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Malik FI, Robertson LA, Armas DR, Robbie EP, Osmukhina A, Xu D, Li H, Solomon SD. A Phase 1 Dose-Escalation Study of the Cardiac Myosin Inhibitor Aficamten in Healthy Participants. JACC Basic Transl Sci 2022; 7:763-775. [PMID: 36061336 PMCID: PMC9436819 DOI: 10.1016/j.jacbts.2022.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
Certain genetic hypertrophic cardiomyopathies may result from hypercontractility of cardiac muscle, caused by pathogenic variants in genes encoding proteins of the cardiac sarcomere. Aficamten (formerly CK-3773274) is a small-molecule selective inhibitor of the cardiac myosin ATPase, which reduces the contractility of cardiomyocytes in vitro and decreases measures of ventricular contractility in animal studies. In this first-in-human, phase 1 study in healthy adults, aficamten was well tolerated; adverse events were generally mild and comparable in frequency to those seen with placebo. Aficamten demonstrated dose-proportional pharmacokinetics with a half-life of 75 to 85 hours. Pharmacodynamically active doses of aficamten decreased left ventricular ejection fraction from baseline in a concentration-dependent manner, informing the design of a phase 2 trial in patients with hypertrophic cardiomyopathy.
This phase 1, randomized, double-blind, placebo-controlled study of aficamten (formerly CK-3773274) in healthy adults identified a pharmacologically active range of doses and exposures. At doses that were pharmacologically active (single doses of ≤50 mg or daily dosing of ≤10 mg for 14 or 17 days), aficamten appeared to be safe and well tolerated. Adverse events were generally mild and no more frequent than with placebo. Pharmacokinetic assessments showed dose proportionality over the range of single doses administered, and pharmacokinetics were not affected by administration with food or in otherwise healthy individuals with a cytochrome P450 2D6 poor metabolizer phenotype. (A Single and Multiple Ascending Dose Study of CK-3773274 in Health Adult Subjects; NCT03767855)
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Key Words
- AE, adverse event
- AUC24, area under the plasma concentration–time curve from time 0 to 24 hours
- CV%,, percent coefficient of variation
- CYP, cytochrome P450
- CYP2D6-PM, cytochrome P450 2D6 poor metabolizer phenotype
- Cmax, maximum plasma drug concentration
- DLRC, Dose Level Review Committee
- ECG, electrocardiogram
- HCM, hypertrophic cardiomyopathy
- LV contractility
- LV, left ventricle
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, left ventricular end-systolic volume
- MAD, multiple ascending dose
- PD, pharmacodynamic
- PK, pharmacokinetic
- QTcF, QT interval corrected for heart rate using Fridericia’s formula
- SAD, single ascending dose
- TEAE, treatment-emergent adverse event
- aficamten
- cardiac myosin inhibitor
- hypertrophic cardiomyopathy
- phase 1
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Affiliation(s)
- Fady I Malik
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Laura A Robertson
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | | | - Edward P Robbie
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Anna Osmukhina
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Donghong Xu
- Research and Development, Cytokinetics, Inc, South San Francisco, California, USA
| | - Hanbin Li
- Certara, Inc, Menlo Park, California, USA
| | - Scott D Solomon
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Cerrud-Rodriguez RC, Burkhoff D, Latib A, Granada JF. A Glimpse Into the Future of Transcatheter Interventional Heart Failure Therapies. JACC Basic Transl Sci 2022; 7:181-91. [PMID: 35257045 DOI: 10.1016/j.jacbts.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 01/09/2023]
Abstract
HF affects millions of patients every year, adding a significant financial burden to global health care systems. This review discusses the role of novel transcatheter-based therapies for the management of HF. Ongoing clinical trials will provide answers on the potential clinical benefits of these technologies in HF outcomes.
Chronic heart failure is one of the most debilitating chronic conditions affecting millions of people and adding a significant financial burden to health care systems worldwide. Despite the significant therapeutic advances achieved over the last decade, morbidity and mortality remain high. Multiple catheter-based interventional therapies targeting different physiological and anatomical targets are already under different stages of clinical investigation. The present paper provides a technical overview of the most relevant catheter-based interventional therapies under clinical investigation.
