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Mechanical cardiac support

Alexander C Bertalovitz, Marika L Osterbur Badhey, Thomas V McDonald
Synonymous nucleotide variation is increasingly recognized as a factor than can affect protein expression, but the underlying mechanisms are incompletely understood. Here, we investigated whether synonymous changes could affect expression of the potassium voltage gated channel subfamily H member 2 (KCNH2) gene, encoding the human ether-a-go-go related gene (hERG) ion channel which is linked to hereditary cardiac arrhythmia. We examined a previously described synthetic version (hERG-CM) with synonymous substitutions designed to reduce GC content, rare codons, and mRNA secondary structure relative to the native construct (hERG-NT)...
June 15, 2018: Journal of Biological Chemistry
David Ouyang, Gunsagar Gulati, Richard Ha, Dipanjan Banerjee
BACKGROUND: Proposed changes to the United Network for Organ Sharing heart transplant allocation protocol will prioritize patients receiving temporary mechanical circulatory support (tMCS), including extracorporeal membrane oxygenation (ECMO), percutaneous ventricular assist devices (PVADs), and intra-aortic balloon pumps (IABPs). We sought to evaluate contemporary trends in the incidence and outcomes of patients who required tMCS during the hospitalization before heart transplantation...
April 26, 2018: Journal of Heart and Lung Transplantation
Mithun Chakravarthy, Masaki Tsukashita, Srinivas Murali
Cardiogenic shock is a clinical syndrome characterized by low cardiac output and sustained tissue hypoperfusion resulting in end-organ dysfunction and death. In-hospital mortality rates range from 50% to 60%. Urgent diagnosis, timely transfer to a tertiary or quaternary medical facility with critical care management capabilities and multidisciplinary shock teams is a must to increase survival. Aggressive, hemodynamically guided medical management with careful monitoring of clinical and hemodynamic parameters with timely use of appropriate mechanical circulatory support devices is often necessary...
July 2018: Critical Care Clinics
Laurent Bonello, Clement Delmas, Guillaume Schurtz, Guillaume Leurent, Eric Bonnefoy, Nadia Aissaoui, Patrick Henry
Cardiogenic shock (CS) is a major challenge in contemporary cardiology. Despite a better understanding of the pathophysiology of CS, its management has only improved slightly. The prevalence of CS has remained stable over the past decade, but its outcome has seen few improvements, with the 1-month mortality rate still in the range of 40-60%. Inotropes and vasopressors are the first-line therapies for CS, but they are associated with significant hazards, and have well-known deleterious effects. Furthermore, a significant number of patients develop refractory CS with haemodynamic instability, causing critical organ hypoperfusion and/or pulmonary congestion, despite increasing doses of catecholamines...
June 11, 2018: Archives of Cardiovascular Diseases
Yapeng Li, Dianhong Zhang, Lingyao Kong, Huiting Shi, Xinyu Tian, Lu Gao, Yuzhou Liu, Leiming Wu, Binbin Du, Zhen Huang, Cui Liang, Zheng Wang, Rui Yao, Yanzhou Zhang
Metabolic dysfunction is a hallmark of cardiac hypertrophy and heart failure. During cardiac failure, the metabolism of cardiomyocyte switches from fatty acid oxidation to glycolysis. However, the roles of key metabolic enzymes in cardiac hypertrophy are not understood fully. Here in the present work, we identified Aldolase A (AldoA) as a core regulator of cardiac hypertrophy. The mRNA and protein levels of AldoA were significantly up-regulated in transverse aortic constriction (TAC)- and isoproterenol (ISO)-induced hypertrophic mouse hearts...
June 11, 2018: Experimental Cell Research
Arif Albulushi, Andreas Giannopoulos, Nikolaos Kafkas, Stylianos Dragasis, Gregory Pavlides, Yiannis S Chatzizisis
Acute right ventricle myocardial infarction (RVMI) is observed in 30-50% of patients presenting with inferior wall myocardial infarction and, occasionally, with anterior wall myocardial infarction. The clinical consequences vary from no hemodynamic compromise to severe hypotension and cardiogenic shock depending on the extent of RV ischemia. Areas covered: The pathophysiological mechanisms, diagnostic steps and novel therapeutic approaches of acute RVMI are described. Expert commentary: Diagnosis of acute RVMI is based on physical examination, cardiac biomarkers, electrocardiography and coronary angiography, whereas non-invasive imaging modalities (echocardiography, cardiac magnetic resonance imaging) play a complementary role...
