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Negative Impact of Acute Reloading after Mechanical Left Ventricular Unloading

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Abstract

Mechanical LV unloading for acute myocardial infarction (MI) is a promising supportive therapy to reperfusion. However, no data is available on exit strategy. We evaluated hemodynamic and cellular effects of reloading after Impella-mediated LV unloading in Yorkshire pigs. First, we conducted an acute study in normal heart to observe effects of unloading and reloading independent of MI-induced ischemic effects. We then completed an MI study to investigate optimal exit strategy on one-week infarct size, no-reflow area, and LV function with different reloading speeds. Initial studies showed that acute reloading causes an immediate rise in end-diastolic wall stress followed by a significant increase in cardiomyocyte apoptosis. The MI study did not result in any statistically significant findings; however, numerically smaller average infarct size and no-reflow area in the gradual reloading group prompt further examination of reloading approach as an important clinically relevant consideration.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

LAD:

Left anterior descending artery

LV:

Left ventricular

MI:

Myocardial infarction

PV:

Pressure-volume

PUMA:

P53 upregulated moderator of apoptosis

2D:

Two-dimensional

3D:

Three-dimensional

TUNEL:

Terminal deoxynucleotidyl transferase dUTP nick end labeling

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Funding

This work was supported by the National Institutes of Health R01 HL139963 (to K. Ishikawa). R. Mazurek and S. Mavropoulos were supported by the National Institutes of Health T32 HL007824-23. T. Sakata was also supported by Japan Heart Foundation/Bayer Yakuhin Research Grant Abroad (to T. Sakata).

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Authors and Affiliations

  1. Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1014, New York, NY, 10029, USA

    Renata Mazurek, Taro Kariya, Tomoki Sakata, Spyros A. Mavropoulos, Anjali J. Ravichandran, Francisco J. Romeo, Kelly P. Yamada & Kiyotake Ishikawa

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  1. Renata Mazurek
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  2. Taro Kariya
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  3. Tomoki Sakata
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  4. Spyros A. Mavropoulos
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  5. Anjali J. Ravichandran
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  6. Francisco J. Romeo
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  7. Kelly P. Yamada
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  8. Kiyotake Ishikawa
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Corresponding author

Correspondence to Kiyotake Ishikawa.

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Competing Interests

K. I. serves as a PI of a research grant to the institution from Abiomed Inc. T. K. and T. S. each received a research fellowship award from Abiomed Inc. R. M. received a research award from Abiomed Inc.

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Associate Editor Emma Jane Birks oversaw the review of this article

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Clinical Relevance

Mechanical left ventricular unloading is a promising supportive therapy for acute myocardial infarction to prevent heart failure progression. This study explores exit strategy as a necessary component in utilizing LV unloading for non-complicated MI that may hold implications for future applications.

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Mazurek, R., Kariya, T., Sakata, T. et al. Negative Impact of Acute Reloading after Mechanical Left Ventricular Unloading. J. of Cardiovasc. Trans. Res. 17, 233–241 (2024). https://doi.org/10.1007/s12265-023-10371-z

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  • DOI: https://doi.org/10.1007/s12265-023-10371-z

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