Remote ischaemic preconditioning ameliorates anthracycline-induced cardiotoxicity and preserves mitochondrial integrity

Abstract Aims Anthracycline-induced cardiotoxicity (AIC) is a serious adverse effect among cancer patients. A central mechanism of AIC is irreversible mitochondrial damage. Despite major efforts, there are currently no effective therapies able to prevent AIC. Methods and results Forty Large-White pigs were included. In Study 1, 20 pigs were randomized 1:1 to remote ischaemic preconditioning (RIPC, 3 cycles of 5 min leg ischaemia followed by 5 min reperfusion) or no pretreatment. RIPC was performed immediately before each intracoronary doxorubicin injections (0.45 mg/kg) given at Weeks 0, 2, 4, 6, and 8. A group of 10 pigs with no exposure to doxorubicin served as healthy controls. Pigs underwent serial cardiac magnetic resonance (CMR) exams at baseline and at Weeks 6, 8, 12, and 16, being sacrifice after that. In Study 2, 10 new pigs received 3 doxorubicin injections (with/out preceding RIPC) and were sacrificed at week 6. In Study 1, left ventricular ejection fraction (LVEF) depression was blunted animals receiving RIPC before doxorubicin (RIPC-Doxo), which had a significantly higher LVEF at Week 16 than doxorubicin treated pigs that received no pretreatment (Untreated-Doxo) (41.5 ± 9.1% vs. 32.5 ± 8.7%, P = 0.04). It was mainly due to conserved regional contractile function. In Study 2, transmission electron microscopy (TEM) at Week 6 showed fragmented mitochondria with severe morphological abnormalities in Untreated-Doxo pigs, together with upregulation of fission and autophagy proteins. At the end of the 16-week Study 1 protocol, TEM revealed overt mitochondrial fragmentation with structural fragmentation in Untreated-Doxo pigs, whereas interstitial fibrosis was less severe in RIPC+Doxo pigs. Conclusion In a translatable large-animal model of AIC, RIPC applied immediately before each doxorubicin injection resulted in preserved cardiac contractility with significantly higher long-term LVEF and less cardiac fibrosis. RIPC prevented mitochondrial fragmentation and dysregulated autophagy from AIC early stages. RIPC is a promising intervention for testing in clinical trials in AIC.

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Remote Ischemic Preconditioning Ameliorates Anthracycline-induced Cardiotoxicity and Preserves Mitochondrial Integrity

10.1101/2020.03.20.000729 ◽

2020 ◽

Author(s):

Carlos Galan-Arriola ◽

Rocio Villena-Gutierrez ◽

Maria I Higuero-Verdejo ◽

Ivan A Diaz-Rengifo ◽

Gonzalo Pizarro ◽

...

Keyword(s):

Cardiac Fibrosis ◽

Contractile Function ◽

Interstitial Fibrosis ◽

Cardiac Contractility ◽

Significant Proportion ◽

Large Animal Model ◽

Large Animal ◽

Mitochondrial Fragmentation ◽

Large White ◽

Tissue Samples

Aims: Anthracycline-induced cardiotoxicity (AIC) is a serious adverse effect in a significant proportion of cancer patients. A central mechanism of AIC is irreversible mitochondrial damage. Despite major efforts, there are currently no effective therapies able to prevent AIC. Methods and Results: Forty Large-White pigs were included. In Study 1, 20 pigs were randomized 1:1 to remote ischemic pre-conditioning (RIPC, 3 cycles of 5 min leg ischemia followed by 5 min reperfusion) or no pretreatment. RIPC was performed immediately before each of five intracoronary doxorubicin injections (0.45 mg/kg) given at weeks 0, 2, 4, 6, and 8. A group of 10 pigs with no exposure to doxorubicin served as healthy controls. Pigs underwent serial cardiac magnetic resonance (CMR) exams at baseline and at weeks 6, 8, 12, and 16. After 16-week CMR, pigs were sacrificed and tissue samples collected. In study 2, 10 new pigs received 3 doxorubicin injections (with/out preceding RIPC) and were sacrificed 2 weeks after the third dose. In Study 1, LVEF remained unchanged in doxorubicin-treated pigs until week 6 (time of the fourth doxorubicin injection). From there on, LVEF progressively declined, but LVEF depression was blunted animals receiving RIPC before doxorubicin (RIPC-Doxo), which had a significantly higher LVEF at week 16 than doxorubicin treated pigs that received no pretreatment (Untreated-Doxo) (mean (SD) 41.5% (9.1) vs 32.5% (8.7), p=0.04). Preserved LVEF was mainly due to conserved contractile function, as evidenced by smaller LVESV, and better regional contractile function. In Study 2, transmission electron microscopy (TEM) after 3 doxorubicin doses showed fragmented mitochondria with severe morphological abnormalities in RIPC+Doxo pigs, together with upregulation of fission proteins and autophagy markers on western blot. At the end of the 16-week Study 1 protocol, TEM revealed overt mitochondrial fragmentation with structural fragmentation in Untreated-Doxo pigs, whereas interstitial fibrosis was significantly less severe in the RIPC+Doxo pigs. Conclusion: In a translatable large animal model of AIC, RIPC applied immediately before each doxorubicin injection resulted in preserved cardiac contractility with significantly higher long-term LVEF and less cardiac fibrosis. RIPC prevented mitochondrial fragmentation and dysregulated autophagy from the early stages of AIC. RIPC is a promising intervention for testing in clinical trials in AIC.

