Improved results in the treatment of patients with ischemic cardiomyopathy and extremely reduced LV-function (EF ≤20%) using a standardized perioperative protocol with the use of levosimendan

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
S Khokhar ◽  
R Haussmann ◽  
A Teske ◽  
D Sutor ◽  
A Larionov ◽  
...  
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Lv Function

scholarly journals Quantitative 4D Flow CMR analysis of intracardiac blood flow energetics in ischemic cardiomyopathy patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Riva ◽  
A Camporeale ◽  
F Sturla ◽  
S Pica ◽  
L Tondi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Cardiomyopathy ◽  
Inverse Correlation ◽  
Lv Function ◽  
Funding Source ◽  
4D Flow ◽  
Anterior Myocardial Infarction ◽  
National Budget ◽  
4D Flow Cmr ◽  
Public Grant

Abstract Background Ischemic cardiomyopathy (ICM) is often associated with negative LV remodelling after myocardial infarction, sometimes resulting in impaired LV function and dilation (iDCM). 4D Flow CMR has been recently exploited to assess intracardiac hemodynamic changes in presence of LV remodelling. Purpose To quantify 4D Flow intracardiac kinetic energy (KE) and viscous energy loss (EL) and investigate their relation with LV dysfunction and remodelling. Methods Patients with prior anterior myocardial infarction underwent a CMR study with 4D Flow sequences acquisition; they were divided into ICM (n=10) and iDCM (n=10, EDV>208 ml and EF<40%). 10 controls were used for comparison. LV was semi-automatically segmented using short axis CMR stacks and co-registered with 4D Flow. Global KE and EL were computed over the cardiac cycle. NT-proBNP measurements were correlated with average and peak values, during systole and diastole. Results Both LV volume and EF significantly differ (P<0.0001) between iDCM (EDV=294±56 ml, EF=24±8%), ICM (EDV=181±32 ml, EF=34±6%) and controls (EDV=124±29 ml, EF=72±5%). If compared to controls, both ICM and iDCM showed significantly lower KE (P≤0.0008); though lower than controls, EL was higher in iDCM than ICM. Within the iDCM subgroup, diastolic mean KE and peak EL reported good inverse correlation with NT-proBNP (r=−0.75 and r=−0.69, respectively). EL indexed (ELI) to average KE during systole was higher in the entire ischemic group as compared to controls (ELI(ischemic) = 0.17 vs. ELI(controls) = 0.10, P=0.0054). Conclusions 4D Flow analyses effectively mapped post-ischemic LV energetic changes, highlighting the disproportionate intraventricular EL relative to produced KE; preliminary good correlation between LV energetic changes and NT-proBNP will deserve further investigation in order to contribute to early detection of heart failure. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Italian Ministry of Health

scholarly journals Comparison of Repeated Doses of C-kit-Positive Cardiac Cells versus a Single Equivalent Combined Dose in a Murine Model of Chronic Ischemic Cardiomyopathy

2021 ◽  
Vol 22 (6) ◽  
pp. 3145
Author(s):  
Qianhong Li ◽  
Yiru Guo ◽  
Yibing Nong ◽  
Alex Tomlin ◽  
Anna Gumpert ◽  
...  
Keyword(s):  
Multiple Dose ◽  
Ischemic Cardiomyopathy ◽  
Dose Group ◽  
Weight Ratio ◽  
Cardiac Cells ◽  
Vehicle Group ◽  
Lv Function ◽  
Body Weight Ratio ◽  
Beneficial Effects ◽  
The Difference