June 14, 2018: Expert Review of Cardiovascular Therapy
Marc Pineton de Chambrun, Nicolas Bréchot, Alain Combes
PURPOSE OF REVIEW: Temporary circulatory support (TCS) with short-term mechanical circulatory support (MCS) devices is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of current devices, their indications and management, and discusses results of recent case series and trials. RECENT FINDINGS: Percutaneous active MCS devices (Impella, TandemHeart…) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are utilized as a bridge to 'decision' that includes weaning after cardiac function recovery, transplantation, long-term MCS and withdrawal in case of futility...
June 8, 2018: Current Opinion in Critical Care
Liza Grosman-Rimon, Michael A McDonald, Danit Freedman, Paul Yip, David Z Cherney, Vivek Rao
INTRODUCTION: The levels of neurohormones were assessed in continuous-flow left ventricular assist device (CF-LVAD) recipients and compared to patients with heart failure (HF) and to healthy controls (HCs), and CF-LVAD recipients with closed or open aortic valves (AVs). METHODS: Aldosterone, norepinephrine, and renin levels were assessed in a total of 46 participants, including CF-LVAD recipients (n = 18), HF patients (n = 14), and HC individuals (n = 14)...
June 14, 2018: Journal of Cardiac Surgery
Guo-Sheng Xiao, Yan-Hui Zhang, Yan Wang, Hai-Ying Sun, Clive M Baumgarten, Gui-Rong Li
BACKGROUND AND PURPOSE: Adrenergic regulation of cell volume-regulated chloride current (ICl.vol ) is species-dependent. The present study investigates the mechanism underlying adrenergic regulation of ICl.vol in human atrial myocytes. EXPERIMENTAL APPROACH: A conventional whole-cell patch voltage-clamp technique was utilized to record membrane current in human atrial myocytes. ICl.vol was evoked by hyposmotic bath solution (0.6-times isosmotic, 0.6T). KEY RESULTS: ICl...
June 13, 2018: British Journal of Pharmacology
Glauco M Plens, Caio Ca Morais, Maria A Nakamura, Patricia N Souza, Marcelo Bp Amato, Mauro R Tucci, Eduardo Lv Costa
BACKGROUND: Sensitive flow or pressure triggers are usually applied to improve ventilator response time. Conversely, too sensitive triggers can incur risk of auto-triggering, a type of asynchrony in which a breath is triggered without inspiratory muscle activity. A frequent cause of auto-triggering is cardiogenic oscillations, characterized by cyclical variations in pressure and flow waveforms caused by cardiac contractions. Our goal was to test trigger performance and capacity to abolish auto-triggering in 5 different ICU ventilators using different simulated levels of cardiogenic oscillations...
June 12, 2018: Respiratory Care
Marit Wiersma, Thais M A Beuren, Edwin L de Vrij, Vera A Reitsema, Jantje J Bruintjes, Hjalmar R Bouma, Bianca J J M Brundel, Robert H Henning
Hibernation consists of torpor, with marked suppression of metabolism and physiological functions, alternated with arousal periods featuring their full restoration. The heart is particularly challenged, exemplified by its rate reduction from 400 to 5-10 beats per minute during torpor in Syrian hamsters. In addition, during arousals, the heart needs to accommodate the very rapid return to normal function, which lead to our hypothesis that cardiac function during hibernation is supported by maintenance of protein homeostasis through adaptations in the protein quality control (PQC) system...
June 9, 2018: Comparative Biochemistry and Physiology. Part B, Biochemistry & Molecular Biology
Syed Yaseen Naqvi, Ibrahim G Salama, Ayhan Yoruk, Leway Chen
Cardiac transplantation is the gold standard treatment for patients with advanced congestive heart failure that is refractory to maximal medical therapy. However, donor heart availability remains the major limiting factor, resulting in a large number of patients waiting long periods of time before transplantation. As a result, mechanical circulatory support devices have been increasingly used as a 'bridge' in order to sustain organ function and stabilise haemodynamics while patients remain on the transplant waiting list or undergo left ventricular assist device surgery...
May 2018: Cardiac Failure Review
Christos Kontogiannis, Dionysios Aravantinos, Ioannis Nanas, Chris J Kapelios, Sotirios Marinakis, Styliani Vakrou, Smaragdi Sarchosi, Despina N Perrea, Jay W Mason, John N Nanas, Konstantinos Malliaras
The pressure unloading left ventricular assist device (PULVAD) is a novel implantable counterpulsation LVAD, designed to provide ventricular unloading with augmentation of LV performance and retention of pulsatility. We assessed the effects of the PULVAD on hemodynamics and LV mechanoenergetics in seven farm pigs with acute ischemic heart failure. The PULVAD was implanted in the thorax and was connected to the ascending aorta. The PULVAD was pneumatically driven by a standard intra-aortic balloon pump console and was electrocardiogram-synchronized to provide LV pressure unloading along with diastolic aortic pressure augmentation...