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Remote ischemic preconditioning ameliorates anthracycline-induced cardiotoxicity and preserves mitochondrial integrity: results from a randomized preclinical trial in pigs

European Heart Journal ◽

10.1093/ehjci/ehaa946.3674 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Galan-Arriola ◽

R Villena-Gutierrez ◽

M.I Higuero-Verdejo ◽

I.A Diaz-Rengifo ◽

G Pizarro ◽

...

Keyword(s):

Animal Model ◽

Ischemic Preconditioning ◽

Contractile Function ◽

Left Ventricular ◽

Remote Ischemic Preconditioning ◽

Large Animal Model ◽

Left Ventricular Ejection ◽

Funding Source ◽

Large Animal ◽

Regional Contractile Function

Abstract Introduction Anthracycline-induced cardiotoxicity (AIC) is a serious adverse effect occurring in a significant proportion of patients. Irreversible mitochondrial damage is a central mechanism of AIC. Despite many efforts, there is a lack of therapies able to prevent AIC. Remote ischemic preconditioning (RIPC) could be a promising therapy to prevent AIC due to the scheduled application of chemotherapy in cancer patients. Purpose To evaluate the cardioprotective efficacy of RIPC in large animal model of AIC. Methods Large-White pigs (n=20) underwent a validated protocol of AIC consisting on five intracoronary doxorubicin injections (0.45 mg/kg), on weeks 0, 2, 4, 6, 8 of the study. Pigs were randomized before the initiation of the study to remote ischemic pre-conditioning (RIPC, 3 cycles of 5 min lower limb ischemia followed by 5 min reperfusion) or sham procedure immediately before doxorubicin injections. An additional group of 10 pigs without any exposure to doxorubicin was carried out as controls. Pigs underwent a comprehensive serial cardiac magnetic resonance (CMR) exam baseline, and on weeks 6, 8, 12, and 16. After 16-week CMR, pigs were sacrificed and tissue samples collected. A second group of 10 pigs (randomized 1:1 for RIPC) underwent the same protocol but were sacrificed 2 weeks after the third doxorubicin dose for early evaluation of tissue changes. Primary endpoint of the study was CMR-based left ventricular ejection fraction on week 16. Results Until week 6 (time of fourth doxorubicin injection), LVEF remained unchanged in both groups. From there on, a progressive decline in LVEF was observed. LVEF depression trajectory was blunted in RIPC animals. Compared to controls, pigs undergoing RIPC before each doxorubicin dose had a significantly higher LVEF at week 16: median (IQR) 45% (27–50%) vs 33% (19–47%) in RIPC and controls respectively, p=0.04. Improvement in LVEF was mainly due to a more preserved contractile function, as evidence by smaller LVESV, and better regional contractile function. After 3 doxorubicin doses, a time where global (LVEF) and regional contractile function was still unchanged, transmission electron microscopy (TEM) showed fragmented mitochondria with remodeled cristae only in control pigs. At the end of the 16 weeks, TEM evaluation in control pigs (as compared to RIPC pigs) showed overt cardiomyocyte's mitochondrial fragmentation with overt structural derangement. At this time, RIPC pigs had significantly less interstitial fibrosis on histology. Conclusions In a translatable large animal model of AIC, RIPC applied immediately before each doxorubicin cycle resulted in a preservation of cardiac contractility with significantly higher long-term LVEF and less cardiac fibrosis. RIPC prevented the deleterious effects of doxorubicin on mitochondria since early stages of AIC. RIPC is a promising intervention to be tested in clinical trials to prevent cardiotoxicity. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The CNIC is supported by the Instituto de Salud Carlos III (ISCIII), the Ministerio de Ciencia e Innovaciόn and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505)