Using a murine model of chronic ischemic cardiomyopathy caused by an old myocardial infarction (MI), we have previously found that three doses of 1 × 106 c-kit positive cardiac cells (CPCs) are more effective than a single dose of 1 × 106 cells. The goal of this study was to determine whether the beneficial effects of three doses of CPCs (1 × 106 cells each) can be fully replicated by a single combined dose of 3 × 106 CPCs. Mice underwent a 60-min coronary occlusion; after 90 days of reperfusion, they received three echo-guided intraventricular infusions at 5-week intervals: (1) vehicle × 3; (2) one combined dose of CPCs (3 × 106) and vehicle × 2; or (3) three doses of CPCs (1 × 106 each). In the combined-dose group, left ventricular ejection fraction (LVEF) improved after the 1st CPC infusion, but not after the 2nd and 3rd (vehicle) infusions. In contrast, in the multiple-dose group, LVEF increased after each CPC infusion; at the final echo, LVEF averaged 35.2 ± 0.6% (p < 0.001 vs. the vehicle group, 27.3 ± 0.2%). At the end of the study, the total cumulative change in EF from pretreatment values was numerically greater in the multiple-dose group (6.6 ± 0.6%) than in the combined-dose group (4.8 ± 0.8%), although the difference was not statistically significant (p = 0.08). Hemodynamic studies showed that several parameters of LV function in the multiple-dose group were numerically greater than in the combined-dose group (p = 0.08 for the difference in LVEF). Compared with vehicle, cardiomyocyte cross-sectional area was reduced only in the multiple-dose group (−32.7%, 182.6 ± 15.1 µm2 vs. 271.5 ± 27.2 µm2, p < 0.05, in the risk region and −28.5%, 148.5 ± 12.1 µm2 vs. 207.6 ± 20.5 µm2, p < 0.05, in the noninfarcted region). LV weight/body weight ratio and LV weight/tibia length ratios were significantly reduced in both cell treated groups vs. the vehicle group, indicating the attenuation of LV hypertrophy; however, the lung weight/body weight ratio was significantly reduced only in the multiple-dose group, suggesting decreased pulmonary congestion. Taken together, these results indicate that in mice with chronic ischemic cardiomyopathy, the beneficial effects of three doses of CPCs on LV function and hypertrophy cannot be fully replicated with a single dose, notwithstanding the fact that the total number of cells delivered with one or three doses is the same. Thus, it is the multiplicity of doses, and not the total number of cells, that accounts for the superiority of the repeated-dose paradigm. This study supports the idea that the efficacy of cell therapy in heart failure can be augmented by repeated administrations.

Abstract 14834: Protective Role of Cardiomyocyte-derived Ddt in Ischemic Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yina Ma ◽  
Xiaoyue Hu ◽  
Daniel Pfau ◽  
Xiaohong Wu ◽  
Veena Rao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Map Kinase ◽  
Ischemic Cardiomyopathy ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
P38 Map Kinase ◽  
Lv Function ◽  
Acute Ischemia ◽  
S6 Kinase ◽  
Sham Surgery

Background: D-dopachrome tautomerase (DDT), the only homolog of macrophage migration inhibitory factor (MIF), is a cytokine highly expressed in cardiomyocytes and exerts autocrine-paracrine effects by signaling through the CD74 receptor. Endogenous DDT and MIF prevent acute ischemia-reperfusion injury and pressure overload-induced heart failure in mice. This study investigated whether endogenous cardiomyocyte DDT has a role in ischemic cardiomyopathy (ICM). Methods: LV tissue was obtained from patients with ICM during heart transplantation and from non-transplanted donor hearts. Plasma DDT concentrations were measured in heart failure outpatients with ICM. Cardiomyocyte-specific DDT knockout (cKO) and littermate control (CON) mice underwent MI or sham surgery. Serial echocardiography was performed to assess LV remodeling after MI or sham surgery. Tissue from the non-infarct region was analyzed 3 days and 4 weeks after MI or sham surgery for histology and molecular studies. Results: Cardiac DDT mRNA and protein expression were reduced in LV from patients transplanted for ICM (n=8). Plasma DDT concentrations below the median value were associated with worse survival in ICM outpatients (p<0.05, n=32). In mice, baseline LV function was similar in DDT cKO and CON after sham surgery and 3 days post-MI. However, DDT cKO mice developed more rapid LV dilatation and decreased LV ejection fraction and stroke volume as early as 1-week post-MI (n=4-6/group, all P<0.05). The DDT cKO mice had smaller cardiomyocyte cross-sectional area 4 weeks after MI (p <0.05), as well as early diminished phosphorylation of mTOR and S6-kinase (3 days post-MI). They also showed increased apoptosis 3 days post-MI and an early increase in p38 MAP kinase activation. Conclusion: Cardiomyocyte-derived DDT prevents adverse cardiac remodeling in ICM, potentially through modulating mTOR/S6 kinase (adaptive hypertrophy) and p38 MAP kinase (limiting apoptosis). Down-regulation of DDT in patients with ICM may contribute to the pathogenesis of advanced heart failure.

