Algisyl-LVR™ with coronary artery bypass grafting reduces left ventricular wall stress and improves function in the failing human heart.
Algisyl-LVR™ with coronary artery bypass grafting reduces left ventricular wall stress and improves function in the failing human heart.
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DOI：
10.1016/j.ijcard.2013.01.003
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发表时间：
2013-10-03
影响因子：
3.5
通讯作者：
Guccione, Julius M.
中科院分区：
文献类型：
--
作者：
Lee, Lik Chuan;Wall, Samuel T.;Klepach, Doron;Ge, Liang;Zhang, Zhihong;Lee, Randall J.;Hinson, Andy;Gorman, Joseph H., III;Gorman, Robert C.;Guccione, Julius M.
关键词：
左心室（LV）壁应力降低是治疗心力衰竭的基石。大型动物模型和计算机模拟表明，向受损的LV壁添加非收缩性材料可以潜在地降低肌纤维应力。我们试图量化新型植入式水凝胶（Algisyl-LVR™）治疗与冠状动脉旁路移植术（即Algisyl-LVR™+CABG）联合对心力衰竭患者LV功能和室壁应力的影响。治疗前（n=3），并在3个月（n=3）和6个月（n=2）后获得的磁共振图像用于重建LV几何形状。心脏功能的量化使用舒张末期容积（EDV），收缩末期容积（ESV），局部壁厚度，球度指数和局部肌纤维应力使用验证的数学模型计算。治疗后左室呈椭圆形，治疗后3个月EDV和ESV均明显下降，EDV从264±91 ml降至146±86 ml，ESV从184±85 ml降至86±76 ml。在此期间，射血分数从32±8%增加到47±18%。所有患者的体积平均壁厚均增加，从1.06±0.21 cm（基线）增加至1.3±0.26 cm（3个月）。这些变化伴随着约35%的肌纤维应力下降，在结束的心脏收缩和结束。治疗后左心室肌纤维应力变得更加均匀。这些结果支持Algisyl-LVR™+CABG治疗导致肌纤维应力降低、LV几何形状恢复和功能改善的新概念。
Left ventricular (LV) wall stress reduction is a cornerstone in treating heart failure. Large animal models and computer simulations indicate that adding non-contractile material to the damaged LV wall can potentially reduce myofiber stress. We sought to quantify the effects of a novel implantable hydrogel (Algisyl-LVR™) treatment in combination with coronary artery bypass grafting (i.e. Algisyl-LVR™+CABG) on both LV function and wall stress in heart failure patients. Magnetic resonance images obtained before treatment (n=3), and at 3 months (n=3) and 6 months (n=2) afterwards were used to reconstruct the LV geometry. Cardiac function was quantified using end-diastolic volume (EDV), end-systolic volume (ESV), regional wall thickness, sphericity index and regional myofiber stress computed using validated mathematical modeling. The LV became more ellipsoidal after treatment, and both EDV and ESV decreased substantially 3 months after treatment in all patients; EDV decreased from 264±91 ml to 146±86 ml and ESV decreased from 184±85 ml to 86±76 ml. Ejection fraction increased from 32±8% to 47±18% during that period. Volumetric-averaged wall thickness increased in all patients, from 1.06±0.21 cm (baseline) to 1.3±0.26 cm (3 months). These changes were accompanied by about a 35% decrease in myofiber stress at end-of-diastole and at end-of-systole. Post-treatment myofiber stress became more uniform in the LV. These results support the novel concept that Algisyl-LVR™+CABG treatment leads to decreased myofiber stress, restored LV geometry and improved function.
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DOI：
10.1056/nejmoa0900559
发表时间：
2009-04-23
期刊：
The New England journal of medicine
影响因子：
--
作者：
Jones RH;Velazquez EJ;Michler RE;Sopko G;Oh JK;O'Connor CM;Hill JA;Menicanti L;Sadowski Z;Desvigne-Nickens P;Rouleau JL;Lee KL;STICH Hypothesis 2 Investigators
通讯作者：
STICH Hypothesis 2 Investigators
影响因子：
24
作者：
Carlucclo, E;Biagioli, P;Ambrosio, G
通讯作者：
Ambrosio, G
影响因子：
4.6
作者：
Guccione, JM;Salahieh, A;Ratcliffe, MB
通讯作者：
Ratcliffe, MB
影响因子：
3.3
作者：
Lee, Randall J.;Hinson, Andy;Sabbah, Hani N.
通讯作者：
Sabbah, Hani N.
影响因子：
4.6
作者：
Mann, Douglas L.;Acker, Michael A.;Kubo, Spencer H.
通讯作者：
Kubo, Spencer H.