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Key Words
- CI, confidence interval
- COVID-19, coronavirus disease 2019
- CS, coronary sinus
- CVP, central venous pressure
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HR, hazard ratio
- LA, left atrium/atrial
- LAP, left atrial pressure
- LV, left ventricular
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, left ventricular end-systolic volume
- LVESVi, left ventricular end-systolic volume index
- NYHA, New York Heart Association
- PCWP, pulmonary capillary wedge pressure
- RA, right atrium/atrial
- RAP, right atrial pressure
- SVC, superior vena cava
- catheter-based therapies
- heart failure
- interventional heart failure
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3
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Marchese P, Cantinotti M, Van den Eynde J, Assanta N, Franchi E, Pak V, Santoro G, Koestenberger M, Kutty S. Left ventricular vortex analysis by high-frame rate blood speckle tracking echocardiography in healthy children and in congenital heart disease. Int J Cardiol Heart Vasc 2021; 37:100897. [PMID: 34786451 PMCID: PMC8579140 DOI: 10.1016/j.ijcha.2021.100897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
Background High-frame rate blood speckle tracking (BST) echocardiography is a new technique for the assessment of intracardiac flow. The purpose of this study was to evaluate the characteristics of left ventricular (LV) vortices in healthy children and in those with congenital heart disease (CHD). Methods Characteristics of LV vortices were analyses based on 4-chamber BST images from 118 healthy children (median age 6.84 years, range 0.01-17 years) and 43 children with CHD (median age 0.99 years, range 0.01-14 years). Both groups were compared after propensity matching. Multiple linear regression was used to identify factors that independently influence vortex characteristics. Results Feasibility of vortex imaging was 93.7% for healthy children and 95.6% for CHD. After propensity matching, there were no overall significant differences in vortex distance to apex, distance to interventricular septum (IVS), height, width, sphericity index, or area. However, multiple regression analysis revealed significant associations of LV morphology with vortex characteristics. Furthermore, CHD involving LV volume overload and CHD involving LV pressure overload were both associated with vortices localized closer to the IVS. Conclusions LV vortex analysis using high-frame rate BST echocardiography is feasible in healthy children and in those with CHD. As they are associated with LV morphology and are modified in some types of CHD, vortices might yield diagnostic and prognostic value. Future studies are warranted to establish applications of vortex imaging in the clinical setting.
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Key Words
- -i, indexed to BSA
- AV, atrioventricular
- BMI, body mass index
- BSA, body surface area
- BST, blood speckle tracking
- Blood speckle imaging
- Bpm, beats per minute
- CHD, congenital heart disease
- CI, correlation index
- Congenital
- ED, end-diastolic
- Echocardiography
- Fps, frame per second
- Heart defects
- ICC, intraclass correlation coefficient
- IQR, interquartile range
- IVS, interventricular septum
- LV, left ventricle/ventricular
- LVEDA, left ventricular end-diastolic area
- LVEDD, left ventricular end-diastolic dimension
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESD, left ventricular end-systolic dimension
- LVESV, left ventricular end-systolic volume
- LVOT, left ventricular outflow tract
- LVPO, CHD involving left ventricle pressure overload
- LVSV, left ventricular stroke volume
- LVVO, CHD involving left ventricular volume overload
- Left ventricle
- MV, mitral valve
- Pediatrics
- RVPO, CHD involving right ventricular pressure overload
- RVVO, CHD involving right ventricular volume overload
- TGA, transposition of the great arteries
- Vortex imaging
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Affiliation(s)
- Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy.,Adult Institute of Clinical Physiology, Pisa, Italy
| | | | - Jef Van den Eynde
- Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Vitali Pak
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Shelby Kutty
- Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
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Kawaguchi S, Soma Y, Nakajima K, Kanazawa H, Tohyama S, Tabei R, Hirano A, Handa N, Yamada Y, Okuda S, Hishikawa S, Teratani T, Kunita S, Kishino Y, Okada M, Tanosaki S, Someya S, Morita Y, Tani H, Kawai Y, Yamazaki M, Ito A, Shibata R, Murohara T, Tabata Y, Kobayashi E, Shimizu H, Fukuda K, Fujita J. Intramyocardial Transplantation of Human iPS Cell-Derived Cardiac Spheroids Improves Cardiac Function in Heart Failure Animals. JACC Basic Transl Sci 2021; 6:239-254. [PMID: 33778211 PMCID: PMC7987543 DOI: 10.1016/j.jacbts.2020.11.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 12/16/2022]
Abstract
The severe shortage of donor hearts hampered the cardiac transplantation to patients with advanced heart failure. Therefore, cardiac regenerative therapies are eagerly awaited as a substitution. Human induced pluripotent stem cells (hiPSCs) are realistic cell source for regenerative cardiomyocytes. The hiPSC-derived cardiomyocytes are highly expected to help the recovery of heart. Avoidance of teratoma formation and large-scale culture of cardiomyocytes are definitely necessary for clinical setting. The combination of pure cardiac spheroids and gelatin hydrogel succeeded to recover reduced ejection fraction. The feasible transplantation strategy including transplantation device for regenerative cardiomyocytes are established in this study.