scholarly journals Distribution of left ventricular thrombus among patients with significantly impaired systolic function

2021 ◽  
Vol 02 ◽  
Author(s):  
Ibrahim Abdullah Alranini ◽  
Hatim Kheirallah ◽  
Juan Jaime Alfonso ◽  
Ahmed R. Al Fagih
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Lv Function ◽  
Variable Degree ◽  
Ventricular Thrombus ◽  
Study Results

Background: The prevalence of left ventricular (LV) thrombus as well as the distribution among patients with a variable degree of left ventricular systolic function impairment due to various etiologies is not well known. Objectives: To describe the distribution of left ventricular thrombus in relation to the underlying pathology, i.e., ischemic versus non-ischemic cardiomyopathy with ejection fraction (EF) below 45%. Methods: All echocardiography studies performed between January 2013 and September 2017 were reviewed, and only those with confirmed LV thrombus were included. The patient’s demographic, clinical characteristics, cardiac history, and echocardiographic parameters were obtained. The cohort was divided into 4 subgroups: 22 patients with EF of 36 - 45% (A), 114 with 26% - 35% (B), 99 with 16 - 25% (C) and 48 with 15% or less (D). Results: A total of 63,732 echocardiography study results were reviewed. Only 282 patients were proved to have LV thrombus with EF less than 45%. 217 (77%) patients had previous myocardial infarction, of which 212 (97.7%) were presented with anterior regional wall motion abnormality. 90 (32.7%) patients were found to have dilated left ventricle, while 41 (14.5%) were diagnosed with dilated cardiomyopathy (DCM). 37 (13.2%) patients had moderately severe to severe mitral regurgitation. It was observed that the highest distribution of LV thrombus was seen in group B (40.3%). Conclusion: The majority of LV thrombus distribution was seen in patients with EF between 26% to 35% due to ischemic cardiomyopathy. Conversely, in the cohort of non-ischemic cardiomyopathy, the majority were observed in those with severely impaired LV function.

Abstract 16121: Recombinant Human Placental Growth Factor 2 is a Safe and Effective Therapy for Ischemic Cardiomyopathy in Atherosclerotic Mice

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ming Wu ◽  
Melissa Swinnen ◽  
Ellen Caluwe ◽  
Hilde Gillijns ◽  
Nina Vanden Driessche ◽  
...  
Keyword(s):  
Growth Factor ◽  
Atherosclerotic Plaque ◽  
Ischemic Cardiomyopathy ◽  
Contractile Function ◽  
Left Ventricular ◽  
Placental Growth Factor ◽  
Plaque Burden ◽  
Lv Function ◽  
Plaque Vulnerability ◽  
Adverse Remodeling

