Chun-Ho Yun1, Jing-Yi Sun2, Barry Templin3, Shih-Hsuan Lin2, Kuan-Ming Chen2, Tung-Hsin Wu4, Chung-Lieh Hung5, Chun-Chieh Liu6, Hsi-Hsien Hsu7, Mohamad Amer Alaiti8, Anas Fares8, Anthony DeCicco8, Hiram G Bezerra8. 1. Department of Medicine, Mackay Medical College, and Mackay Medicine Nursing and Management College, Taipei, Taiwan; Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan. 2. Department of Biomedical Imaging and Radiologic Sciences, National Yang Ming University, Taipei, Taiwan. 3. Cardiokinetix, Menlo Park, California. 4. Department of Biomedical Imaging and Radiologic Sciences, National Yang Ming University, Taipei, Taiwan. Electronic address: tung@ym.edu.tw. 5. Department of Medicine, Mackay Medical College, and Mackay Medicine Nursing and Management College, Taipei, Taiwan; Department of Internal Medicine, Division of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan. Electronic address: jotaro3791@gmail.com. 6. Department of Internal Medicine, Division of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan. 7. Department of Medicine, Mackay Medical College, and Mackay Medicine Nursing and Management College, Taipei, Taiwan. 8. Cardiovascular Department, University Hospitals Case Medical Center, Cleveland, Ohio.
Abstract
BACKGROUND: Percutaneous ventricular restoration therapy with the use of a left ventricle (LV)-partitioning Parachute device has emerged as a clinical treatment option for LV apical aneurysm after extensive anterior myocardial infarction (AMI). We assessed changes of diastolic mechanics and functional improvements following LV Parachute device implantation by means of cardiac computerized tomography (CCT). METHODS AND RESULTS: CCT data were obtained from 28 patients before and after LV Parachute device implantation. Diastolic functional indices were determined by means of quantitative CCT assessment: 1) transmitral velocities in early (E) and late (A) diastole and ratio (E/A); 2) early diastolic mitral septal tissue velocity (Ea) and E/Ea; and 3) vortex formation time (VFT). Functional improvements were assessed with the use of New York Heart Association (NYHA) functional classification. Among the study patients, there were no significant differences in all transmitral velocities and E/A, though there was significantly increased Ea, reduced E/Ea, and greater VFT 6 months after LV Parachute device implantation. Finally, the improvement of diastolic functional indices after Parachute treatment correlated with observed clinical functional alterations (Δ E/Ea and Δ NYHA functional class:, r = 0.563; P = .002; Δ VFT and Δ NYHA functional class: r = -0.507; P = .006). CONCLUSIONS: LV Parachute device implantation therapy in heart failure caused by AMI and LV apical aneurysm formation showed improvements in several diastolic functional mechanics according to CCT-based measures.
BACKGROUND: Percutaneous ventricular restoration therapy with the use of a left ventricle (LV)-partitioning Parachute device has emerged as a clinical treatment option for LV apical aneurysm after extensive anterior myocardial infarction (AMI). We assessed changes of diastolic mechanics and functional improvements following LV Parachute device implantation by means of cardiac computerized tomography (CCT). METHODS AND RESULTS: CCT data were obtained from 28 patients before and after LV Parachute device implantation. Diastolic functional indices were determined by means of quantitative CCT assessment: 1) transmitral velocities in early (E) and late (A) diastole and ratio (E/A); 2) early diastolic mitral septal tissue velocity (Ea) and E/Ea; and 3) vortex formation time (VFT). Functional improvements were assessed with the use of New York Heart Association (NYHA) functional classification. Among the study patients, there were no significant differences in all transmitral velocities and E/A, though there was significantly increased Ea, reduced E/Ea, and greater VFT 6 months after LV Parachute device implantation. Finally, the improvement of diastolic functional indices after Parachute treatment correlated with observed clinical functional alterations (Δ E/Ea and Δ NYHA functional class:, r = 0.563; P = .002; Δ VFT and Δ NYHA functional class: r = -0.507; P = .006). CONCLUSIONS: LV Parachute device implantation therapy in heart failure caused by AMI and LV apical aneurysm formation showed improvements in several diastolic functional mechanics according to CCT-based measures.
Authors: Tom Hendriks; Remco A J Schurer; Lawien Al Ali; Ad F M van den Heuvel; Pim van der Harst Journal: Heart Fail Rev Date: 2018-11 Impact factor: 4.214