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Journal of Cardiovascular Translational Research

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07.05.2018 | Original Article

Mechano-chronotropic Unloading During the Acute Phase of Myocardial Infarction Markedly Reduces Infarct Size via the Suppression of Myocardial Oxygen Consumption

verfasst von: Genya Sunagawa, Keita Saku, Takahiro Arimura, Takuya Nishikawa, Hiroshi Mannoji, Kazuhiro Kamada, Kiyokazu Abe, Takuya Kishi, Hiroyuki Tsutsui, Kenji Sunagawa

Erschienen in: Journal of Cardiovascular Translational Research | Ausgabe 2/2019

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Abstract

The oxygen supply-demand imbalance is the fundamental pathophysiology of myocardial infarction (MI). Reducing myocardial oxygen consumption (MVO₂) in acute MI (AMI) reduces infarct size. Since left ventricular (LV) mechanical work and heart rate are major determinants of MVO₂, we hypothesized that the combination of LV mechanical unloading and chronotropic unloading during AMI can reduce infarct size via synergistic suppression of MVO₂. In a dog model of ischemia-reperfusion, as we predicted, the combination of mechanical unloading by Impella and bradycardic agent, ivabradine (IVA), synergistically reduced MVO₂. This was translated into the striking reduction of infarct size with Impella + IVA administered 60 min after the onset of ischemia compared to no treatment (control) and Impella groups (control 56.3 ± 6.5, Impella 39.9 ± 7.4 and Impella + IVA 23.7 ± 10.6%, p < 0.001). In conclusion, Impella + IVA during AMI reduced infarct size via marked suppression of MVO₂. The mechano-chronotropic unloading may serve as a powerful therapeutic option for AMI.

Heusch, G. (2016). Myocardial ischemia: lack of coronary blood flow or myocardial oxygen supply/demand imbalance? Circulation Research, 119, 194–196. https://doi.org/10.1161/CIRCRESAHA.116.308925.CrossRefPubMed

Rentrop, K. P., & Feit, F. (2015). Reperfusion therapy for acute myocardial infarction: concepts and controversies from inception to acceptance. American Heart Journal, 170, 971–980. https://doi.org/10.1016/j.ahj.2015.08.005.CrossRefPubMed

Roe, M. T., Messenger, J. C., Weintraub, W. S., Cannon, C. P., Fonarow, G. C., Dai, D., Chen, A. Y., Klein, L. W., Masoudi, F. A., McKay, C., Hewitt, K., Brindis, R. G., Peterson, E. D., & Rumsfeld, J. S. (2010). Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention. Journal of the American College of Cardiology, 56, 254–263. https://doi.org/10.1016/j.jacc.2010.05.008.CrossRefPubMed

Rogers WJ, Frederick PD, Stoehr E, Canto JG, Ornato JP, Gibson CM, Pollack CV Jr, Gore JM, Chandra-Strobos N, Peterson ED, French WJ (2008) Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. American Heart Journal 156: 1026–1034. doi: https://doi.org/10.1016/j.ahj.2008.07.030.

Pfeffer, M. A., & Braunwald, E. (1990). Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation, 81, 1161–1172. https://doi.org/10.1161/01.CIR.81.4.1161.CrossRef

Müller, K. D., Sass, S., Gottwik, M. G., & Schaper, W. (1982). Effect of myocardial oxygen consumption on infarct size in experimental coronary artery occlusion. Basic Research in Cardiology, 77, 170–181. https://doi.org/10.1007/BF01908170.CrossRefPubMed

Kapur, N. K., Paruchuri, V., Urbano-Morales, J. A., Mackey, E. E., Daly, G. H., Qiao, X., Pandian, N., Perides, G., & Karas, R. H. (2013). Mechanically unloading the left ventricle before coronary reperfusion reduces left ventricular wall stress and myocardial infarct size. Circulation, 128, 328–336. https://doi.org/10.1161/CIRCULATIONAHA.112.000029.CrossRefPubMed

Tamareille, S., Achour, H., Amirian, J., Felli, P., Bick, R. J., Poindexter, B., Geng, Y. J., Barry, W. H., & Smalling, R. W. (2008). Left ventricular unloading before reperfusion reduces endothelin-1 release and calcium overload in porcine myocardial infarction. The Journal of Thoracic and Cardiovascular Surgery, 136, 343–351. https://doi.org/10.1016/j.jtcvs.2008.01.021.CrossRefPubMed

Suga, H., Hisano, R., Hirata, S., Hayashi, T., Yamada, O., & Ninomiya, I. (1983). Heart rate-independent energetics and systolic pressure-volume area in dog heart. The American Journal of Physiology, 244, H206–H214. https://doi.org/10.1152/ajpheart.1983.244.2.H206.CrossRefPubMed

10.