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Development of a preclinical model of ischemic cardiomyopathy in swine

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.01103.2010 ◽

2011 ◽

Vol 301 (2) ◽

pp. H530-H537 ◽

Cited By ~ 16

Author(s):

Kiyotake Ishikawa ◽

Dennis Ladage ◽

Yoshiaki Takewa ◽

Elisa Yaniz ◽

Jiqiu Chen ◽

...

Keyword(s):

Ischemic Cardiomyopathy ◽

Left Ventricular ◽

Large Animal Model ◽

Left Ventricular Ejection ◽

Hibernating Myocardium ◽

Left Ventricular Volumes ◽

Preclinical Model ◽

Large Animal ◽

Total Occlusion ◽

Ventricular Ejection Fraction

A number of promising therapies for ischemic cardiomyopathy are emerging, and the role of translational research in testing the efficacy and safety of these agents in relevant clinical models has become important. The goal of this study was to develop a chronic model of ischemic cardiomyopathy in a large animal model. In this study, 40 consecutive pigs were initially enrolled. To induce progressive stenosis, a plastic occluder with a fixed diameter of 1.0 mm fitted with an 18-gauge copper wire was placed around the proximal left anterior descending (LAD) coronary artery. Coronary angiography, hemodynamic measurements, and echocardiography were performed at 2 wk and 1, 2, and 3 mo. Overall mortality was 26% at 3 mo, and up to 80% of the pigs showed total occlusion of LAD at 1 mo. A significant depression of peak LV pressure rate of rise (+dP/d tmax) was observed in the animals showing total artery occlusion throughout the study. Left ventricular ejection fraction was also impaired, and the left ventricular volumes tended to be larger in the pigs with occlusion. Approximately 10% of scar tissue was found in the LAD occluded pigs, whereas the coronary flow pattern in the rest of the area took the pattern of hibernating myocardium. At the same time, histological and protein analysis established the presence of fibrosis and ongoing apoptosis in the ischemic area. In this model, the timing and incidence of total occlusion and low mortality offer significant advantages over other ischemic cardiomyopathy models in conducting preclinical studies.

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P6276Impact of the cardiac specific deletion of AMPKalpha2 on the contractile and metabolic phenotype of the heart in male and female mice

European Heart Journal ◽

10.1093/eurheartj/ehz746.0875 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Grimbert ◽

M N Sanz ◽

C Rucker-Martin ◽

M Novotova ◽

M Gressette ◽

...

Keyword(s):

Contractile Function ◽

Left Ventricular ◽

Metabolic Phenotype ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Male And Female ◽

Female Mice ◽

Sex Specificity ◽

Specific Deletion

Abstract Introduction Mitochondrial dysfunction plays a major role in the Heart Failure (HF) pathophysiology.The AMP activated protein kinase (AMPK) is activated by a high AMP-ADP/ATP ratio and regulates a number of metabolic pathways. Many studies have highlighted a protective role of AMPK in HF, but its relevance to cardiac tissue, its metabolic part and its sex specificity are not well established. Purpose Then, the aim of this study is to determine the role of AMPK in the healthy and failing heart in male and female mice. Methods We developed and validated a mouse strain with an adult-inducible cardiac-specific deletion of AMPKα2, the major cardiac isoform, using the Cre-Lox system (40mg/kg tamoxifen injection on two consecutive days at adult age). At four months after the deletion, cardiac contractility, morphology and metabolism were studied in control and KO mice from both sexes. Results We observed only in male KO mice a decrease of left ventricular ejection fraction (−10%), an increase of the total fibrosis (+64%) and defects in mitochondrial structures. Male KO mice also showed a reduced (−28%) mitochondrial respiration via complex I associated with a different cardiolipin species distribution. Conclusion Our results reveal in adult healthy hearts, a sex-specificity in the effects of AMPKα2 deletion, leading to impaired contractile function related to metabolic and non-metabolic alterations only in male mice.