June 5, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Marieh B Al-Handawi, Patrick Commins, Durga Prasad Karothu, Gijo Raj, Liang Li, Pance Naumov
Ischemic heart disease often leads to myocardial infarction and remains the most common cause for death in humans. Although the exact impetus for the infarction remains elusive, a mechanism has been proposed that relates the disease to the observed high cholesterol levels in the body. The mechanism claims that cholesterol crystallizes inside the arterial plaque into needle-shaped crystals. The crystals puncture the fibrous cap of the plaque, whereby the necrotic contents of the plaque are spilled, subsequently clotting the blood vessels...
June 7, 2018: Chemistry: a European Journal
Payal K Gurnani, Allison Bohlmann, Robert J March
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used as a bridge to cardiac recovery in patients following a major cardiac event. There is a lack of literature surrounding prolonged use of eptifibatide and optimal dosing during ECMO. This case report describes our experience with extended durations and standard dosing of eptifibatide in the setting of ECMO. CASE: A 40-year-old male with a history of Marfan's syndrome, aortic root and ascending aortic aneurysm status post a modified Bentall with a St...
June 1, 2018: Perfusion
Kevin R Krull, Kristina K Hardy, Lisa S Kahalley, Ilse Schuitema, Shelli R Kesler
Recent research has demonstrated that survivors of childhood cancer are at risk for a myriad of late effects that affect physical and mental quality of life. We discuss the patterns and prevalence of neurocognitive problems commonly experienced by survivors of CNS tumors and acute lymphoblastic leukemia, the two most commonly researched cancer diagnoses. Research documenting the direct effects of tumor location and treatment type and intensity is presented, and patient characteristics that moderate outcomes (eg, age at diagnosis and sex) are discussed...
June 6, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Rohit K Kharbanda, Eusebio Garcia-Izquierdo, A J J C Bogers, Natasja Ms De Groot
High-resolution atrial mapping studies have provided novel insights in the pathophysiology of atrial fibrillation (AF) in the last few years. Increasing attention is being drawn to the so-called focal activation patterns (FAPs); however there is no consensus on criteria to identify and characterize these patterns. Areas covered: In this expert review, an overview of definitions and criteria used to examine FAPs obtained from atrial mapping studies is provided and studies reporting on the underlying mechanisms are discussed...
June 6, 2018: Expert Review of Cardiovascular Therapy
Kevin L Sack, Yaghoub Dabiri, Thomas Franz, Scott D Solomon, Daniel Burkhoff, Julius M Guccione
Predictive computation models offer the potential to uncover the mechanisms of treatments whose actions cannot be easily determined by experimental or imaging techniques. This is particularly relevant for investigating left ventricular mechanical assistance, a therapy for end-stage heart failure, which is increasingly used as more than just a bridge-to-transplant therapy. The high incidence of right ventricular failure following left ventricular assistance reflects an undesired consequence of treatment, which has been hypothesized to be related to the mechanical interdependence between the two ventricles...
2018: Frontiers in Physiology
Veysel Tosun, Necmettin Korucuk, Ali Yaşar Kılınç, Turgut Uygun, Refik Emre Altekin, Ünal Güntekin, Cengiz Ermiş
OBJECTIVE: Nondippers are known to carry a high risk of cardiovascular morbidity and mortality. The aim of this study was to investigate the effects of dipper and nondipper status of hypertension on left atrial (LA) systolic and diastolic functions using two-dimensional speckle tracking echocardiography (2D-STE), P-wave dispersion (PWD), and P terminal force (PTF) in hypertensive patients. METHODS: A total of 72 patients and 39 healthy individuals were included in the study...
June 4, 2018: Echocardiography
Marissa A Brunetti, J William Gaynor, Lauren B Retzloff, Jessica L Lehrich, Mousumi Banerjee, Venugopal Amula, David Bailly, Darren Klugman, Josh Koch, Javier Lasa, Sara K Pasquali, Michael Gaies
OBJECTIVES: Cardiopulmonary failure in children with cardiac disease differs from the general pediatric critical care population, yet the epidemiology of extracorporeal membrane oxygenation support in cardiac ICUs has not been described. We aimed to characterize extracorporeal membrane oxygenation utilization and outcomes across surgical and medical patients in pediatric cardiac ICUs. DESIGN: Retrospective analysis of the Pediatric Cardiac Critical Care Consortium registry to describe extracorporeal membrane oxygenation frequency and outcomes...
June 2018: Pediatric Critical Care Medicine
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