Publications by authors named "Shiva Annamalai"
Article Synopsis
- In-hospital mortality rates for patients experiencing cardiogenic shock remain high, even with advanced support devices like VA-ECMO and Impella.
- A study analyzed blood samples from 11 patients before and after device implantation, focusing on changes in the plasma proteome using SOMAscan technology.
- The findings indicated that both ECMO and Impella lead to reduced inflammatory markers and increased cell death among inflammatory cells, suggesting that these proteins could be potential targets for new treatments or biomarkers in managing acute myocardial circulatory support (AMCS).
Article Synopsis
- - The study investigates the relationship between low left ventricular stroke volume index (LVSVI) 30 days after transcatheter aortic valve replacement (TAVR) and survival rates, hypothesizing that steady-state LVSVI is linked to 1-year mortality.
- - Analyzing data from 238 TAVR patients, the results show that patients with normalized LVSVI post-TAVR had significantly lower 1-year mortality rates compared to those with low flow, indicating LVSVI as a potential marker for patient outcomes.
- - The findings suggest that LVSVI at 30 days post-TAVR can predict 1-year mortality and highlight the need for further research to explore its potential as a
Article Synopsis
- - New research reveals that acute myocardial infarction (AMI) heightens inflammation and MMP-9 activity in the kidney, underscoring a need for better understanding of this response.
- - A study involving swine showed that using Impella support before heart reperfusion decreased MMP-9 levels and reduced kidney damage compared to ischemia-reperfusion or VA-ECMO methods.
- - Impella support not only lessened heart injury but also mitigated harmful kidney signaling pathways, suggesting it may offer protective benefits during cardiac events like AMI.
Article Synopsis
- * IVC occlusion decreased left ventricular pressures, volumes, cardiac output, and mean arterial pressure, while SVC occlusion mainly reduced left ventricular diastolic pressure and volumes without impacting cardiac output.
- * The preCARDIA system, a new technology for SVC occlusion, showed promise in achieving stable cardiac function while reducing filling pressures, and will be further evaluated in the upcoming VENUS-HF trial.
Article Synopsis
- Researchers studied the effects of left ventricular (LV) unloading before reperfusion on infarct size during acute myocardial infarction in swine models, finding that it might enhance blood flow to the heart.
- They compared two support methods: Impella CP and venoarterial extracorporeal membrane oxygenation (VA-ECMO) after prolonged heart artery blockage, discovering that Impella significantly reduced heart damage compared to continued blockage, whereas VA-ECMO did not.
- The study concluded that LV unloading with Impella increased collateral blood flow while reducing heart workload and infarct size, suggesting a potential therapeutic strategy for heart attacks.
Article Synopsis
- Acutely decompensated heart failure can cause serious health issues due to fluid overload affecting the heart and kidneys; the study aimed to see if temporarily blocking the superior vena cava (SVC) could help.* -
- In a trial with eight patients suffering from systolic heart failure, temporarily occluding the SVC successfully lowered heart filling pressures without negatively impacting blood pressure or cardiac output.* -
- The initial results showed that SVC occlusion was safe and well-tolerated, paving the way for further research to explore its potential as a treatment for acute heart failure.*
Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality. Pioneering preclinical work reported by Peter Maroko and Eugene Braunwald in 1971 identified oxygen supply and demand are primary determinants of myocardial infarct size in the setting of a heart attack. Since the 1950s, advances in mechanical engineering led to the development of short-term circulatory support devices that range from pulsatile to continuous flow pumps.
View Article and Find Full Text PDFArticle Synopsis
- * Researchers have investigated whether using mechanical support pumps to lower the heart's oxygen demand can decrease heart damage in AMI since the 1970s.
- * Recent studies, including the Door to Unload ST-segment Elevation Myocardial Infarction (DTU-STEMI) pilot trial, have focused on modern circulatory support pumps to explore this approach further.
Background: Acute heart failure refractory to medical therapy is a major cause of morbidity and mortality. The Aortix device (Procyrion Inc) is a percutaneously delivered entrainment pump positioned in the descending aorta.
Methods And Results: Using the newest generation Aortix device in 8 adult male Yorkshire swine, we tested the hypothesis that positioning in the abdominal aorta may provide superior hemodynamic effects than thoracic positioning in a swine model of postinfarct left ventricular injury.
Article Synopsis
- Myocarditis with cardiogenic shock poses treatment challenges, but the use of Impella devices for mechanical support is becoming more common.
- A study analyzed data from 34 patients across 21 sites, revealing that 62% of those receiving Impella support during myocarditis survived their hospital stay with improved heart function.
- This research suggests that Impella devices are a safe and effective option for managing patients suffering from myocarditis complicated by cardiogenic shock.
Hemolysis is a potential limitation of percutaneously delivered left-sided mechanical circulatory support pumps, including trans valvular micro-axial flow pumps (TVP). Hemolytic biomarkers among durable left ventricular assist devices include lactate dehydrogenase (LDH) >2.5 times the upper limit of normal (ULN) and plasma-free hemoglobin (pf-Hb) >20 mg/dL.
View Article and Find Full Text PDFMyocardial injury induces significant changes in ventricular structure and function at both the cellular and anatomic level, leading to ventricular remodeling and subsequent heart failure. Unloading left ventricular pressure has been studied in both the short-term and long-term settings, as a means of preventing or reversing cardiac remodeling. In acute myocardial infarction, cardiac unloading is used to reduce oxygen demand and limit infarct size.
View Article and Find Full Text PDFArticle Synopsis
- Heart failure following acute myocardial infarction (AMI) significantly impacts patient health, and research indicates that reducing left ventricular (LV) work before restoring blood flow (primary unloading) could minimize heart damage.
- This study in male swine showed that 30 minutes of LV unloading before reperfusion effectively reduced infarct size and improved heart function long-term, compared to immediate reperfusion.
- Mechanistic findings revealed that unloading enhances cellular respiration and protects against heart tissue damage by increasing levels of a cardioprotective protein (SDF-1α), ultimately leading to less scar tissue and better cardiac performance after 28 days.
Contrast induced nephropathy after coronary or vascular intervention: More biomarkers than answers.
Catheter Cardiovasc Interv
June 2018
Rising urine NGAL and serum creatinine after 48 hr are potentially useful in predicting persistent creatinine increase in patients with contrast-induced AKI. Urinary NGAL may allow for early identification of a high-risk cohort following PCI. Future studies are needed to determine whether renal biomarkers are affected by clinical variables, such as heart failure acute mechanical circulatory support (AMCS) and whether they can be used to identify patients who would benefit from either AMCS reno-protection during PCI remains unknown.
View Article and Find Full Text PDFBackground: Prognosis is poor for patients with decompensated advanced heart failure (HF) refractory to medical therapy. Evaluating candidacy for durable mechanical circulatory support (MCS), cardiac transplantation, or palliative care is complex, and time is often needed to stabilize the patient hemodynamically. The Impella 5.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the effectiveness of intra-aortic balloon counterpulsation pumps (IABPs) in improving hemodynamic status in patients with advanced heart failure (HF) before LVAD surgery.
- It compares 10 patients with advanced HF receiving IABP therapy to 5 control patients with preserved left ventricular function, examining changes in various cardiac metrics.
- Results show that IABP therapy significantly increased cardiac index and improved the myocardial oxygen supply:demand ratio while reducing left ventricular stroke work, particularly benefiting those classified as CI-responders.