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01-09-2012 | Original Article

The effect of combined treatment with Impella^® and landiolol in a swine model of acute myocardial infarction

Authors: Isamu Yoshitake, Mitsumasa Hata, Akira Sezai, Satoshi Unosawa, Shinji Wakui, Haruka Kimura, Kin-ichi Nakata, Hiroaki Hata, Motomi Shiono

Published in: Journal of Artificial Organs | Issue 3/2012

Abstract

Cardiogenic shock is associated with a high mortality rate in patients with acute myocardial infarction (AMI). We developed a new treatment approach named heart rest therapy (HRT) for complete revascularization in the early stage of AMI using an ultra-short-acting β-blocker (landiolol) and an Impella^® left ventricular assist device and verified the effect of this therapy in a swine model. In 18 male pigs, AMI was induced by left anterior descending coronary artery occlusion at the level of the second diagonal branch for 120 min, followed by 240 min of reperfusion. The animals were divided into three groups: group A had no support, group B was supported with the Impella^®, and group C was treated with HRT from 90 min after ischemia to 240 min after reperfusion. Infarct ratio (percentage of the infarct area relative to the area at infarct risk) was significantly reduced in group C (group A 65.38 ± 6.07, group B 39.66 ± 11.16, group C 21.78 ± 7.29), with a significant difference between groups A and B (P < 0.001), A and C (P < 0.001), and B and C (P = 0.006). Heart rates were significantly lower in group C at 30 min (P = 0.01), 60 min (P = 0.022), and 240 min (P = 0.032) after reperfusion compared with group B, without development of hypotension. HRT at the early stage in AMI stabilized the hemodynamic conditions and reduced infarct size and complications in a swine model. These results suggest that HRT can improve the prognosis of patients with AMI.

Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McInlay SM, LeJemtel TH. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med. 1999;341:625–34.PubMedCrossRef

Goldberg RJ, Gore JM, Alpert JS, Osganian V, de Groot J, Bade J, Chen Z, Frid D, Dalen JE. Cardiogenic shock after acute myocardial infarction: incidence and mortality from a community-wide perspective, 1975 to 1988. N Engl J Med. 1991;325:1117–22.PubMedCrossRef

Merhige ME, Smalling RW, Cassidy D, Barrett R, Wise G, Short J, Wampler RK. Effect of the hemopump left ventricular assist device on regional myocardial perfusion and function. Reduction of ischemia during coronary occlusion. Circulation. 1989;80:III158–66.PubMed

Meyns BP, Nishimura Y, Racz R, Jashari R, Flameng W. Organ perfusion with Hemopump device assistance with and without intraaortic balloon pumping. J Thorac Cardiovasc Surg. 1997;114:243–53.PubMedCrossRef

Smalling RW, Cassidy DB, Barrett R, Lachterman B, Felli P, Ameirian J. Improved regional myocardial blood flow, left ventricular unloading, and infarct salvage using an axial-flow, transvalvular left ventricular assist device: a comparison with intra-aortic balloon counterpulsation and reperfusion alone in a canine infarction model. Circulation. 1992;85:1152–9.PubMedCrossRef

Jurmann MJ, Siniawski H, Erb M, Drews T, Hetzer R. Initial experience with miniature axial flow ventricular assist devices for postcardiotomy heart failure. Ann Thorac Surg. 2004;77:1642–7.PubMedCrossRef

Siegenthaler MP, Brehm K, Strecker T, Hanke T, Noetzold A, Olschewski M, Weyand M, Sievers H, Beyersdorf F. The Impella Recover microaxial left ventricular assist device reduces mortality for postcardiotomy failure: a three-center experience. J Thorac Cardiovasc Surg. 2004;127:812–22.PubMedCrossRef

Garatti A, Colombo T, Russo C, Lanfranconi M, Milazzo F, Catena E, Bruschi G, Frigerio M, Vitali E. Left ventricular mechanical support with the Impella Recover left direct microaxial blood pump: a single-center experience. Artif Organs. 2006;30:523–8.PubMedCrossRef

Seyfarth M, Sibbing D, Bauer I, Froehlich G, Bott-Fluegel L, Byrne R, Dirschinger J, Kastrati A, Schoemig A. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008;52:1584–8.PubMedCrossRef

10.

Cheng JM, den Uil CA, Hoeks SE, van der Ent M, Jewbali LS, van Domburg RT, Serruys PW. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. 2009;30:2101–8.CrossRef

11.

Yusuf S, Peto R, Lewis J, Collins R, Sleight P. Beta-blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985;27:335–71.PubMedCrossRef

12.

