups 1 and 2. There was no difference in the time of seroconversion between groups. There was a difference between the time of onset of first clinical signs between groups 1 and 4. This difference was likely because of the different examination days. Differences in housing and handling were likely the reason for the differences in severity of clinical signs. This model results in consistent, significant clinical signs in all horses at approximately the same time period after inoculation but was most severe in horses that did not experience a second transport.
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Affiliation(s)
- W J A Saville
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210-1092, USA.
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