scholarly journals The importance of clinically relevant background therapy in cardioprotective studies

2020 ◽  
Vol 115 (6) ◽  
Author(s):  
Zhenhe He ◽  
Sean M. Davidson ◽  
Derek M. Yellon
Keyword(s):  
Myocardial Infarct ◽  
Pharmacological Therapy ◽  
Opioid Agonist ◽  
Acute Myocardial Infarct ◽  
Pharmacological Agents ◽  
Mechanistic Pathway ◽  
Additional Protection ◽  
Vessel Patency ◽  
Background Therapy ◽  
Rapid Restoration

AbstractTreatment of acute myocardial infarct patients (AMI) includes rapid restoration of coronary blood flow and pharmacological therapy aimed to prevent pain and maintain vessel patency. Many interventions have been investigated to offer additional protection. One such intervention is remote ischaemic conditioning (RIC) involving short-episodes of ischaemia of the arm with a blood pressure cuff, followed by reperfusion to protect the heart organs from subsequent severe ischaemia. However, the recent CONDI2-ERIC-PPCI multicentre study of RIC in STEMI showed no benefit in clinical outcome in low risk patients. It could also be argued that these patients were already in a partially protected state, highlighting the disconnect between animal- and clinical-based outcome studies. To improve potential translatability, we developed an animal model using pharmacological agents similar to those given to patients presenting with an AMI, prior to PPCI. Rats underwent MI on a combined background of an opioid agonist, heparin and a platelet-inhibitor thereby allowing us to assess whether additional cardioprotective strategies had any effect over and above this “cocktail”. We demonstrated that the “background drugs” were protective in their own right, reducing MI from 57.5 ± 3.7% to 37.3 ± 2.9% (n = 11, p < 0.001). On this background of drugs, RIC did not add any further protection (38.0 ± 3.4%). However, using a caspase inhibitor, which acts via a different mechanistic pathway to RIC, we were able to demonstrate additional protection (20.6 ± 3.3%). This concept provides initial evidence to develop models which can be used to evaluate future animal-to-clinical translation in cardioprotective studies.

Abstract 13306: Impella Combined With Extracorporeal Membrane Oxygenation Synergistically Unloads the Left Ventricle and Reduces Infarct Size in a Model of Myocardial Infarction With Cardiogenic Shock

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Genya Sunagawa ◽  
Keita Saku ◽  
Takuya Nishikawa ◽  
Nobuhiro Suematsu ◽  
Toru Kubota ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Infarct Size ◽  
Coronary Arteries ◽  
Myocardial Infarct ◽  
Left Ventricular ◽  
Assist Device ◽  
Acute Myocardial Infarct ◽  
Membrane Oxygenation ◽  
Coronary Ligation

Introduction: Extracorporeal membrane oxygenation (ECMO) supports hemodynamics in cardiogenic shock (CS) at the expense of left ventricular (LV) overload. LV assist device (LVAD) also supports hemodynamics, whereas LVAD unloads LV. Therefore, the combination of ECMO and LVAD would augment hemodynamic support and unload LV. We hypothesized that the combination therapy in acute myocardial infarct (AMI) in CS could synergistically improve hemodynamics and unload LV, which, in turn, reduces infarct size. Methods: In protocol 1, we ligated coronary arteries and created AMI with CS in 5 mongrel dogs (15.1±0.3 kg). We transvascularly introduced Impella CP into LV. We kept the ECMO flow constant at 1.8L/min. We compared hemodynamics and the LV pressure-volume area (PVA, an index of LV oxygen consumption) under 3 conditions; Control, ECMO, and ECMO+Impella (ECPELLA) in each dog. In protocol 2 (n=15), we ligated coronary arteries for 180 min and then reperfused. We activated Impella CP and/or ECMO from 60 min after the coronary ligation to the end of the experiment. We allocated dogs into 3 groups, no support (Control), ECMO, and ECPELLA and compared infarct size at 180 min after reperfusion among 3 groups. Results: In protocol 1, both ECMO and ECPELLA increased arterial pressure compared to Control (Control: 63±9, ECMO: 88±10 and ECPELLA: 97±18 mmHg, p < 0.05), and resolved the CS status. ECPELLA strikingly reduced PVA by 83% relative to Control (1500±326, 2038±357 and 258±182 mmHg*ml, p<0.001). In protocol 2, ECPELLA markedly reduced the infarct size (15±8%) compared to Control (53±7%, p<0.05) and ECMO (39±10%, p<0.05). Conclusions: ECPELLA before reperfusion markedly improved hemodynamics, reduced PVA, and limited infarct size in a dog model of MI with CS. ECPELLA could prevent ECMO-induced LV overload and synergistically exert powerful anti-infarct effects in AMI with CS.