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Transitioning from Preclinical to Clinical Heart Failure with Preserved Ejection Fraction: A Mechanistic Approach

Journal of Clinical Medicine ◽

10.3390/jcm9041110 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1110 ◽

Cited By ~ 1

Author(s):

Antoni Bayes-Genis ◽

Felipe Bisbal ◽

Julio Núñez ◽

Enrique Santas ◽

Josep Lupón ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Hypertension ◽

Ejection Fraction ◽

Right Ventricular ◽

Left Atrial ◽

Interstitial Fibrosis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Preserved Ejection Fraction ◽

Ventricular Ejection Fraction

To better understand heart failure with preserved ejection fraction (HFpEF), we need to better characterize the transition from asymptomatic pre-HFpEF to symptomatic HFpEF. The current emphasis on left ventricular diastolic dysfunction must be redirected to microvascular inflammation and endothelial dysfunction that leads to cardiomyocyte remodeling and enhanced interstitial collagen deposition. A pre-HFpEF patient lacks signs or symptoms of heart failure (HF), has preserved left ventricular ejection fraction (LVEF) with incipient structural changes similar to HFpEF, and possesses elevated biomarkers of cardiac dysfunction. The transition from pre-HFpEF to symptomatic HFpEF also involves left atrial failure, pulmonary hypertension and right ventricular dysfunction, and renal failure. This review focuses on the non-left ventricular mechanisms in this transition, involving the atria, right heart cavities, kidneys, and ultimately the currently accepted driver—systemic inflammation. Impaired atrial function may decrease ventricular hemodynamics and significantly increase left atrial and pulmonary pressure, leading to HF symptoms, irrespective of left ventricle (LV) systolic function. Pulmonary hypertension and low right-ventricular function are associated with the incidence of HF. Interstitial fibrosis in the heart, large arteries, and kidneys is key to the pathophysiology of the cardiorenal syndrome continuum. By understanding each of these processes, we may be able to halt disease progression and eventually extend the time a patient remains in the asymptomatic pre-HFpEF stage.

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Endomyocardial biopsies in the diagnosis of myocardial involvement in systemic lupus erythematosus

Lupus ◽

10.1177/0961203319897116 ◽

2020 ◽

Vol 29 (2) ◽

pp. 199-204 ◽

Cited By ~ 2

Author(s):

Y Gartshteyn ◽

M Tamargo ◽

S Fleischer ◽

T Kapoor ◽

J Li ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Interstitial Fibrosis ◽

Left Ventricular ◽

Diagnostic Methods ◽

Left Ventricular Ejection ◽

Systemic Lupus ◽

Ventricular Ejection Fraction ◽

Myocyte Hypertrophy ◽

Myocardial Involvement

Background Endomyocardial biopsy (EMB) is considered the gold standard for diagnosing myocardial involvement in most inflammatory conditions, including systemic lupus erythematosus (SLE). However, EMBs are rarely performed, and most of the myocardial histopathology reports in SLE consist of postmortem data. We therefore sought to describe the histopathologic findings of contemporary EMBs in SLE performed in clinical practice. Methods A retrospective review of histopathology reports from SLE patients who underwent EMB from 1994 to 2017 was performed. A total of 41 SLE patients had cardiac pathology reports. Of these, 11 histopathology reports were EMBs, and the remaining were valvular specimens. Results A total of 11 SLE EMBs were reviewed. It was found that 45% of the patients had hypertension, 27% had coronary artery disease, 9% had hyperlipidemia, and 36% had end-stage renal disease. None had diabetes or smoked. The mean left ventricular ejection fraction was 37%. On histopathology, 10 had mild interstitial fibrosis, 9 had myocyte hypertrophy, 3 had organized blood clots, and 3 had a mild infiltration of lymphocytes and macrophages without clear evidence of myocarditis. None had vasculitis, endocarditis, ischemia, amyloid deposition, or lamellar or curvilinear inclusions. Conclusion EMBs are rarely performed in SLE. In this case series, nonspecific interstitial fibrosis and myocyte hypertrophy were the most common findings, suggesting EMBs have limited value in the diagnosis of cardiac involvement in SLE and rather rule out competing conditions. These data support the need for diagnostic methods with high sensitivity and specificity for SLE heart disease.

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Abstract 12624: Blockade of Exosome Secretion Attenuates Inflammatory Cytokines, Mitigates Cardiac Dysfunction, and Reduces Mortality in Polymicrobial Sepsis

Circulation ◽

10.1161/circ.130.suppl_2.12624 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Xiaohong Wang ◽

Dongze Qin ◽

Kobina Essandoh ◽

Wei Huang ◽

Liwang Yang ◽

...