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Key Words
- CM, cardiomyocyte
- CMR, cardiac magnetic resonance
- CS, cardiac spheroid
- ECG, electrocardiogram
- EF, ejection fraction
- FAC, fractional area change
- GH, gelatin hydrogel
- HF, heart failure
- LV, left ventricular
- LVEDV, left ventricular end-diastolic volume
- LVESV, left ventricular end-systolic volume
- VEGF, vascular endothelial growth factor
- cardiac spheroids
- cardiomyocyte
- cell transplantation
- dp/dtmax, maximum rate of left ventricular pressure rise
- hPSC, human pluripotent stem cell
- heart failure
- hiPSC, human induced pluripotent stem cell
- human iPS cells
- sCM, single cardiomyocyte
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Affiliation(s)
- Shinji Kawaguchi
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Soma
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuaki Nakajima
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Kanazawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shugo Tohyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Department of Organ Fabrication, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Tabei
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Akinori Hirano
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noriko Handa
- Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Hishikawa
- Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi, Japan
| | - Takumi Teratani
- Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi, Japan
| | - Satoshi Kunita
- Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi, Japan
| | - Yoshikazu Kishino
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Marina Okada
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Sho Tanosaki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shota Someya
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuika Morita
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hidenori Tani
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yujiro Kawai
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Yamazaki
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akira Ito
- Department of Chemical Systems Engineering, School of Engineering, Nagoya University, Nagoya, Japan
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Tabata
- Laboratory of Biomaterials, Department of Regeneration Science, Engineering Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Eiji Kobayashi
- Department of Organ Fabrication, Keio University School of Medicine, Tokyo, Japan.,Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Jun Fujita
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Endowed Course for Severe Heart Failure Treatment Ⅱ, Keio University School of Medicine, Tokyo, Japan
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5
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Wan SH, Torres-Courchoud I, McKie PM, Slusser JP, Redfield MM, Burnett JC, Hodge DO, Chen HH. Cardiac Versus Renal Response to Volume Expansion in Preclinical Systolic Dysfunction With PDEV Inhibition and BNP. ACTA ACUST UNITED AC 2020; 4:962-972. [PMID: 31909303 PMCID: PMC6939015 DOI: 10.1016/j.jacbts.2019.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/11/2022]
Abstract
In preclinical systolic dysfunction, defined as left ventricular systolic dysfunction with no heart failure signs or symptoms, impairment in cardiorenal response to volume expansion may lead to symptomatic heart failure. Rescue of this impaired process in preclinical disease may prevent development of symptomatic heart failure. In preclinical systolic dysfunction, inhibition of phosphodiesterase-V in combination with exogenous B-type natriuretic peptide administration results in improved cardiac function but worsened renal function in response to acute volume expansion. Future studies are needed to further define the physiological effects and long-term outcomes of phosphodiesterase-V inhibition and exogenous BNP administration. Understanding the cardiorenal effects and outcomes of combination phosphodiesterase-V with exogenous B-type natriuretic peptide may affect the clinical management of patients with preclinical systolic dysfunction and renal dysfunction.
Impaired cardiorenal response to acute saline volume expansion in preclinical systolic dysfunction (PSD) may lead to symptomatic heart failure. The objective was to determine if combination phosphodiesterase-V inhibition and exogenous B-type natriuretic peptide (BNP) administration may enhance cardiorenal response. A randomized double-blinded, placebo-controlled study was conducted in 21 subjects with PSD and renal dysfunction. Pre-treatment with tadalafil and subcutaneous BNP resulted in improved cardiac function, as evidenced by improvement in ejection fraction, left atrial volume index, and left ventricular end-diastolic volume. However, there was reduced renal response with reduction in renal plasma flow, glomerular filtration rate, and urine flow. (Tadalafil and Nesiritide as Therapy in Pre-clinical Heart Failure; NCT01544998)
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Key Words
- ACC, American College of Cardiology
- AHA, American Heart Association
- ANP, atrial natriuretic peptide
- B-type natriuretic peptide
- BNP, B-type natriuretic peptide
- GFR, glomerular filtration rate
- HF, heart failure
- LAVI, left atrial volume index
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, left ventricular end-systolic volume
- NP, natriuretic peptide
- PDEV, type V phosphodiesterase
- PSD, preclinical systolic dysfunction
- RPF, renal plasma flow
- SC, subcutaneous
- VE, acute saline volume expansion
- cGMP, cyclic guanosine monophosphate
- cardiorenal
- heart failure
- nesiritide
- phosphodiesterase inhibition
- systolic dysfunction
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Affiliation(s)
- Siu-Hin Wan
- Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota.,Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota
