Jozef Bartunek

Dobutamine enhances cardiodepressant effects of receptor-mediated coronary endothelial stimulation.

BACKGROUNDnIn humans, intracoronary infusion of substance P reduces left ventricular end-systolic pressure and left ventricular peak systolic pressure because of earlier onset of left ventricular relaxation induced by paracrine myocardial action of mediators released from the coronary endothelium. The present study investigated in humans the effects of beta-adrenergic stimulation, which also induces earlier left ventricular relaxation, on the left ventricular myocardial contractile response to intracoronary infusion of substance P.nnnMETHODS AND RESULTSnData were obtained in 13 patients after cardiac transplantation and in 3 patients with dilated nonischemic cardiomyopathy. Microtip left ventricular pressure recordings were obtained during a 5-minute intracoronary infusion of substance P (20 pmol/min) under control conditions and then repeated during concurrent intravenous administration of dobutamine. In the presence of dobutamine, intracoronary substance P caused a greater fall in left ventricular end-systolic pressure (transplantation control, -9 +/- 11 versus transplantation dobutamine, -20 +/- 18 mm Hg [P < .05]; cardiomyopathy control, -4 +/- 1 versus cardiomyopathy dobutamine, -10 +/- 3 mm Hg [P < .05]) and in left ventricular peak systolic pressure (transplantation control, -14 +/- 10 versus transplantation dobutamine, -30 +/- 22 mm Hg [P < .01]; cardiomyopathy control, -9 +/- 7 versus cardiomyopathy dobutamine, -15 +/- 6 mm Hg [P = .1]).nnnCONCLUSIONSnDobutamine enhances the cardiodepressant effect on myocardial contractile performance of receptor-mediated coronary endothelial stimulation in transplant recipients and in patients with dilated nonischemic cardiomyopathy. This enhancement could result from a potentiating interaction of the relaxation-hastening effect exerted by beta-adrenergic stimulation and by mediators released from the coronary endothelium, such as nitric oxide.

Translational approach to heart failure

1. Pathophysiology of Heart Failure: Back to Basics Gilles W De Keulenaer, Vincent Segers, Dirk L Brutsaert 2. Heart Failure with Normal Left Ventricular Ejection Fraction - Basic Principles and Clinical Diagnostics Otto A. Smiseth, Espen W. Remme, Anders Opdahl, Svend Aakhus and Helge Skulstad 3. 17 Cardiorenal Syndrome Revisited Matthias Dupont , Wilfried Mullens, and W. H. Wilson Tang 4. Doppler Echocardiography in the Clinical Evaluation of Heart Failure: What Clinicians Need to know and Echocardiographers Should Report Ivan Stankovic and Jens-Uwe Voigt 5. Back to Earth: Common sense in the Management of Heart Failure Marc Goethals 6. Atrial Fibrillation and Heart Failure: Rate versus Rhythm Control Mackram F. Eleid, Yong-Mei Cha, and Win-Kuang Shen 7. Repetitive ICD Shocks and Incessant VTs in Heart Failure: What to Do? Martin Eisenberger, Tom De Potter, Peter Geelen, 8. Dyssynchronous Heart Failure: From Bench to Bedside Caroline J.M. van Deursen, Lars B. van Middendorp, and Frits W. Prinzen 9. 18 Telemonitoring and Sensor Technologies in Chronic Heart Failure Matthias Dupont, Wilfried Mullens, and W. H. Wilson Tang 10. Functional Mitral Regurgitation: the Surgeonss Perspective Jerry Braun and Robert J.M. Klautz 11. Percutaneous Approaches to Treat Functional Mitral Regurgitation: Current State of Affairs and Future Perspectives David Messika-Zeitoun 12. Tailored Approach to Functional Mitral Regurgitation Martin Penicka and Frank Van Praet 13. Revascularization and Left Ventricular Reconstruction in a Patient with Ischemic Heart Failure: to STICH or not to STICH? Marisa Di Donato 14. Cardiac arrest en Refractory Cardiogenic Shock 15. Left Ventricular Assist Devices - From Bridge to Transplant to Destination Therapy Lars H. Lund 16. Novel Device-based Strategies in Treatment of Chronic Heart Failure Gabor Toth, Marc Vanderheyden, and Jozef Bartunek 17. Total Artificial Heart Christof Stamm, Roland Hetzer 18. Stem Cell Therapy for Ischemic Heart Disease Atta Behfar, Jozef Bartunek, and Andre Terzic 19. Immunosuppressive Management of the Heart Transplant Recipient Sofie Verstreken

Percutaneous Ventricular Restoration Using the Parachute Device: The Parachute III Pressure-Volume Loop Sub-study

ABSTRACT Background: Left ventricular (LV) dilatation and remodeling following acute myocardial infarction increases wall stress, ventricular volumes and leads to heart failure (HF), which is associated with a high mortality. Percutaneous ventricular restoration (pVR) therapy reduces LV volumes leading to a more effective ejection. This study investigated the hemodynamic effects of LV volume reduction from pVR on LV performance and its interaction with the arterial system. Methods: Ten patients with symptomatic ischemic HF of New York Heart Association (NYHA) classes II to IV with LV antero-apical wall motion abnormalities underwent Parachute implantation. Pressure-volume loops were recorded immediately pre- and post-pVR implantation and at 6-month follow up. Results: Parachute implantation significantly reduced end-diastolic volume index (from 112 ± 39 mL to 100 ± 41 mL; p < 0.05), with a greater relative reduction in end-systolic volume index (from 66 ± 33 mL to 56 ± 32 mL; p < 0.05) with an overall 7% increase in ejection fraction (from 38 ± 11 to 46 ± 14%; p < 0.05). Furthermore, there was an observed reduction in dyssynchrony index (from 20 ± 4 to 14 ± 6%; p < 0.05) and enhanced contractile function (Ees) immediately post-procedure, sustained at 6-months (from 0.92 ± 0.27 mmHg/mL to 1.37 ± 0.52 mmHg/mL, p < 0.05). Conclusion: This present study confirms positive hemodynamic effects of LV volume reduction using the Parachute percutaneous ventricular restoration device. The Parachute device improved synchronous contraction and enhanced ventricular-arterial interaction likely due to LV reverse remodeling.

Novel Device-Based Strategies in Treatment of Chronic Heart Failure

Multimodal treatments can alleviate the symptoms or reverse the progression of heart failure. Besides the lifestyle management and pharmacological therapies, various device-based interventions have been introduced. In this review, we summarize recent developments with regard to treatment of chronic heart failure as they are designed to target various components in the cascade of heart failure progression.