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Review
. 2018 Nov 27:7:F1000 Faculty Rev-1852.
doi: 10.12688/f1000research.14597.1. eCollection 2018.

From bedside to bench and back again: translational studies of mechanical unloading of the left ventricle to promote recovery after acute myocardial infarction

Navin K Kapur  1   2   3 , Shiva Annamalai  1   2   3 , Lara Reyelt  1   2   3 , Samuel J Karmiy  1   2   3 , Allen A Razavi  1   2   3 , Sina Foroutanjazi  1   2   3 , Aditya Chennojwala  1   2   3 , Kiyotake Ishikawa  4
Affiliations
Review

From bedside to bench and back again: translational studies of mechanical unloading of the left ventricle to promote recovery after acute myocardial infarction

Navin K Kapur et al. F1000Res. .

Abstract

Heart failure is a major cause of global morbidity and mortality. Acute myocardial infarction (AMI) is a primary cause of heart failure due in large part to residual myocardial damage despite timely reperfusion therapy. Since the 1970's, multiple preclinical laboratories have tested whether reducing myocardial oxygen demand with a mechanical support pump can reduce infarct size in AMI. In the past decade, this hypothesis has been studied using contemporary circulatory support pumps. We will review the most recent series of preclinical studies in the field which led to the recently completed Door to Unload ST-segment Elevation Myocardial Infarction (DTU-STEMI) safety and feasibility pilot trial.

Keywords: Unloading; acute myocardial infarction; mechanical circulatory support; preclinical models.

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Conflict of interest statement

Competing interests: Navin Kapur has received research funding from Abiomed Inc., Abbott (Santa Clara, CA, USA), Boston Scientific (Minneapolis, MN, USA), MD Start (Paris, France), CardiacAssist Inc. (Pittsburgh, PA, USA), and Maquet Cardiovascular Inc. (Rastatt, Germany). Kiyotake Ishikawa has received research funding from Abiomed Inc. The other authors declare that they have no competing interests.No competing interests were disclosed.No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. Infarct size as a correlate of heart failure onset.
All-cause mortality ( A) and heart failure hospitalization ( B), showing a strong association between infarct size and adverse outcomes during 1-year follow-up.
Figure 2.
Figure 2.. Left ventricular (LV) unloading and pressure volume (PV) area figure.
( A) Relationship between pressure and volume and the myocardial oxygen demand. ( B) PV loop on and off left atrial to femoral artery (LA-FA) bypass (TandemHeart). ( C) PV loop on and off trans-valvular unloading (Impella CP).
Figure 3.
Figure 3.
Association between infarct percentage and left ventricular (LV) wall stress ( A), infarct percentage after Impella 5.0 unloading (# p<0.05 versus Impella 5.0 unloading) ( B), infarct scar size and unloading (* p<0.05 versuss IRI; † p<0.001 versus IRI; ‡ p<0.05 versus partial unload) ( C), and average peak velocity over time ( D) AAR, area-at-risk; IRI, ischemia reperfusion injury.
Figure 4.
Figure 4.
Late gadolinium enhancement (LGE) and anatomical pathology evidence ( A) as well as magnetic resonance imaging evidence ( B) of reduced scar percentage due to unloading CMR, cardiovascular magnetic resonance.
See this image and copyright information in PMC

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