A Statement for healthcare professionals from the American Heart Association and the American College of Cardiology. AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update. Circulation. 2001;104:1577–9.

13.

Third Joint Task Force of the European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2003;24:1601–10.

14.

The Task Force on Beta-blockers of European Society of Cardiology. Expert consensus document on β-adrenergic receptor blockers. Eur Heart J. 2004;25:1341–62.CrossRef

15.

Chen ZM, Pan HC, Chen YP, Peto R, Collins R, Jiang LX, Xie JX, COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Early intravenous then oral metoprolol in 45852 patients with acute myocardial infarction: randomized placebo-controlled trial. Lancet. 2005;366:1622–32.PubMedCrossRef

16.

Park H, Otani H, Oishi C, Fujikawa M, Yamashita K, Okazaki T, Sato D, Ueyama T, Iwasaka J, Yamamoto Y, Iwasaka T. Efficacy of intracoronary administration of a short-acting β-blocker landiolol during reperfusion in pigs. Int J Cardiol. 2011;146:347–53. Epub 25 August 2009.

17.

Kloner RA, Rezkalla SH. Cardiac protection during acute myocardial infarction: where do we stand in 2004? J Am Coll Cardiol. 2004;44:276–86.PubMedCrossRef

18.

Pfisterer M, Cox JL, Granger CB, Brener SJ, Naylor CD, Califf RM, van de Werf F, Stebbins AL, Lee KL, Topol EJ, Armstrong PW. Atenolol use and clinical outcomes after thrombolysis for acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA (alteplase) for Occluded Coronary Arteries. J Am Coll Cardiol. 1998;32:634–40.PubMedCrossRef

19.

Kitamura A, Sakamoto A, Inoue T, Ogawa R. Efficacy of an ultrashort-acting beta-adrenoceptor blocker (ONO-1101) in attenuating cardiovascular responses to endotracheal intubation. Eur J Clin Pharmacol. 1997;51:467–71.PubMedCrossRef

20.

Dahlin LG, Peterzen B. Impella used for hemostasis by left ventricular unloading, in a case with left ventricular posterior wall rupture. Ann Thorac Surg. 2008;85:1445–7.PubMedCrossRef

21.

Patane F, Grassi R, Zucchetti MC, Ceresa F, Amata AD, Zingarelli E, Sansone F, Marte F, Patane S. The use of Impella Recover in the treatment of post-infarction ventricular septal defect: a new case report. Int J Cardiol. 2010;144:313–5.PubMedCrossRef

22.

Dixon SR, Henriques JP, Mauri L, Sjauw K, Civitello A, Kar B, Loyalka P, Resnic FS, Teirstein P, Makkar R, Palacios IF, Collins M, Moses J, Benali K, O’Neill WW. A prospective feasibility trial investigating the use of the Impella 2.5 system in patients undergoing high-risk percutaneous coronary intervention (The PROTECT I Trial): initial U.S. experience. JACC Cardiovasc Interv. 2009;2:91–6.

23.

Sjauw KD, Konorza T, Erbel R, Danna PL, Viecca M, Minden HH, Butter C, Engstrøm T, Hassager C, Machado FP, Pedrazzini G, Wagner DR, Schamberger R, Kerber S, Matheny DG, Schofer J, Engstroem AE, Henriques JP. Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry. J Am Coll Cardiol. 2009;54:2430–4.PubMedCrossRef

24.

Lilli A, Vecchio S, Chechi T, Vittori G, Giuliani G, Spaziani G, Consoli L, Giannotti F, Baldereschi G, Margheri M. Left ventricular support device for cardiogenic shock during myocardial infarction due to stent thrombosis: a single centre experience. Int J Cardiol. 2011;148:337–40. Epub 19 January 2010.

Title: The effect of combined treatment with Impella® and landiolol in a swine model of acute myocardial infarction
Authors: Isamu Yoshitake
Mitsumasa Hata
Akira Sezai
Satoshi Unosawa
Shinji Wakui
Haruka Kimura
Kin-ichi Nakata
Hiroaki Hata
Motomi Shiono
Publication date: 01-09-2012
Publisher: Springer Japan
Published in: Journal of Artificial Organs / Issue 3/2012
Print ISSN: 1434-7229
Electronic ISSN: 1619-0904
DOI: https://doi.org/10.1007/s10047-012-0640-x

At a glance: The STEP trials

Springer Medicine

The effect of combined treatment with Impella^® and landiolol in a swine model of acute myocardial infarction

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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