Non-pharmacological therapy of acute heart failure: when drugs alone are not enough

2021 ◽  
pp. 651-663
Author(s):  
Jeroen Dauw ◽  
Wilfried Mullens ◽  
Johan Vijgen ◽  
Pascal Vranckx
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Signs And Symptoms ◽  
Coronary Intervention ◽  
Pharmacological Therapy ◽  
Circulatory Support ◽  
Pharmacologic Therapy ◽  
Pharmacological Agents ◽  
Acute Heart Failure Syndrome ◽  
Percutaneous Coronary

Acute heart failure syndrome has been defined as new-onset or a recurrence of worsening signs and symptoms of heart failure, necessitating urgent or emergency management. The management of acute heart failure syndrome is challenging, given the heterogeneity of the patient population, in terms of the clinical presentation, pathophysiology, prognosis, and therapeutic options. The management of acute heart failure syndrome is a dynamic process, requiring ongoing simultaneous diagnosis (monitoring) and treatment. Pharmacological agents remain the mainstay of therapy for acute heart failure syndrome. However, at all time, during the early diagnostic, etiologic, and therapeutic work-up, non-pharmacologic therapy may be indicated and should be considered. The management of the complex cardiac patient with acute heart failure syndrome and/or (potential) haemodynamic compromise has become a special dimension for specialized myocardial intervention centres, providing 24 hours per day and 7 days per week state-of-the-art facilities for (primary) percutaneous coronary intervention and cardiac intensive care, including mechanical ventilation, ultrafiltration, with or without dialysis, and short-term percutaneous mechanical circulatory support. Through the understanding of the underlying pathophysiology and approaches into the problems of acute heart failure syndrome, one should be better prepared to understand and treat its many facets.

scholarly journals ORAL AB II QUICK FIRE BASIC1393Validation of aortic in-vitro strain measurement by Magnetic Resonance Imaging with realistic abdominal aortic aneurism phantom1474A novel method of Segment Length Tracking providing regional strain measures from standard CMR cine images in CRT candidates1623T1 mapping can quantify the area-at-risk and infarct size – no need for T2 mapping or conventional LGE imaging in acute STEMI at 1.5T1373Reliability and reproducibility of trans-valvular flow measurement by 4D flow magnetic resonance imaging in acute myocardial infarct patients: two centre study1588Insights into hypertensive heart disease phenotypes: spectrum of myocyte, interstitial and vascular changes by cardiovascular MRI1412Myocardial partition coefficient of gadolinium: A comparison between patients with acute myocarditis, chronic infarction and healthy volunteers1386A comparison of circumferential strain results from multiple software packages in healthy subjects

2016 ◽  
Vol 17 (suppl 1) ◽  
pp. i10-i13
Author(s):  
Yufei Wang ◽  
A Zweerink ◽  
Heerajnarain Bulluck ◽  
P. Garg ◽  
Jonathan C L Rodrigues ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Acute Myocarditis ◽  
Myocardial Infarct ◽  
T2 Mapping ◽  
Hypertensive Heart Disease ◽  
Segment Length ◽  
Resonance Imaging ◽  
4D Flow ◽  
Acute Myocardial Infarct

scholarly journals Beneficial Effects of Physical Activity in Diabetic Patients

2020 ◽  
Vol 5 (3) ◽  
pp. 70
Author(s):  
Francesca Cannata ◽  
Gianluca Vadalà ◽  
Fabrizio Russo ◽  
Rocco Papalia ◽  
Nicola Napoli ◽  
...  
Keyword(s):  
Physical Activity ◽  
Metabolic Control ◽  
Multidisciplinary Approach ◽  
Pharmacological Therapy ◽  
Diabetic Patients ◽  
Clinical Role ◽  
Pharmacological Agents ◽  
Antidiabetic Therapy ◽  
Beneficial Effects ◽  
The Right

One of the main goals of diabetic therapy is to achieve the best metabolic control to prevent the development and progression of potential complications. A multidisciplinary approach characterized by the combination of diet, physical activity (PA) and drug therapy with oral and injectable (non-insulin) pharmacological agents, is desirable to optimize metabolic control. The aim of this review is to explain the contribution of PA and its beneficial effects on patients affected by type 1 (T1D) and type 2 diabetes (T2D). We provide an overview of evidence on the effects of PA for the main two types of diabetes mellitus (DM) to identify the right level of PA to be recommended. We discuss the physiological and clinical role of PA in people with DM. It can be concluded that the objective of antidiabetic therapy should be the achievement and optimization of metabolic control through a multidisciplinary approach involving non-pharmacological therapy such as diet and PA, which has a crucial role.

scholarly journals The clinical estimation of acute myocardial infarct size with 99mTechnetium pyrophosphate scintigraphy.

Circulation ◽  
1978 ◽  
Vol 57 (2) ◽  
pp. 307-313 ◽  
Author(s):  
D N Sharpe ◽  
E H Botvinick ◽  
D M Shames ◽  
A Norman ◽  
K Chatterjee ◽  
...  
Keyword(s):  
Infarct Size ◽  
Myocardial Infarct ◽  
Myocardial Infarct Size ◽  
Acute Myocardial Infarct
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