Aim: Angiogenic growth factor therapy carries a risk of stimulating atherosclerotic plaque growth. We evaluated whether systemic infusion of recombinant human placental growth factor (rhPlGF) 2 improves myocardial neovascularization, left ventricular (LV) function and adverse remodeling in a murine model of advanced atherosclerosis and chronic myocardial infarction (MI) without increasing atherosclerotic plaque size and plaque vulnerability. Methods: ApoE -/- mice were fed a high cholesterol diet and MI was induced 4 weeks (w) later using 60 min LAD occlusion followed by reperfusion. After 8 w, we assessed LV function using echocardiography and randomized mice to receive rhPlGF2 (450μg/kg/day, n=20) or PBS (n=20) via osmotic minipumps for 28 days. Echocardiography and histological analyses were performed at 12 and 20 w. Results: Infusion of rhPlGF2 increased PlGF plasma levels for 3 w up to ~1600-fold without adverse side effects, or changes in total cholesterol and high sensitive CRP levels. In rhPlGF2-treated mice, capillary and arteriolar density was significantly higher in ischemic myocardium (2813±212 capillaries/mm 2 at 12 w vs 2144±478 in PBS, P <0.05; 125±18 arterioles/mm 2 at 20 w vs 77±13 in PBS, P =0.001). RhPlGF2 significantly improved ejection fraction (EF), reduced LV end-systolic and end-diastolic volume indices at 12 w and prevented further LV dilation and EF deterioration at 20 w (Figure). RhPlGF2 did not increase plaque area in the aortic arch, or the degree of fibrosis, calcification, capillary or arteriolar density and MAC3-positive cell areas in plaques at 12 and 20 w. Conclusion: Systemic rhPlGF2 infusion significantly improves neovascularization and contractile function, and prevents LV adverse remodeling in chronic ischemic cardiomyopathy without increasing atherosclerotic plaque burden or plaque vulnerability. RhPlGF2 may represent a promising and safe therapeutic strategy in chronic ischemic cardiomyopathy.

Myocardial Viability Assessment

2015 ◽  
Author(s):  
Vasken Dilsizian ◽  
Ines Valenta ◽  
Thomas H. Schindler
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Medical Therapy ◽  
Ischemic Cardiomyopathy ◽  
Interstitial Fibrosis ◽  
Artery Bypass ◽  
Hibernating Myocardium ◽  
Lv Function ◽  
Term Survival ◽  
Myocardial Viability Assessment

Heart failure may be a consequence of ischemic or non-ischemic cardiomyopathy. Etiologies for LV systolic dysfunction in ischemic cardiomyopathy include; 1) transmural scar, 2) nontransmural scar, 3) repetitive myocardial stunning, 4) hibernating myocardium, and 5) remodeled myocardium. The LV remodeling process, which is activated by the renin-angiotensin system (RAS), stimulates toxic catecholamine actions and matrix metalloproteinases, resulting in maladaptive cellular and molecular alterations5, with a final pathway to interstitial fibrosis. These responses to LV dysfunction and interstitial fibrosis lead to progressive worsening of LV function. Established treatment options for ischemic cardiomyopathy include medical therapy, revascularization, and cardiac transplantation. While there has been continuous progress in the medical treatment of heart failure with beta-blockers, angiotensin-converting enzyme (ACE) inhibition, angiotensin II type 1 receptor (AT1R) blockers, and aldosterone to beneficially influence morbidity and mortality, the 5-years mortality rate for heart failure patients remains as high as 50%. Revascularization procedures include percutaneous transluminal coronary artery interventions (PCI) including angioplasty and endovascular stent placement and coronary artery bypass grafting (CABG). Whereas patents with heart failure due to non-coronary etiologies may best benefit from medical therapy or heart transplantation, coronary revascularization has the potential to improve ventricular function, symptoms, and long term survival, in patients with heart failure symptoms due to CAD and ischemic cardiomyopathy.

