Device-based percutaneous treatments to decompress the left atrium in heart failure with preserved ejection fraction

Riccardi, Mauro; Tomasoni, Daniela; Vizzardi, Enrico; Metra, Marco; Adamo, Marianna

doi:10.1007/s10741-022-10280-4

Cited by 5 publications

(5 citation statements)

References 68 publications

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“…Interatrial shunt (IAS) devices are emerging as a novel treatment option for patients with heart failure (HF) and mildly reduced or preserved ejection fraction (HFpEF) 1–3 . Latent pulmonary vascular disease might affect the benefits of IAS devices 1 .…”

Section: Pathophysiology and Diagnosismentioning

confidence: 99%

March 2023 at a glance: pathophysiology, medical therapy and devices

Tomasoni

Adamo

Metra

2023

European J of Heart Fail

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Interatrial shunt (IAS) devices are emerging as a novel treatment option for patients with heart failure (HF) and mildly reduced or preserved ejection fraction (HFpEF). 1-3 Latent pulmonary vascular disease might affect the benefits of IAS devices. 1 Schuster et al. 4 hypothesized that non-invasive characterization of cardiac and pulmonary physiology by cardiac magnetic resonance (CMR) during exercise may help in patient selection for IAS. Overall, 75 patients with HFpEF who underwent rest and exercise stress right heart catheterization, echocardiography and CMR were included. Latent pulmonary vascular disease, defined as pulmonary vascular resistance during exercise stress ≥1.74 Wood units, was associated with impaired right ventricular (RV) functional reserve and diastolic filling with a consequent reduction in left ventricular cardiac index. Cardiac amyloidosisCardiac amyloidosis (CA) is associated with disproportionally elevated natriuretic peptide and troponin levels. 5,6 Vergaro et al. 7 investigated the diagnostic role of these biomarkers in 1149 patients with suspected CA who underwent a diagnostic work-up in three European centres (n = 343, derivation cohort; n = 806, validation cohort). N-terminal pro-B-type natriuretic peptide <180 ng/L and high-sensitivity troponin T (hs-TnT) <14 ng/L ruled out the diagnosis of CA, whereas hs-TnT ≥86 ng/L was found as a rule-in cut-off for CA.

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Section: Pathophysiology and Diagnosismentioning

confidence: 99%

March 2023 at a glance: pathophysiology, medical therapy and devices

Tomasoni

Adamo

Metra

2023

European J of Heart Fail

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“…Novel approaches to shunt creation, including a device that creates a shunt from the left atrium to the coronary sinus, are being studied. A recent review of these concepts and their outcomes is available [36 ▪▪ ].…”

Section: Devices To Treat Heart Failure With Preserved Ejection Fractionmentioning

confidence: 99%

Group 2 pulmonary hypertension: from diagnosis to treatment

Frantz

2023

Current Opinion in Pulmonary Medicine

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Purpose of review Pulmonary hypertension associated with left heart disease (PHLHD) is common and associated with adverse prognosis. Proper diagnosis is critical to avoid inappropriate treatment. Practical approaches to noninvasive diagnosis are available, though invasive hemodynamics including volume loading or exercise are often necessary for definitive diagnosis. Treatment strategies and research in the field is rapidly evolving. Recent findings Combined pre and post capillary pulmonary hypertension is associated with remodeling of the pulmonary vasculature that is proportional to the severity of the pulmonary hypertension. Even quite mild elevation of pulmonary vascular resistance (PVR), (greater than 2.0 Wood units (WU)) is associated with adverse outcome. Guideline-directed medical therapy (GDMT) for left heart failure has rapidly evolved, including approval of SGLT2 inhibitors for treatment of heart failure with preserved ejection fraction (HFpEF). However, full implementation of GDMT is lagging. Utilization of implanted pulmonary artery pressure monitoring can facilitate patient management in selected patient phenotypes and has been utilized to demonstrate improvement in pulmonary pressures with emerging therapies in HFpEF including SGLT2 inhibitors and sacubitril/valsartan. A variety of shunt devices to create a left-to-right shunt in order to decompress the left heart are available or undergoing clinical trials. There is concern that there could be adverse response to such devices in patients who have even mild elevation of pulmonary vascular resistance. Sleep disordered breathing is common in PHLHD and should be aggressively sought out and treated. Summary Even mild elevation in pulmonary vascular resistance is associated with adverse outcome. A systematic approach to diagnosis of PHLHD is essential. Guideline-directed medical therapy for PHLHD prioritizes optimal management of the left heart disease. Pulmonary artery pressure sensors are useful in selected patients.

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“…The Interatrial Shunt Device (IASD, Corvia Medical, Tewksbury, MA, USA) is a selfexpanding nitinol cage that is placed percutaneously via the femoral vein to create an 8-mm-diameter communication between the atria [59]. The initial data in the REDUCE-LAP I trial 1-year follow-up data demonstrated the safety and patency of the device at 1-year, as well as promising results in hospitalization (22% in IASD versus 63% in control, p = 0.06) [24].…”

Section: Interatrial Shunting Devicesmentioning

confidence: 99%

Structural Interventions in Heart Failure: Mending a Broken Heart

Katzianer

Albert

2023

JCM

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Advanced heart failure is often accompanied by perturbations in cardiac chamber or valve geometries which result in worsening cardiac function and hemodynamics. Once limited to surgical procedures, recent developments in minimally invasive percutaneous techniques have demonstrated efficacy in patients with both reduced and preserved ejection fraction who are at an elevated surgical risk for perioperative events. This review highlights a subset of the interventions available in clinical practice or in development for the treatment of these valvular and structural alterations.

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Device-based percutaneous treatments to decompress the left atrium in heart failure with preserved ejection fraction

Cited by 5 publications

References 68 publications

March 2023 at a glance: pathophysiology, medical therapy and devices

March 2023 at a glance: pathophysiology, medical therapy and devices

Group 2 pulmonary hypertension: from diagnosis to treatment

Structural Interventions in Heart Failure: Mending a Broken Heart

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