Neuronal sympathetic stimulation for selective enhancement of left ventricular inotropy without increasing cardiac afterload. A novel approach for treating postoperative low output syndromes

Identification of patients with cardiogenic shock and right ventricle (RV) dysfunction who may require biventricular rather than isolated left ventricular (LV) support remains challenging. In this setting, rigorous hemodynamic evaluation of biventricular contractility and load during initiation of LV support guides therapy. We now report a novel approach to assess biventricular pressure-volume loops in a patient receiving Impella 5.5 support for heart failure and shock.

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PH-0649 Left-ventricular MRI navigation: a novel approach for motion-free thoracic and cardiac radiotherapy

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)07381-3 ◽

2021 ◽

Vol 161 ◽

pp. S517-S518

Author(s):

A. van Lier ◽

O. Akdag ◽

S. Mandija ◽

P. Borman ◽

E. Alberts ◽

...

Keyword(s):

Left Ventricular ◽

Novel Approach

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Abstract 89: The Ventriculo-Ventricular Coupling Index: A Novel Approach to Assessing Biventricular Function

Circulation Research ◽

10.1161/res.111.suppl_1.a89 ◽

2012 ◽

Vol 111 (suppl_1) ◽

Author(s):

Navin K Kapur ◽

Mark J Aronovitz ◽

Robert Blanton ◽

Emily Mackey ◽

Vikram Paruchuri ◽

...

Keyword(s):

Heart Failure ◽

Steady State ◽

Left Ventricular ◽

External Jugular Vein ◽

Arterial Elastance ◽

Left Heart Failure ◽

Novel Approach ◽

Coupling Index ◽

Ventricular Efficiency ◽

The Right

Bi-ventricular (Bi-V) function in primary pulmonary hypertension (PPH) or PH secondary to left heart failure (SPH) remains difficult to characterize. As a measure of ventricular efficiency, ventriculo-arterial coupling (VAC) is calculated as the ratio of effective arterial elastance (Ea) to end-systolic elastance (Ees). No measure currently assesses ventriculo-ventricular coupling (VVC). Therefore, we developed a novel catheter-based approach to quantify Bi-V function using pressure-volume loop (PVL) analysis and hypothesized that Bi-V VAC ratios, defined as the VVC index (VVCI), may discriminate PPH and SPH. Methods: Adult male mice (n=6/group) underwent constriction of the pulmonary artery (PAC) or thoracic aorta (TAC) to model PPH and SPH respectively. Sham-operated animals underwent a left thoracotomy. Closed chest simultaneous Bi-V catheterization was performed after 7 days in PPH and 10 weeks in SPH. Conductance catheters were used for right and left ventricular PVL analysis via the right external jugular vein and right common carotid artery under steady-state conditions and with variable preload. Results: Steady-state Bi-V PVL and changes in VAC ratios and the VVCI are shown below. In sham mice VAC ratios and the VVCI reflect optimal ventricular efficiency. In PPH, the VVCI is significantly increased, while in SPH, the VVCI is significantly decreased compared to controls. Conclusion: These results identify a novel method to quantify Bi-V function in mice and further show that the VVCI can distinguish PPH and SPH. These findings have important implications for examining cardiac function in preclinical and clinical studies of left- and right-sided heart failure.

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Assessment of right ventricular sympathetic dysfunction in patients with arrhythmogenic right ventricular cardiomyopathy: An 123I-metaiodobenzylguanidine SPECT/CT study

Journal of Nuclear Cardiology ◽

10.1007/s12350-018-01545-3 ◽

2018 ◽

Vol 27 (6) ◽

pp. 2402-2409 ◽

Cited By ~ 3

Author(s):

Andrei Todica ◽

Johannes Siebermair ◽

Julia Schiller ◽

Mathias J. Zacherl ◽

Wolfgang P. Fendler ◽

...

Keyword(s):

Right Ventricular ◽

Hybrid Imaging ◽

State Of The Art ◽

Task Force ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Sympathetic Innervation ◽

Left Ventricular ◽

Sympathetic Dysfunction ◽

Novel Approach ◽

Significant Difference

Abstract Purpose The purpose of the study was to evaluate a novel approach for the quantification of right ventricular sympathetic dysfunction in patients diagnosed with ARVC/D through state-of-the-art functional SPECT/CT hybrid imaging. Methods Sympathetic innervation of the heart was assessed using 123I-MIBG-SPECT/CT in 17 patients diagnosed with ARVC according to the modified task force criteria, and in 10 patients diagnosed with idiopathic ventricular fibrillation (IVF). The 123I-MIBG-uptake in the left (LV) and right ventricle (RV) was evaluated separately based on anatomic information derived from the CT scan, and compared to the uptake in the mediastinum (M). Results There was a significant difference in the LV/M ratio between the ARVC/D and the IVF groups (3.2 ± 0.5 vs. 3.9 ± 0.8, P = 0.014), with a cut-off value of 3.41 (77% sensitivity, 80% specificity, AUC 0.78). There was a highly significant difference in the mean RV/M ratios between both groups (1.6 ± 0.3 vs. 2.0 ± 0.2, P = 0.001), with optimal cut-off for discrimination at 1.86 (88% sensitivity, 90% specificity, AUC 0.93). Conclusion Employing state-of-the-art functional SPECT/CT hybrid imaging, we could reliably assess and quantify right and left ventricular sympathetic innervation. The RV/M ratio was significantly lower in patients diagnosed with ARVC/D and provided sensitive and specific discrimination between patients with ARVC/D and IVF patients.