Suga, H., Hisano, R., Goto, Y., Yamada, O., & Igarashi, Y. (1983). Effect of positive inotropic agents on the relation between oxygen consumption and systolic pressure volume area in canine left ventricle. Circulation Research, 53, 306–318. https://doi.org/10.1161/01.RES.53.3.306.CrossRefPubMed

11.

Saku, K., Kakino, T., Arimura, T., Sakamoto, T., Nishikawa, T., Sakamoto, K., Ikeda, M., Kishi, T., Ide, T., & Sunagawa, K. (2016). Total mechanical unloading minimizes metabolic demand of left ventricle and dramatically reduces infarct size in myocardial infarction. PLoS One, 11, e0152911. https://doi.org/10.1371/journal.pone.0152911. eCollection 2016.

12.

Tanaka, N., Nozawa, T., Yasumura, Y., Futaki, S., Hiramori, K., & Suga, H. (1990). Heart-rate-proportional oxygen consumption for constant cardiac work in dog heart. The Japanese Journal of Physiology, 40, 503–521. https://doi.org/10.2170/jjphysiol.40.503.CrossRefPubMed

13.

Burzotta, F., Trani, C., Doshi, S. N., Townend, J., van Geuns, R. J., Hunziker, P., Schieffer, B., Karatolios, K., Møller, J. E., Ribichini, F. L., Schäfer, A., & Henriques, J. P. (2015). Impella ventricular support in clinical practice: collaborative viewpoint from a European expert user group. International Journal of Cardiology, 201, 684–691. https://doi.org/10.1016/j.ijcard.2015.07.065.CrossRefPubMed

14.

Borer, J. S., & Le Heuzey, J. Y. (2008). Characterization of the heart rate-lowering action of ivabradine, a selective I(f) current inhibitor. American Journal of Therapeutics, 15, 461–473. https://doi.org/10.1097/MJT.0b013e3181758855.CrossRefPubMed

15.

Sakamoto, T., Kakino, T., Sakamoto, K., Tobushi, T., Tanaka, A., Saku, K., Hosokawa, K., Onitsuka, K., Murayama, Y., Tsutsumi, T., Ide, T., & Sunagawa, K. (2015). Changes in vascular properties, not ventricular properties, predominantly contribute to baroreflex regulation of arterial pressure. American Journal of Physiology. Heart and Circulatory Physiology, 308, H49–H58. https://doi.org/10.1152/ajpheart.00552.CrossRefPubMed

16.

Arimura, T., Saku, K., Kakino, T., Nishikawa, T., Tohyama, T., Sakamoto, T., Sakamoto, K., Kishi, T., Ide, T., & Sunagawa, K. (2017). Intravenous electrical vagal nerve stimulation prior to coronary reperfusion in a canine ischemia-reperfusion model markedly reduces infarct size and prevents subsequent heart failure. International Journal of Cardiology, 227, 704–710. https://doi.org/10.1016/j.ijcard.2016.10.074.CrossRefPubMed

17.

Saku K, Kakino T, Arimura T, Sunagawa G, Nishikawa T, Sakamoto T, Kishi T, Tsutsui H, Sunagawa K (2018) Total left ventricular mechanical unloading using Impella in myocardial infarction strikingly reduces infarct size, preserves left ventricular function and prevents subsequent heart failure in dogs. Circ Heart Fail. in press.

18.

Colin, P., Ghaleh, B., Monnet, X., Hittinger, L., & Berdeaux, A. (2004). Effect of graded heart rate reduction with ivabradine on myocardial oxygen consumption and diastolic time in exercising dogs. The Journal of Pharmacology and Experimental Therapeutics, 8, 236–240. https://doi.org/10.1124/jpet.103.059717.CrossRef

19.

Gardiner SM, Kemp PA, March JE, Bennett T (1995) Acute and chronic cardiac regional haemodynamic effects of the novel bradycardic agent, S16257, in conscious rats. Br j Pharmacol. 115:579–586.doi.org/10.1111/j.1476-5381.1995.tb14971.x.

20.

Achour, H., Boccalandro, F., Felli, P., Amirian, J., Uthman, M., Buja, M., & Smalling, R. W. (2005). Mechanical left ventricular unloading prior to reperfusion reduces infarct size in a canine infarction model. Catheterization and Cardiovascular Interventions, 64, 182–192. https://doi.org/10.1002/ccd.20271.CrossRefPubMed

21.

