Welcome to this special supplement of Interventional Cardiology Review. This supplement is devoted to the proceedings of the second annual Acute Cardiac Unloading and REcovery (A-CURE) Working Group meeting, which was held on 25 August 2017 in Barcelona, Spain. The A-CURE Working Group is comprised of leading academic experts in clinical and basic cardiac research and is dedicated to advancing the science and clinical application of acute cardiac unloading. This meeting also brought together experts from multiple disciplines, including interventional cardiologists, heart failure specialists, cardiac surgeons, molecular biologists and biomedical engineers.
Cardiac traumas such as myocardial infarction (MI), myocarditis, cardiomyopathy and cardiogenic shock impair the ability of the heart to pump blood, resulting in end organ failure and, ultimately, death. Most therapeutic approaches to these traumas aim to maintain cardiac output but, in the process, impose further stress on the heart. This meeting focused on the use of new technologies in the treatment of these traumas. Acute cardiac unloading decreases myocardial oxygen consumption and maximises the ability of the heart to rest and recover after damage. Mechanical unloading employs percutaneously inserted ventricular assist devices such as the FDA-approved and CE-marked Impella family of devices, the Tandem Heart and the Investigational HeartMate PHP.
This supplement features a number of presentations covering a broad range of subjects related to cardiac unloading. The first sessions were devoted to the basic science underlying the concept of mechanical unloading. The meeting began with a presentation by Daniel Burkhoff describing the basic science behind acute ventricular and myocardial unloading. This was followed by Navin Kapur, who provided some insights into the molecular basis of mechanical unloading, describing the mechanism of cardioprotection at the cellular level. Gene therapy is receiving considerable current interest as a therapeutic strategy in heart failure (HF). Roger Hajjar presented data in support of his hypothesis that acute mechanical unloading using the Impella may improving gene delivery by enhancing viral uptake. Jacob Møller closed the first session by comparing the differential haemodynamic responses of Impella and extracorporeal membrane oxygenation (ECMO) support in a new large animal model of cardiogenic shock.
In the second session, which discussed progress towards a clinical mandate for cardiac unloading, Carsten Tschöpe examined the role of acute mechanical unloading as a bridge to recovery in patients with fulminant myocarditis. Babar Basir described the Detroit Cardiogenic Shock Initiative, which has produced a protocol for the treatment of cardiogenic shock. Finally, Perwaiz Meraj presented details of the first prospective feasibility study to evaluate the use of the Impella CP pump for unloading of the left ventricle prior to primary percutaneous coronary intervention in patients presenting with acute ST-segment elevation MI. The morning ended with three talks from featured abstracts: Carlos Del Rio presented data from his investigation into how mechanical support may affect the mechano-energetic relationship in the heart, Silvia Burchielli described a study that showed that cardiorespiratory support in a swine model of acute MI was able to drastically reduce mortality and provide an effective bridge to reperfusion, and Kiyotake Ishikawa discussed his innovative research demonstrating that left ventricle support using Impella reduces left atrial stretch and inhibits atrial arrhythmias through reduced oxidative stress.
The afternoon’s presentations had a stronger focus on the clinical applications of ventricular unloading. The keynote speaker, Valentin Fuster, discussed the evolution of cardiovascular disease therapy, including identifying risk at early stages of life, treating subclinical disease and the challenges of treating older patients. Elazar Edelman discussed the use of hysteresis loops generated by support devices to track cardiac function. Mark Anderson described the clinical applications of the Impella RP, which is designed for right heart support. Ralf Westenfeld discussed the role of Impella support in facilitating pulmonary decongestion in cardiogenic shock. This session ended with Dirk Westermann discussing the use of the combination of ECMO and Impella support in cardiogenic shock.
The meeting concluded with two talks from selected abstracts. Kapil Lotun presented a study investigating mechanical circulatory support during cardiac arrest. In addition, Daniel Scheiber, the Young Investigator Scholarship awardee, described his research demonstrating that mitochondrial reactive oxygen species production is reduced in the left ventricle of mechanically unloaded hearts.
The presentations highlighted some exciting new developments and represent the substantial advances in the field of acute myocardial unloading and recovery in the last year. The A-CURE Working Group meeting is unique in involving a diverse group of experts from multiple disciplines within a unique setting.
Interventional Cardiology Review would like to thank all expert reviewers who contributed towards this edition. A special thanks goes to our Editorial Board for their continued support and guidance. We hope that you find this supplement informative and interesting.