First-in-Human Experience of Mechanical Preload Control in Patients With HFpEF During Exercise

Kaiser, Daniel W.; Platzer, DO Patrick; Miyashiro, Katie; Canfield, BS James; Patel, BA Rupal; Liu, Dandan; Goar, Frederick St.; Kaiser, Clayton A.

doi:10.1016/j.jacbts.2020.12.007

Cited by 4 publications

(2 citation statements)

References 28 publications

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“… 12 , 13 , 14 , 15 Similarly, in patients with HF and preserved ejection fraction, a transient, titrated partial occlusion of the IVC through balloon inflation during exercise resulted in approximately 25% reduction in pulmonary artery pressure (without deterioration of cardiac output) and improvement in metrics of exercise tolerance. 16 , 17 , 17 …”

Section: Discussionmentioning

confidence: 99%

Safety, Feasibility of Controllable Decrease of Vena Cava Pressure by Doraya Catheter in Heart Failure

Zymliński¹,

Biegus²,

Vanderheyden³

et al. 2023

JACC: Basic to Translational Science

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Section: Discussionmentioning

confidence: 99%

Safety, Feasibility of Controllable Decrease of Vena Cava Pressure by Doraya Catheter in Heart Failure

Zymliński¹,

Biegus²,

Vanderheyden³

et al. 2023

JACC: Basic to Translational Science

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“…The rate of venous return to the heart can be reduced mechanically through partial or complete occlusion of the superior vena cava or the inferior vena cava. Kaiser et al 39 were the first to conduct a proof-of-concept study to provide initial safety and feasibility of modulating preload through this method in HFpEF patients during exercise. Balloon inflation in the inferior vena cava was performed during exercise in 6 HFpEF patients to reduce and maintain PAPs.…”

Section: Emerging Nonpharmacological Preload Reduction Therapiesmentioning

confidence: 99%

Targeting Preload in Heart Failure: Splanchnic Nerve Blockade and Beyond

Fudim

Khan

Paracha

et al. 2022

Circ: Heart Failure

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Preload augmentation represents a critical mechanism for the cardiovascular system to increase effective circulating blood volume to increase cardiac filling pressures and, subsequently, for the heart to increase cardiac output. The splanchnic vascular compartment is the primary source of vascular capacity and thus the primary target for preload recruitment in humans. Under normal conditions, sympathetic stimulation of these primary venous vessels promotes the shift of blood from the splanchnic to the thoracic compartment and elevates preload and cardiac output. However, in heart failure, since filling pressures may be elevated at rest due to decreased venous capacitance, incremental recruitment of preload to enhance cardiac output may exacerbate congestion and limit exercise capacity. Accordingly, recent attention has focused on therapies designed to regulate splanchnic vascular redistribution to improve cardiac filling pressures and patient-centered outcomes such as quality of life and exercise capacity in patients with heart failure. In this review, we discuss the relevance of splanchnic circulation as a venous reservoir, the contribution of stressed blood volume to heart failure pathogenesis, and the implications for pharmacological therapeutic interventions to prevent heart failure decompensation. Further, we review emerging device-based approaches for cardiac preload reduction such as partial/complete occlusion of the superior vena cava or the inferior vena cava.

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