Neurohumoral response and clinical effectiveness of continuous aortic flow augmentation in patients with decompensated heart failure
- First Online:
- 40 Downloads
The increasing number of patients with progressive or exacerbated heart failure that is refractory to medical treatment necessitates the development of innovative cardiac assist devices. The aim of this study was to investigate whether a new percutaneously inserted system, which allows continuous aortic flow augmentation (CAFA), could be shown to be clinically effective with neurohormonal benefit in patients admitted with decompensated heart failure. Patients with exacerbations of chronic heart failure were recruited for the study. A percutaneous circulation assist device (Cancion system) promoting CAFA was implanted for up to 4 days in each patient. Clinical improvement was evaluated by measuring the clinical status according to the New York Heart Association (NYHA) classification and biochemical parameters including troponin and B-type natriuretic peptide (BNP) as markers of cardiac necrosis and cardiac overload; these parameters were measured before, during, and after CAFA treatment. The decrease in BNP was determined after implantation, reaching, on average, a maximum decrease of 57% at 72 h (P = 0.04). The neurohumoral response remained significant (P < 0.05) up to 120 h after implantation, with a decrease in BNP levels of 37%, on average, compared to baseline values. Troponin I did not show any significant change during mechanical assistance (P > 0.2). All patients had improved clinical status according to the NYHA classification, and the improvement lasted for more than 1 week. Percutaneous heart-assist devices promoting CAFA offer clinical improvement and a neurohumoral response, with a significant BNP reduction in severe exacerbation of chronic heart failure that is refractory to medical treatment.
Key wordsHeart failure Continuous aortic flow augmentation B-type natriuretic peptide (BNP) Heart-assist device
Unable to display preview. Download preview PDF.
- 4.Konstam MA, Czerska B, Böhm M, Oren RM, Sadowski J, Khanal S, Abraham WT, Wasler A, Dahm JB, Gavazzi A, Gradinac S, Legrand V, Mohacsi P, Poelzl G, Radovancevic B, Van Bakel AB, Zile MR, Cabuay B, Bartus K, Jansen P. Continuous aortic flow augmentation: a pilot study of hemodynamic and renal responses to a novel percutaneous intervention in decompensated heart failure. Circulation 2005;112:3107–3114PubMedCrossRefGoogle Scholar
- 5.Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, Van Lente F; Chronic Kidney Disease Epidemiology Collaboration. Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007;53:766–772PubMedCrossRefGoogle Scholar
- 8.Miller LW, Pagani FP, Russell SD, John R, Boyle AJ, Aaronson KD, Conte JV, Naka Y, Mancini D, Delgado RM, MacGillivray TE, Farrar DJ, Frazier OH; HeartMate II Clinical Investigators. Use of continuous flow device in patients awaiting heart transplantation. N Engl J Med 2007;357:885–896PubMedCrossRefGoogle Scholar
- 10.Schirger JA, Boerrigter G, Chen HH, Costello-Boerrigter LC, Viole T, Konstam MA, Burnett JC. Renal protection with the Cancion system in severe experimental CHF. J Cardiac Fail 2005;11:139Google Scholar
- 15.Wagner FD, Buz S, Zais H, Stasch JP, Hetzer R, Hocher B. Humoral and hemodynamic responses after left ventricular assist device implantation and heart transplantation. Exp Biol Med (Maywood) 2006;231:861–864Google Scholar
- 16.Bruggink AH, de Jonge N, van Oosterhout MF, Van Wichen DF, de Koning E, Lahpor JR, Kemperman H, Gmelig-Meyling FH, de Weger RA. Brain natriuretic peptide is produced both by cardiomyocytes and cells infiltrating the heart in patients with severe heart failure supported by a left ventricular assist device. J Heart Lung Transplant 2006;25:174–180PubMedCrossRefGoogle Scholar