Keyword(s):

Inflammatory Cytokines ◽

Cardiac Dysfunction ◽

Contractile Function ◽

Cecal Ligation ◽

Left Ventricular ◽

Polymicrobial Sepsis ◽

Raw 264.7 Cells ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Tnf Α

Introduction: Exosomes, a group of nano-vesicles secreted from living cells, are documented to increase in the circulation and are believed to promote cardiac dysfunction in sepsis patients and animal models. However, whether inhibition of exosome release could exert a cardio-protective effect in polymicrobial sepsis remains unexplored. Methods and Results: C57BL/6 mice (male, 8-week old) were pre-treated with GW4869 (dissolved in DMSO, injection i.p. at a dose of 2.5μg/g body weight), a known inhibitor of exosome secretion. Same volume of DMSO was used as controls. One hour later, cecal ligation and puncture (CLP) surgery was performed to induce polymicrobial sepsis. We found that the concentration of serum exosomes, measured by membrane markers CD63 and CD81with detection ELISA kits, was increased by 3.5-fold in DMSO-CLP mice, but no increase was detected in GW4869-CLP mice or in sham operated mice (n=4-6, p<0.01). Myocardial contractile function, assessed at 12h post-CLP using a SONOS-7500 echocardiography system, revealed that pre-injection of GW4869 significantly attenuated CLP-associated cardiac dysfunction, evidenced by an improved left ventricular ejection fraction (LVEF) and minor axis fractional shortening (LVFS), compared to DMSO controls (n=8-10, p<0.01). Myeloperoxidase (MPO) activity, a marker of myocardial inflammation, measured with a [[Unable to Display Character: ﬂ]]uorometric assay kit, also showed a significant reduction in GW4869-pre-treated mice, compared to DMSO-controls (n=5, p<0.01). Similarly, serum levels of inflammatory cytokines TNF-α and IL-1β triggered by CLP were reduced by 72% and 61%, respectively in GW4869-treated mice, compared with controls (n=6). Furthermore, we observed that 67% (n=9) of the DMSO controls, but only 20% in GW4869-treated mice (n=10) had died by 48h post-CLP. In vitro study confirmed that GW4869 limited the production of TNF-α and IL-1β in RAW 264.7 cells (a mouse macrophage cell line) challenged with endotoxin (LPS, 1μg/ml, 24 h). Conclusions: Together, this study indicates that blockade of exosome secretion could attenuate the inflammatory cytokine response as well as the consequent cardiac dysfunction and mortality in polymicrobial sepsis. Thus, our study may provide a new approach to the treatment of sepsis.

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A Bioengineered Neuregulin-Hydrogel Therapy Reduces Scar Size and Enhances Post-Infarct Ventricular Contractility in an Ovine Large Animal Model

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd7040053 ◽

2020 ◽

Vol 7 (4) ◽

pp. 53

Author(s):

Jeffrey E. Cohen ◽

Andrew B. Goldstone ◽

Hanjay Wang ◽

Brendan P. Purcell ◽

Yasuhiro Shudo ◽

...

Keyword(s):

Cardiac Function ◽

Systolic Pressure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Coronary Artery Ligation ◽

Large Animal ◽

Ventricular Contractility ◽

Intramyocardial Injection ◽

Ventricular Ejection Fraction ◽

Scar Size

The clinical efficacy of neuregulin (NRG) in the treatment of heart failure is hindered by off-target exposure due to systemic delivery. We previously encapsulated neuregulin in a hydrogel (HG) for targeted and sustained myocardial delivery, demonstrating significant induction of cardiomyocyte proliferation and preservation of post-infarct cardiac function in a murine myocardial infarction (MI) model. Here, we performed a focused evaluation of our hydrogel-encapsulated neuregulin (NRG-HG) therapy’s potential to enhance cardiac function in an ovine large animal MI model. Adult male Dorset sheep (n = 21) underwent surgical induction of MI by coronary artery ligation. The sheep were randomized to receive an intramyocardial injection of saline, HG only, NRG only, or NRG-HG circumferentially around the infarct borderzone. Eight weeks after MI, closed-chest intracardiac pressure–volume hemodynamics were assessed, followed by heart explant for infarct size analysis. Compared to each of the control groups, NRG-HG significantly augmented left ventricular ejection fraction (p = 0.006) and contractility based on the slope of the end-systolic pressure–volume relationship (p = 0.006). NRG-HG also significantly reduced infarct scar size (p = 0.002). Overall, using a bioengineered hydrogel delivery system, a one-time dose of NRG delivered intramyocardially to the infarct borderzone at the time of MI in adult sheep significantly reduces scar size and enhances ventricular contractility at 8 weeks after MI.