Abstract 2817: The Impact of Exercise-Induced Changes in Intraventricular Dyssynchrony on the Functional Improvement in Patients with Non-Ischemic Cardiomyopathy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Soo-Jin Kang ◽  
Hong-Seok Lim ◽  
Un-Jung Choi ◽  
Byung-Joo Choi ◽  
So-Yeon Choi ◽  
...  
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Doppler Imaging ◽  
Functional Improvement ◽  
Peak Exercise ◽  
Lv Function ◽  
Functional Changes ◽  
Exercise Induced ◽  
Induced Changes ◽  
The Impact

Background: We studied whether dynamic changes in LV asynchrony may affect the functional improvement of LV in medically treated patients with non-ischemic cardiomyopathy (CMP). Methods: Supine bicycle exercise was performed in 41 patients (age 51±12 years, EF 33±8%). Using tissue Doppler imaging, the average of peak systolic velocities of 6 basal LV segments were obtained at rest (V b ) and peak exercise (V p ). ΔV was calculated by [V p -V b ], reflecting the contractile reserve. Dyssynchrony index (SD 4 ) was defined as the standard deviation of the time to peak systolic velocities at 4 basal & mid segments of septum and lateral wall on apical 4 chamber view. ΔSD 4 was calculated as [peak exercise SD 4 - resting SD 4 ]. Follow-up echocardiography was done in 35 patients after medication for 11.2±4.2 months. Functional changes of LV was assessed by ΔEF FU and %change of ESV (ΔESV FU ). Results: Baseline SD 4 was 24±17 ms. During exercise, SD 4 increased in 24 patients (ΔSD 4 =+14±12 ms), whereas decreased in 17 patients (ΔSD 4 =-17±14 ms). ΔSD 4 correlated with ΔV (r=-0.36, p=0.021) and exercise-induced increase in MR (ΔJet/LA area (%); r=0.31, p=0.05 and ΔPISA radius at 40cm/s of aliasing v; r=0.46, p=0.003). ΔV and ΔPISA were related to the follow-up change of LV function. Especially, ΔSD 4 independently correlated with ΔEF FU (β= -0.82, p<0.001) and also with ΔESV FU (β= 0.40, p=0.021)(Fig ). However, baseline SD 4 didn’t affect ΔEF FU . On ROC curve analysis, sensitivity and specificity of ΔSD 4 <4.0 ms were 82% and 78% for predicting ΔEF FU >+5% and 70% and 63% for predicting ΔESV FU <-15%. Conclusion : Exercise-induced changes in dyssynchrony (ΔSD 4 ) can predict the functional improvement in non-ischemic CMP.

P4586Bilateral internal thoracic artery grafting neutralizes detrimental effect of diabetes on survival in patients with ischemic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Kainuma ◽  
K T Taniguchi ◽  
K T Toda ◽  
S M Miyagawa ◽  
Y Y Yoshikawa ◽  
...  
Keyword(s):  
Survival Rate ◽  
Survival Benefit ◽  
Ischemic Cardiomyopathy ◽  
Internal Thoracic Artery ◽  
Hazard Ratio ◽  
Lv Function ◽  
Diabetic Patients ◽  
Confident Interval ◽  
Diabetic Status ◽  
Insulin Dependent