| | | | - Paul M McKie
- Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota.,Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Margaret M Redfield
- Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota.,Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota
| | - John C Burnett
- Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota.,Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Horng H Chen
- Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota.,Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota
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6
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Traverse JH, Henry TD, Dib N, Patel AN, Pepine C, Schaer GL, DeQuach JA, Kinsey AM, Chamberlin P, Christman KL. First-in-Man Study of a Cardiac Extracellular Matrix Hydrogel in Early and Late Myocardial Infarction Patients. JACC Basic Transl Sci 2019; 4:659-669. [PMID: 31709316 PMCID: PMC6834965 DOI: 10.1016/j.jacbts.2019.07.012] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 12/16/2022]
Abstract
A first-in-man clinical trial was completed with VentriGel, an extracellular matrix hydrogel derived from decellularized porcine myocardium, in post–MI patients. Results from the trial support the safety and feasibility of transendocardial injection of VentriGel in post–MI patients with left ventricular dysfunction. Although the study was not designed to evaluate efficacy, there were suggestions of improvements including increases in 6-min walk test distance and decreases in New York Heart Association functional class across the entire cohort of patients. Improvements in left ventricular remodeling were mainly observed in patients who were treated >1-year post–MI as opposed to <1 year. Results from the trial warrant further evaluation in larger randomized, controlled clinical trials.
This study evaluated the safety and feasibility of transendocardial injections of VentriGel, a cardiac extracellular matrix hydrogel, in early and late post–myocardial infarction (MI) patients with left ventricular (LV) dysfunction. VentriGel was delivered in 15 patients with moderate LV dysfunction (25% ≤ LV ejection fraction ≤ 45%) who were between 60 days to 3 years post-MI and were revascularized by percutaneous coronary intervention. The primary endpoints were incidence of adverse events and abnormal clinical laboratory results. This first-in-man study established the safety and feasibility of delivering VentriGel in post-MI patients, thus warranting further evaluation in larger, randomized clinical trials.
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Key Words
- BNP, B-type natriuretic peptide
- CMR, cardiac magnetic resonance
- ECM, extracellular matrix
- EF, ejection fraction
- LV, left ventricular
- LVEDV, left ventricular end-diastolic volume
- LVESV, left ventricular end-systolic volume
- MI, myocardial infarction
- MLWHFQ, Minnesota Living with Heart Failure Questionnaire
- NYHA, New York Heart Association
- biomaterial
- catheter
- heart failure
- injectable
- myocardial infarction
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Affiliation(s)
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Nabil Dib
- Dignity Health Mercy Gilbert Medical Center, Gilbert, Arizona
| | - Amit N Patel
- Dewitt Daughtry Family Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida
| | - Carl Pepine
- University of Florida College of Medicine, Gainesville, Florida
| | - Gary L Schaer
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | | | | | | | - Karen L Christman
- Department of Bioengineering, Sanford Consortium for Regenerative Medicine, La Jolla, California
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Almahmoud MF, Gonzalez HM, Swett K, Tarraf W, Schneiderman N, Kansal MM, Lamar M, Talavera GA, Rodriguez CJ. Association of Cardiac Structure and Function With Neurocognition in Hispanics/Latinos: The Echocardiographic Study of Latinos. Mayo Clin Proc Innov Qual Outcomes 2018; 2:165-75. [PMID: 30225446 DOI: 10.1016/j.mayocpiqo.2018.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective To study the associations of comprehensive measures of cardiac structure and function with multidimensional neurocognitive measures. Patients and Methods The Echocardiographic Study of Latinos is a population-based cohort of Hispanic/Latino adults older than 45 years enrolled from October 1, 2011, through June 30, 2014. Neurocognitive measures included Word Fluency (WF), Brief-Spanish English Verbal Learning Test (B-SEVLT), and Digit Symbol Substitution Test. The B-SEVLT included B-SEVLT-recall and B-SEVLT-sum. Echocardiographic measures included cardiac structure, systolic and diastolic function, and myocardial strain. Multivariable regression models were fit using survey statistics and sampling probabilities. Results A total of 1794 participants (mean age, 56±0.5 years; 56% women) were included in the analysis. In the adjusted model, higher left ventricular mass index was associated with lower B-SEVLT-sum and Digit Symbol Substitution Test scores. Left ventricular systolic dysfunction was associated with lower WF scores. Abnormal left ventricular geometry was associated with lower B-SEVLT-sum scores. Higher relative wall thickness was associated with B-SEVLT-recall and B-SEVLT-sum scores. Mitral annular relaxation velocities were associated with lower B-SEVLT-recall, B-SEVLT-sum, and WF scores. Higher mitral inflow to annular early diastolic velocity ratio was associated with lower B-SEVLT-recall and B-SEVLT-sum scores. Diastolic dysfunction was associated with lower B-SEVLT-sum scores. Finally, lower global longitudinal strain was associated with lower WF scores. Conclusion Alterations in cardiac structure, systolic and diastolic function, and myocardial strain were associated with worse neurocognitive function. Further study is needed to determine the mechanisms (ie, impairment of cerebral flow and silent brain infarctions) mediating these heart-brain associations.