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Creation of artificial chords during mitral valve replacement in patients with rheumatic heart disease

Kazan medical journal ◽

10.17816/kmj1872 ◽

2012 ◽

Vol 93 (3) ◽

pp. 479-484

Author(s):

I V Abdul’yanov ◽

M N Mukharyamov ◽

R K Dzhordzhikiya ◽

I I Vagizov

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Contractile Function ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Left Ventricular Geometry ◽

Control Group ◽

Ventricular Ejection Fraction

Aim. To evaluate the effectiveness and safety of the use of artificial chords using polytetrafluoroethylene sutures during mitral valve replacement in patients with rheumatism. Methods. The study included 134 patients operated on for isolated rheumatic mitral valve disease. Immediate (10 days) and long-term (24 months) results were evaluated in the three groups of patients, depending on the method of valve replacement: creation of prosthetic chords using polytetrafluoroethylene sutures (37 patients), preservation of native chords (67 patients), total excision of the subvalvular apparatus (control group, 30 patients). Results. 24 months after surgery in the group of prosthetic chords and the group of preserved native chords recorded was a significant decrease in the pulmonary artery pressure, the left atrial size and a reduction in the end-diastolic left ventricular size. In the control group of patients reported was a reduction in left ventricular ejection fraction in long-term follow up. Conclusion. The use of polytetrafluoroethylene sutures in order to create new chords demonstrated their safety and effectiveness in preserving the physiological left ventricular geometry; artificial chords, as well as the preserved native chords, have a positive effect on the left ventricular contractile function in the remote postoperative period.

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In-hospital results of rheolytic catheter thrombectomy in patients with STEMI

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2016-3-54-61 ◽

2016 ◽

Vol 20 (3) ◽

pp. 54

Author(s):

M V Malkhasyan ◽

V A Kuznetsov ◽

I S Bessonov ◽

P I Pavlov

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Contractile Function ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Old Myocardial Infarction ◽

Mean Time

Aim. The article focuses on the evaluation of short-term efficacy of rheolytic thrombectomy (AngioJet) in patients with STEMI. Methods. 188 patients (85.6% men) with STEMI underwent primary PCI by means of rheolytic catheter thrombectomy (AngioJet). The mean age was 54.1 ± 10.7 years. 32 (17 %) of patients had old myocardial infarction. 104 (55.9 %) patients were diagnosed with ST-elevated inferior myocardial infarction. 22 (12 %) patients were operated under cardiogenic shock. Mean time from the appearance of symptoms to admission was 222.5 [70, 584] min. Anterior interventricular artery (38.3 %) and right coronary artery (43.6 %) were the main infarction-related arteries. Results. Complete thrombotic occlusion of the coronary artery occurred in 144 (77.4%) patients. Mean “door-to-balloon” time amounted to 41.5 [30; 60]. Coronary thrombus was fully removed in 107 (60.8%) of patients. Stents with antiproliferative effect were implanted in 48.8 % of patients. Immediate angiographic success was achieved in 177 (94.1%) cases. Mean time of PCI was 60 [50; 80] min. PCI complications were registered in 3 (1.6%) patients. Intraoperative life-threatening arrhythmias happened in 22 (11.7 %) patients. The phenomenon of "no-reflow" occurred in 6 (3.2%) PCI cases. The rate of in-hospital mortality was 5.9%, including patients with cardiogenic shock (36.4%) and those without it (1.9 %). MACCE (main adverse cardio-cerebral events) were observed in 15 (8%) cases. According to ECG data obtained postoperatively, 26 % of patients demonstrated no regional asynergy, while a decrease in myocardial contractile function occurred in just 26 % of cases, with the average left ventricular ejection fraction running to 57.5±9 %. Mean in-hospital stay was 9.5±0.6 days. Conclusion. The results of this study suggest that rheolytic catheter thrombectomy (AngioJet) is a safe and effective modality. Immediate hospital results show low rate complications and low in-hospital mortality.Received 13 April 2016. Accepted 9 June 2016.Conflict of interest: The authors declare no conflict interests.

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