Abstract Background In ischemic cardiomyopathy patients requiring coronary artery bypass grafting (CABG), the association of diabetic status with outcomes after surgery as well as survival benefit with bilateral internal thoracic artery (ITA) grafting remain largely unknown. Purpose We evaluated the associations of diabetic status with postoperative LV reverse remodeling, change in renal function, and late outcome following surgical revascularization, with focus on cases with severely impaired LV function. We also attempted to determine the survival benefit of bilateral ITA grafting over single ITA grafting according to diabetic status. Methods We classified 188 patients (mean age 67±9 years) with left ventricular (LV) ejection fraction ≤40% who underwent isolated initial CABG into non-diabetic (n=64), non-insulin-dependent DM (NIDM, n=74), and insulin-dependent DM (IDM, n=50) groups. Results At baseline, there were no differences between the diabetic and non-diabetic patients in terms of age, LV function parameters and degree of coronary artery disease, while the diabetic patients were more likely to present chronic kidney disease and peripheral vascular disease. During follow-up (68±47 months), the 5-year survival rate was 84% and 65% in the non-diabetic and diabetic patients respectively (p=0.034). After adjusting for all covariates, both NIDM and IDM were independently associated with increased mortality (NIDM: adjusted hazard ratio 1.9, 95% confident interval 1.0–3.7, p=0.049; IDM: adjusted hazard ratio 2.4, 95% confident interval 1.2–4.8, p=0.016) and composite adverse events defined as mortality and/or heart failure readmission (NIDM: hazard ratio 1.7, 95% confident interval 1.0–2.8, p=0.038; IDM: hazard ratio 3.0, 95% confident interval 1.7–5.1, p<0.001). Diabetic patients showed less improvements in LV dimensions and ejection fraction (interaction effect p<0.05 for all), and steady decrease in the estimated glomerular filtration rate over time after surgery (group effect p<0.05). Among non-diabetic patients, there was no difference in survival rate between single ITA and bilateral ITA grafting (5-year: 86% vs. 80%, p=0.95), whereas among diabetic patients, survival of those who received the latter was better (57% vs. 81%, p=0.004). Multivariate analysis revealed that use of bilateral ITA was significantly associated with decreased risk of mortality (hazard ratio 0.3, 95% confident interval 0.1–0.8, p=0.024). Conclusion Non-insulin- and insulin-dependent diabetes was significantly associated with worse long-term clinical outcome after CABG for ischemic cardiomyopathy. Bilateral ITA grafting has potential to improve survival in diabetic patients with ischemic cardiomyopathy.

scholarly journals Predictors of Ischemic Cardiomyopathy in Patients with Acute Myocardial Infarction who Underwent Percutaneous Coronary Intervention

2020 ◽  
Vol 95 (3) ◽  
pp. 188-200
Author(s):  
Hye Sook Kim ◽  
Myung Ho Jeong ◽  
Hyun Ju Yoon ◽  
Yongcheol Kim ◽  
Seok-Joon Sohn ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ischemic Cardiomyopathy ◽  
Multivariate Logistic Regression Analysis ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Lv Function ◽  
Mitral Inflow ◽  
Diastolic Velocity ◽  
Mitral Inflow Velocity

Background/Aims: Many patients with acute myocardial infarction (AMI) suffer from heart failure due to progressive ischemic left ventricular (LV) remodeling. This study investigated the predictors of ischemic cardiomyopathy (ICMP) in patients with AMI who underwent successful percutaneous intervention.Methods: A total of 547 patients with AMI were divided into two groups: ICMP (n = 66, 67.1 ± 11.9 years, 78.8% males) and non-ICMP (n = 481, 62.5 ± 12.2 years, 70.1% males).Results: On echocardiography, the LVEF was significantly decreased (41.7 ± 10.5 vs. 55.4 ± 10.3%, <i>p</i> < 0.001) but the LV end-diastolic (54.1 ± 7.2 vs. 49.3 ± 5.3 mm, <i>p</i> < 0.001) and systolic (42.1 ± 8.0 vs. 33.5 ± 6.0 mm, <i>p</i> < 0.001) dimensions significantly increased in the ICMP group compared with the non-ICMP group. According to multivariate logistic regression analysis, LVEF < 50% (odds ratio [OR] 8.722, 95% confidence interval [CI] 2.986–25.478, <i>p</i> < 0.001), LV end-diastolic dimension > 55 mm (OR 4.511, 95% CI 1.561–13.038, <i>p</i> = 0.005), and ratio of early mitral inflow velocity to mitral annular early diastolic velocity (E/e’) ≥ 15 (OR 3.270, 95% CI 1.168–9.155, <i>p</i> = 0.024) were independent predictors of ICMP development.Conclusions: The present study demonstrates that a larger LV size, lower LV function, and increased E/e’ (≥ 15) were independent predictors of ICMP. Therefore, the development of ICMP should be carefully monitored in AMI patients with these features.

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