Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

Rosalia, Luca; Ozturk, Caglar; Shoar, Saeed; Fan, Yiling; Malone, Grainne; Cheema, Faisal H.; Conway, Claire; Byrne, Robert A.; Duffy, Garry P.; Malone, Andrew; Roche, Ellen T.; Hameed, Aamir

doi:10.1016/j.jacbts.2021.06.002

Cited by 26 publications

(30 citation statements)

References 148 publications

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“…A new MCL was presented for the purpose of early testing and validation of novel technologies for the treatment of HFpEF that interact only with the left side of the heart, such as circulatory support devices providing cannulation between the left atrium and left ventricle. Examples of devices which could be tested in this way are the mechanical circulatory support devices outlined by Rosalia et al (1). Two models of the MCL were developed and assessed for their abilities to simulate HFpEF.…”

Section: Discussionmentioning

confidence: 99%

“…Heart Failure with Preserved Ejection Fraction (HFpEF) is one of two main phenotypes of Heart Failure (HF), the other being Heart Failure with Reduced Ejection Fraction (HFrEF). They are characterized by Left Ventricular ejection fraction (LVEF) ≥ 50% and LVEF ≤ 40%, respectively (1). HFpEF makes up approximately 50% of the HF population (2), a number that is expected to rise in the coming decades due to a combination of rising life expectancy, increased prevalence of metabolic disorders associated with this disease, and a lack of adequate therapies (2)(3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

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In vitro benchtop mock circulatory loop for heart failure with preserved ejection fraction emulation

Malone

Gallagher

Saidi

et al. 2022

Front. Cardiovasc. Med.

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In this work, a novel mock circulatory loop (MCL) is presented that is capable of simulating both healthy cardiac function and Heart Failure with preserved Ejection Fraction (HFpEF). This MCL differs from others presented in the literature as it features two independently actuated heart chambers, representing the left atrium and the left ventricle. This is an important improvement over other designs as it allows for potential HFpEF treatments to be examined, not just in relation to their effect on the left ventricle but also on the left atrium. The aim of this work was to show that novel MCL designs could be developed to allow for testing of new mechanical circulatory support devices for the treatment of HFpEF. Two loop configurations are presented, one featuring hard PVC cylindrical chambers and one that features soft silicone chambers which are anatomically analogous to the native heart. We show that both MCLs are capable of simulating the onset of HFpEF with a sustained increase in diastolic pressure of 62.03% and a sustained decrease in end diastolic volume (EDV) of 14.24%.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

In vitro benchtop mock circulatory loop for heart failure with preserved ejection fraction emulation

Malone

Gallagher

Saidi

et al. 2022

Front. Cardiovasc. Med.

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“…The lack of effective medical therapies has sparked an interest in developing device-based therapies for HFpEF. These devices can be classified into: devices that decompress the left atrium – such as inter-atrial shunt device (IASD) and left atrial assist device (LAAD), devices that improve the left ventricle compliance such as left ventricle expander, devices that synchronize atrial contractions such as left atrial permanent pacing, and neuromodulators that activate baroreceptors in the wall of the carotid artery to restore autonomic balance (Table 1) [31,32 ▪ ].…”

Section: Novel Device-based Therapy For Managing Hypertension In Hear...mentioning

confidence: 99%

New concepts in heart failure with preserved ejection fraction and hypertension

Joury

Gupta

Krim

2022

Current Opinion in Cardiology

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Purpose of reviewHypertension (HTN) remains the most common and strongest contributing factor to the development of heart failure with preserved ejection fraction (HFpEF). In this review, we aim to summarize the pathophysiological processes linking HTN to HFpEF and highlight novel concepts in medical and device-based management of HFpEF and HTN.Recent findingsDespite the global increase in the prevalence of HFpEF, there has been limited benefit in current medication and device-based therapy for this complex syndrome. The hallmark of HFpEF is an elevated left intra-atrial and ventricular pressure and exertional dyspnea. Traditional medications used for treating HTN in patients with reduced left ventricular ejection fraction have unclear benefits in patients with HFpEF. Careful analysis of emerging medications such as angiotensin receptor–neprilysin inhibitor and sodium–glucose co-transporter-2 inhibitors showed benefit in reducing not only blood pressure but also hospitalizations in patients with HFpEF. Current data on device-based therapy aims to reduce left intra-atrial pressure, ventricular pressure and stimulate baroreceptors to lower blood pressure; however, needs further investigation.SummaryThe nexus of HTN and HFpEF remains strong and complex. Although traditional medications for treating HFrEF did not affect long-term outcomes, novel therapies with angiotensin receptor neprilysin-inhibitor and sodium-glucose co-transporter-2 inhibitor offer promising results. Many device-based interventions in the HFpEF population are being developed with the aim to reduce left intra-atrial and ventricular pressure; however, their role in HFpEF hypertensive patients needs to be further investigated.

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“…These events arise from providing continuous-flow support to restrictive or hypertrophic cardiac anatomies, such as those associated with HFpEF ( Topilsky et al, 2011 ; Wynne et al, 2011 ; Muthiah et al, 2013 ). To overcome these complications, a variety of other devices, including atrial shunts, LV expanders, electrical stimulators, and mechanical circulatory support (MCS) devices, are currently under development specifically for HFpEF ( Rosalia et al, 2021b ). While these technologies are at various stages of development, none have received FDA approval.…”

Section: Introductionmentioning

confidence: 99%

A Multi-Domain Simulation Study of a Pulsatile-Flow Pump Device for Heart Failure With Preserved Ejection Fraction

2022

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Mechanical circulatory support (MCS) devices are currently under development to improve the physiology and hemodynamics of patients with heart failure with preserved ejection fraction (HFpEF). Most of these devices, however, are designed to provide continuous-flow support. While it has been shown that pulsatile support may overcome some of the complications hindering the clinical translation of these devices for other heart failure phenotypes, the effects that it may have on the HFpEF physiology are still unknown. Here, we present a multi-domain simulation study of a pulsatile pump device with left atrial cannulation for HFpEF that aims to alleviate left atrial pressure, commonly elevated in HFpEF. We leverage lumped-parameter modeling to optimize the design of the pulsatile pump, computational fluid dynamic simulations to characterize hydraulic and hemolytic performance, and finite element modeling on the Living Heart Model to evaluate effects on arterial, left atrial, and left ventricular hemodynamics and biomechanics. The findings reported in this study suggest that pulsatile-flow support can successfully reduce pressures and associated wall stresses in the left heart, while yielding more physiologic arterial hemodynamics compared to continuous-flow support. This work therefore supports further development and evaluation of pulsatile support MCS devices for HFpEF.

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Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

Cited by 26 publications

References 148 publications

In vitro benchtop mock circulatory loop for heart failure with preserved ejection fraction emulation

In vitro benchtop mock circulatory loop for heart failure with preserved ejection fraction emulation

New concepts in heart failure with preserved ejection fraction and hypertension

A Multi-Domain Simulation Study of a Pulsatile-Flow Pump Device for Heart Failure With Preserved Ejection Fraction

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