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Key Words
- B-SEVLT, Brief-Spanish English Verbal Learning Test
- BMI, body mass index
- CVH, cardiovascular health
- DSST, Digit Symbol Substitution Test
- E/e′ ratio, ratio of the early mitral inflow velocity to the mitral annular early diastolic velocity
- ECHO-SOL, Echocardiographic Study of Latinos
- EF, ejection fraction
- GLS, global longitudinal strain
- HCHS/SOL, Hispanic Community Health Study/Study of Latinos
- LA, left atrial
- LAVI, left atrial volume index
- LV, left ventricular
- LVESV, left ventricular end-systolic volume
- LVMI, left ventricular mass index
- RWT, relative wall thickness
- SIS, Six-Item Screener
- S′, peak systolic annular velocity
- WF, Word Fluency
- e′, mitral annular early diastolic velocity
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8
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Ghani A, Delnoy PPHM, Adiyaman A, Ottervanger JP, Ramdat Misier AR, Smit JJJ, Elvan A. Septal rebound stretch as predictor of echocardiographic response to cardiac resynchronization therapy. Int J Cardiol Heart Vasc 2015; 7:22-7. [PMID: 28785641 DOI: 10.1016/j.ijcha.2015.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/01/2015] [Indexed: 01/14/2023]
Abstract
Aim Septal rebound stretch (SRSsept) reflects an inefficient deformation of the septum during systole and is a potential new echocardiographic tool to predict response to Cardiac Resynchronization Therapy (CRT). However, there are only limited data on the potential predictive value of SRSsept on echocardiographic response. We evaluated the predictive value of SRSsept on echocardiographic response to CRT in a large population. Methods and results A total of 138 consecutive patients with functional class II–IV heart failure who underwent CRT were studied. Echocardiography was performed at baseline and after a mean follow-up period of 22 ± 8 months. Echocardiographic response to CRT was defined as a reduction in LV end-systolic volume ≥ 15%. Receiver operating characteristic curve analysis was performed to define the optimal cut-off value for SRSsept. Multivariable analyses were performed to adjust for potential confounders. Mean age was 68 ± 8 years (30% female). Mean baseline LV ejection fraction was 26 ± 7%, 51% had ischemic etiology. LBBB or LBBB like morphology was present in 95% of patients. Mean SRSsept was 4.4 ± 3.2%, 56% of patients had SRSsept ≥ 4%. Ninety six patients (70%) were echocardiographic responders. Baseline SRSsept was significantly higher in responders compared to non-responders (5.1 ± 3.2 vs 3.0 ± 2.7, P < 0.001). The optimal cut-off value for SRSsept to predict response to CRT was 4.0%. After both univariate (OR 3.74, 95% CI 1.72–8.10) and multivariate analyses (OR 3.71, 95% CI 1.49–9.2), baseline SRSsept > 4% independently predicted the response to CRT. Conclusions Baseline septal rebound stretch is independently associated with echocardiographic response to CRT. Septal rebound stretch was used to predict response to CRT in patient who underwent CRT-D implantation. Echocardiographic response to CRT was defined as a reduction in LV end-systolic volume ≥ 15%. Baseline SRSsept was significantly higher in echocardiographic responders compared to non-responders to CRT. The optimal cut-off value for SRSsept was 4%. Baseline septal rebound stretch was independently associated with echocardiographic response to CRT.
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Key Words
- CABG, coronary artery bypass grafting
- CRT, cardiac resynchronization therapy
- Cardiac resynchronization therapy
- Heart failure
- IVMD, inter-ventricular mechanical delay
- LBBB, left bundle branch block
- LV-dyssynchrony
- LVEDD, left ventricular end-diastolic diameter
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESD, left ventricular end-systolic diameter
- LVESV, left ventricular end-systolic volume
- NYHA, New York Heart Association
- PCI, percutaneous coronary intervention
- RBBB, right bundle branch block
- Response
- SRSSept, septal rebound stretch
- Septal rebound stretch
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