Welcome to this special supplement of Interventional Cardiology Review. This supplement is devoted to the proceedings of the first annual Acute Cardiac Unloading and REcovery (A-CURE) symposium, which was held on 26 August 2016 in Rome, Italy. This 1-day meeting brought together experts from a number of disciplines – including Interventional Cardiology Review. This supplement is devoted to the interventional cardiologists, heart failure specialists, cardiac surgeons, molecular biologists and biomedical engineers – to discuss the science behind and clinical application of acute cardiac unloading. Over 100 physicians, clinical and preclinical researchers, basic researchers, medical students, post-doctoral scientists and graduate students from 21 different countries were in attendance.
The growing global heart failure patient population poses clinical, economic and social challenges and there is no clear line of sight to a sustainable solution. The goal of the A-CURE meeting was to share cutting-edge, cross-discipline basic and clinical research, looking at acute cardiac unloading as a therapeutic platform for the prevention of heart failure and the development of therapies aimed at heart muscle recovery. One of the focuses of this meeting was on advancing the paradigm shift currently underway in the management of myocardial ischaemia–reperfusion injuries. Although early coronary intervention has reduced the acute mortality in myocardial infarction (MI), the late development of heart failure is increasing at an alarming rate. For the first time, acute cardiac unloading within the clinic has been made technically feasible by the development of percutaneously inserted ventricular assist devices (VADs) such as the Impella® (Abiomed) and the TandemHeart® (CardiacAssist Inc). These devices mechanically unload the heart and reduce myocardial oxygen consumption. Clinical and preclinical investigations from independent laboratories over the past decade have routinely demonstrated that acute unloading has beneficial impacts when treating acute MI and other aetiologies of acute heart failure. For the first time, the A-CURE symposium brought together leading researchers in the field of acute unloading to present their current work and generate open scientific discussions in a public forum.
This supplement features a number of presentations describing the basic science underlying acute unloading of the heart, its clinical applications, and the opportunities in and challenges of performing clinical trials. The morning’s presentations were largely devoted to preclinical studies and the basic science underlying mechanical unloading. The meeting began with an overview from Eugene Braunwald, one of the most renowned figures in the field of cardiology. Daniel Burkhoff presented the basic science behind acute ventricular and myocardial unloading. Next, Kenji Sunagawa described vagal nerve stimulation, another approach to myocardial protection that has been combined successfully with mechanical unloading in animal models. Navin Kapur explored further the concept of mechanical unloading, discussing the mechanism of cardioprotection at the cellular level. In addition, Dr Kapur described a number of fascinating studies demonstrating that initially reducing left ventricular work and delaying coronary reperfusion may limit myocardial injury in acute MI. A member of Dr Kapur’s research team, Michele Esposito, was the winner of the Young Investigator Scholarship presented by the A-CURE Working Group. Dr Esposito described her study demonstrating that primary unloading causes a change in gene expression within the infarct zone that initiates a number of cardioprotective processes during acute MI. To close the morning session, Patrick Hunziker shared insights from his considerable experience of implanting Impella VADs.
The afternoon’s presentations had a stronger focus on clinical and practical studies. The keynote speaker, Joseph Hill, discussed the global health and economic burden of heart failure, as well as describing the factors affecting myocardial plasticity. Mark Anderson presented a surgeon’s perspective on cardiac unloading and myocardial recovery. William O’Neill presented data from the catheter-based VAD Registry™, a global observational clinical registry designed to monitor patient safety and real-world outcomes of patients supported with the Impella device. James Udelson discussed the practical difficulties of designing clinical trials to test the efficacy and safety of left VADs in a patient population where event rates are low. Michael Cohen discussed the benefits of post-conditioning at the time of reperfusion in acute MI. Ryan Tedford described the use of mechanical support for right-sided and biventricular failure. Finally, Derek Hausenloy identified other opportunities, in addition to unloading, for reducing infarct size following MI. Dr Kapur closed the meeting by acknowledging that the day had been ground-breaking in involving such a diversity of expertise from multiple disciplines.
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 continuing support and guidance. We hope that you find this supplement informative and interesting.