Meyns, B., Stolinski, J., Leunens, V., Verbeken, E., & Flameng, W. (2003). Left ventricular support by catheter-mounted axial flow pump reduces infarct size. Journal of the American College of Cardiology, 41, 1087–1095. https://doi.org/10.1016/S0735-1097(03)00084-6.CrossRefPubMed

22.

Engström, A. E., Sjauw, K. D., Baan, J., Remmelink, M., Claessen, B. E., Kikkert, W. J., Hoebers, L. P., Vis, M. M., Koch, K. T., Meuwissen, M. M., Tijssen, J. G., De Winter, R. J., Piek, J. J., & Henriques, J. P. (2011). Long-term safety and sustained left ventricular recovery: long-term results of percutaneous left ventricular support with Impella LP2.5 in ST-elevation myocardial infarction. EuroIntervention, 6, 860–865. https://doi.org/10.4244/EIJV6I7A147.CrossRefPubMed

23.

O'Neill, W. W., Schreiber, T., Wohns, D. H., Rihal, C., Naidu, S. S., Civitello, A. B., Dixon, S. R., Massaro, J. M., Maini, B., & Ohman, E. M. (2014). The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella Registry. Journal of Interventional Cardiology, 27, 1–11. https://doi.org/10.1111/joic.12080.CrossRefPubMed

24.

Yoshitake, I., Hata, M., Sezai, A., Unosawa, S., Wakui, S., Kimura, H., Nakata, K., Hata, H., & Shiono, M. (2012). The effect of combined treatment with Impella(®) and landiolol in a swine model of acute myocardial infarction. Journal of Artificial Organs, 15, 231–239. https://doi.org/10.1007/s10047-012-0640-x.CrossRefPubMed

25.

Kontos, M. C., Diercks, D. B., Ho, P. M., Wang, T. Y., Chen, A. Y., & Roe, M. T. (2011). Treatment and outcomes in patients with myocardial infarction treated with acute β-blocker therapy: results from the American College of Cardiology’s NCDR(®). American Heart Journal, 161, 864–870. https://doi.org/10.1016/j.ahj.2011.01.006.CrossRefPubMed

26.

Chen, Z. M., Pan, H. C., Chen, Y. P., Peto, R., Jiang LX, C. R., Xie, J. X., Liu, L. S., & COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. (2005). Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomized placebo-controlled trial. Lancet, 366, 1622–1632. https://doi.org/10.1016/S0140-6736(05)67661-1.CrossRefPubMed

27.

Calvillo, L., Vanoli, E., Andreoli, E., Besana, A., Omodeo, E., Gnecchi, M., Zerbi, P., Vago, G., Busca, G., & Schwartz, P. J. (2011). Vagal stimulation, through its nicotinic action, limits infarct size and the inflammatory response to myocardial ischemia and reperfusion. Journal of Cardiovascular Pharmacology, 58, 500–507. https://doi.org/10.1097/FJC.0b013e31822b7204.CrossRefPubMed

28.

Dae, M. W., Gao, D. W., Sessler, D. I., Chair, K., & Stillson, C. A. (2002). Effect of endovascular cooling on myocardial temperature, infarct size, and cardiac output in human-sized pigs. American Journal of Physiology. Heart and Circulatory Physiology, 282, H1584–H1591. https://doi.org/10.1152/ajpheart.00980.2001.CrossRefPubMed

29.

Erlinge, D., Götberg, M., Grines, C., Dixon, S., Baran, K., Kandzari, D., & Olivecrona, G. K. (2013). A pooled analysis of the effect of endovascular cooling on infarct size in patients with ST-elevation myocardial infarction. EuroIntervention, 8, 1435–1440. https://doi.org/10.4244/EIJV8I12A217.CrossRefPubMed

Titel: Mechano-chronotropic Unloading During the Acute Phase of Myocardial Infarction Markedly Reduces Infarct Size via the Suppression of Myocardial Oxygen Consumption
verfasst von: Genya Sunagawa
Keita Saku
Takahiro Arimura
Takuya Nishikawa
Hiroshi Mannoji
Kazuhiro Kamada
Kiyokazu Abe
Takuya Kishi
Hiroyuki Tsutsui
Kenji Sunagawa
Publikationsdatum: 07.05.2018
Verlag: Springer US
Erschienen in: Journal of Cardiovascular Translational Research / Ausgabe 2/2019
Print ISSN: 1937-5387
Elektronische ISSN: 1937-5395
DOI: https://doi.org/10.1007/s12265-018-9809-x

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