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SHARED CARE: A NOVEL APPROACH TO LEFT VENTRICULAR ASSIST DEVICE (LVAD) IMPLANT FOLLOW UP

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31401-7 ◽

2020 ◽

Vol 75 (11) ◽

pp. 774

Author(s):

Ganesh Gajanan ◽

Kulpreet Barn ◽

Jerome Thomas ◽

Mauricio Garrido ◽

Rohinton Morris ◽

...

Keyword(s):

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Shared Care ◽

Assist Device ◽

Ventricular Assist ◽

Novel Approach ◽

Left Ventricular Assist

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Arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy beyond ejection fraction

Heart ◽

10.1136/heartjnl-2019-315942 ◽

2020 ◽

Vol 106 (9) ◽

pp. 656-664 ◽

Cited By ~ 4

Author(s):

Antonio Cannatà ◽

Giulia De Angelis ◽

Andrea Boscutti ◽

Camilla Normand ◽

Jessica Artico ◽

...

Keyword(s):

Ejection Fraction ◽

Risk Stratification ◽

Dilated Cardiomyopathy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Novel Approach ◽

Magnetic Resonance Parameters ◽

Reverse Remodelling ◽

Life Threatening

Sudden cardiac death and arrhythmia-related events in patients with non-ischaemic dilated cardiomyopathy (NICM) have been significantly reduced over the last couple of decades as a result of evidence-based pharmacological and non-pharmacological therapeutic strategies. Nevertheless, the arrhythmic stratification in patients with NICM remains extremely challenging, and the simple indication based on left ventricular ejection fraction appears to be insufficient. Therefore, clinicians need to go beyond the current criteria for implantable cardioverter-defibrillator implantation in the direction of a multiparametric evaluation of arrhythmic risk. Several parameters for arrhythmic risk stratification, ranging from electrocardiographic, echocardiographic, imaging-derived and genetic markers, are crucial for proper arrhythmic risk stratification and a multiparametric evaluation of risk in patients with NICM. In particular, integration of cardiac magnetic resonance parameters (mostly late gadolinium enhancement) and specific genetic information (ie, presence of LMNA, PLN, FLNC mutations) appears fundamental for proper implementation of the current arrhythmic risk stratification. Finally, a novel approach focused on both arrhythmic risk and prediction of left ventricular reverse remodelling during follow-up might be useful for effective multiparametric and dynamic arrhythmic risk stratification in NICM. In the future, a complete and integrated evaluation might be mandatory to implement arrhythmic risk prediction in patients with NICM and to discriminate the competing risk between heart failure-related events and life-threatening arrhythmias.

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Transhepatic echocardiography: a novel approach for imaging in left ventricle assist device patients with difficult acoustic windows

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa002 ◽

2020 ◽

Vol 21 (5) ◽

pp. 491-497 ◽

Cited By ~ 1

Author(s):

Mihai Strachinaru ◽

Daniel J Bowen ◽

Alina Constatinescu ◽

Olivier C Manintveld ◽

Jasper J Brugts ◽

...

Keyword(s):

Left Ventricle ◽

Significant Proportion ◽

Left Ventricular ◽

Assist Device ◽

Novel Approach ◽

Significant Difference ◽

Inflow Cannula ◽

Probe Orientation ◽

And Function ◽

Ventricle Assist Device

Abstract Aims A significant proportion of left ventricle assist device (LVAD) patients have very difficult transthoracic echocardiographic images. The aim of this study was to find an echocardiographic window which would provide better visualization of the heart in LVAD patients with limited acoustic windows. Methods and results Based on the anatomic relationships in LVAD patients, a right intercostal transhepatic approach was proposed. By using a computer simulator, we searched for the appropriate probe orientation. Further, 15 ambulatory LVAD patients (age 56 ± 15 years, 73% males) underwent two echocardiographic studies: one normal transthoracic echocardiography following the institutional protocol (Echo 1) and a second study which included the transhepatic approach (Echo 2). The two exams were performed by two different sonographers and the results validated by a third observer for agreement. The transhepatic intercostal window was feasible in all patients, with an image quality allowing good visualization of structures in 93%. Precise quantification of the left ventricular (LV) and right ventricular (RV) function was achieved more often in the Echo 2 (10 vs. 3 patients for LV, P = 0.03 and 14 vs. 8 patients for RV, P = 0.04). A significant difference existed also in the quantification of the LVAD inflow cannula flow by pulsed Doppler (11 patients in Echo 2 vs. 3 patients in Echo 1, P = 0.009). Conclusion This is the first study describing a new echocardiographic window in LVAD patients. The transhepatic window may provide better quantification of left and RV dimensions and function and improvement in Doppler interrogation of the inflow cannula.

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