Progressive improvement in cardiac performance with continuous aortic flow augmentation (aortic flow therapy) in patients hospitalized with severe heart failure: Results of the Multicenter Trial of the Orqis Medical Cancion System for the Enhanced Treatment of Heart Failure Unresponsive to Medical Therapy (MOMENTUM)

2010 ◽  
Vol 29 (1) ◽  
pp. 86-92 ◽  
Author(s):  
Michael R. Zile ◽  
Paolo C. Colombo ◽  
Mandeep Mehra ◽  
Barry Greenberg ◽  
Scott Brown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Medical Therapy ◽  
Severe Heart Failure ◽  
Multicenter Trial ◽  
Cardiac Performance ◽  
Aortic Flow ◽  
Progressive Improvement

Abstract 2416: Progressive Improvement in Cardiac Performance produced by Continuous Aortic Flow Augmentation in Patients Hospitalized with Acute Decompensated Heart Failure: Results from the MOMENTUM Trial

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Michael R Zile ◽  
Paolo Colombo ◽  
Mandeep Mehra ◽  
Barry Greenberg ◽  
Scott Brown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Medical Therapy ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Cardiac Performance ◽  
Aortic Flow ◽  
Stroke Work ◽  
Pulmonary Capillary ◽  
Vasodilator Treatment ◽  
The Relationship

Previous studies indicate that superimposing continuous aortic flow augmentation (CAFA) on pulsatile aortic flow yields vasodilation, unloading, and improved cardiac performance. Whether improvement in indices of cardiac performance are dependent or independent of changes in hemodynamic load has not been examined. Multi-center Trial of Orqis® Medical Cancion® System for Enhanced Treatment of heart failure (HF) Unresponsive to Medical Therapy (MOMENTUM) is a randomized trial comparing CAFA plus medical therapy (n = 109) vs. medical therapy alone (n = 59) in patients hospitalized with HF inadequately responsive to therapy. Entry required reduced LVEF and cardiac index, elevated pulmonary capillary wedge pressure (PCWP), and either impaired renal function or high diuretic requirement, despite IV inotrope or vasodilator treatment. CAFA was achieved for up to 96 hrs using an arterial-to-arterial circuit (flow up to 1.5 L/min). Changes in cardiac performance were assessed using the relationship between stroke work (stroke volume x [Mean blood pressure-PCWP] x 0.00133, kg*cm) and PCWP. Figure shows hemodynamic effects (mean ± SEM) at baseline (B) and at hours post-B time. CAFA progressively improves LV performance (↑ Stroke Work and ↓ PCWP, p < 0.05 for both) resulting in an upward-leftward shift in the Starling function curve. In contrast, medical therapy alone resulted in no change in cardiac performance (↓ Stroke Work and ↓ PCWP, p < 0.05 for both), no shift in Starling curve. CAFA treatment, independent of changes in both preload and afterload, increased stroke work and decreased PCWP by progressively improving cardiac performance.

scholarly journals Effects of Continuous Aortic Flow Augmentation in Patients With Exacerbation of Heart Failure Inadequately Responsive to Medical Therapy

Circulation ◽  
2008 ◽  
Vol 118 (12) ◽  
pp. 1241-1249 ◽  
Author(s):  
Barry Greenberg ◽  
Barbara Czerska ◽  
Reynolds M. Delgado ◽  
Robert Bourge ◽  
Michael R. Zile ◽  
...  
Keyword(s):  
Heart Failure ◽  
Medical Therapy ◽  
Aortic Flow

Intermittent 6-month low-dose dobutamine infusion in severe heart failure: DICE Multicenter Trial

1999 ◽  
Vol 138 (2) ◽  
pp. 247-253 ◽  
Author(s):  
Fabrizio Oliva ◽  
Roberto Latini ◽  
Alessandro Politi ◽  
Lidia Staszewsky ◽  
Aldo P. Maggioni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Low Dose ◽  
Severe Heart Failure ◽  
Multicenter Trial ◽  
Dobutamine Infusion

Plasma vasopressin response to osmotic and hemodynamic stimuli in heart failure

1985 ◽  
Vol 248 (3) ◽  
pp. H396-H402 ◽  
Author(s):  
B. F. Uretsky ◽  
J. G. Verbalis ◽  
T. Generalovich ◽  
A. Valdes ◽  
P. S. Reddy
Keyword(s):  
Heart Failure ◽  
Cardiac Index ◽  
Arterial Pressure ◽  
Arginine Vasopressin ◽  
Severe Heart Failure ◽  
Plasma Osmolality ◽  
Cardiac Performance ◽  
Plasma Vasopressin ◽  
Osmotic Loading ◽  
Unit Increase

Arginine vasopressin (AVP) regulation was studied in 42 patients with severe heart failure (CHF) and 10 patients without CHF during cardiac catheterization. Plasma AVP levels were elevated in CHF compared with non-CHF patients (2.98 +/- 2.48 vs. 1.01 +/- 0.44 pg/ml, P less than 0.01). In non-CHF patients, osmotic loading with angiographic contrast caused increases in plasma osmolality (283 +/- 4 to 290 +/- 5 mosmol/l, P less than 0.05) and AVP (1.01 +/- 0.44 to 1.79 +/- 0.20 pg/ml, P less than 0.001). In 10 CHF patients, similar osmotic loading produced an increase in plasma osmolality (275 +/- 13 to 288 +/- 17 mosmol/l, P less than 0.05) and an exaggerated rise in plasma AVP (3.61 +/- 3.17 to 16.30 +/- 12.17 pg/ml, P less than 0.001). The increase in plasma AVP per unit increase in osmolality was greater (P less than 0.01) in the CHF patients (1.36 +/- 1.25 pg . mosmol-1 . 1(-1)) than in non-CHF patients (0.18 +/- 0.17). To determine whether improved cardiac performance would lower AVP levels, 18 CHF patients received the experimental agent MDL 17,043, with improved cardiac index (1.9 +/- 0.4 to 3.3 +/- 0.7 1 . min-1 . m-2, P less than 0.001). Plasma AVP levels did not change significantly (1.99 +/- 0.74 to 2.81 +/- 2.06 pg/ml), but significant inverse correlations were found between changes in plasma AVP and changes in mean (r = -0.53) and systolic (r = -0.65) arterial pressure after MDL 17,043 infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

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