Resources

7th Annual A-CURE Symposium Summary

The 7th Annual A-CURE Symposium took place on November 4, 2022, in Chicago, IL.

An Analysis of Extracellular Matrix Proteins Involved in the Loaded and Unloaded Heart after Myocardial Infarction

Spyros Mavropoulos, MD, PhD (Mt Sinai) presents an abstract called An Analysis of Extracellular Matrix Proteins Involved in the Loaded and Unloaded Heart after Myocardial Infarction at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

CMR-derived Infarct Size on LV Remodeling: the Roll-in DTU Experience

William O'Neill, MD (Henry Ford Hospital) presents Impact of CMR-derived Infarct Size on LV Remodeling: the Roll-in DTU Experience at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

Unload-ECMO Randomized Controlled Trial for LV Unloading with VA-ECMO in Severe Cardiogenic Shock

Benedikt Schrage, MD from UKE Hamburg presents Unload-ECMO Randomized Controlled Trial for LV Unloading with VA-ECMO in Severe Cardiogenic Shock at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

Delaying Reperfusion for Thirty Minutes in the Presence of Active LV Unloading Reduces Infarct Size in Anterior STEMI: A Per Protocol Analysis of the STEMI Door to Unload (DTU) Pilot Study

Navin Kapur, MD (Tufts Medical Center) presents Delaying Reperfusion for Thirty Minutes in the Presence of Active LV Unloading Reduces Infarct Size in Anterior STEMI: A Per Protocol Analysis of the STEMI Door to Unload (DTU) Pilot Study at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

Automatic LV Unloading using a Percutaneous Transvalvular Microaxial Flow Pump during VA-ECMO Support

Benedikt Schrage, MD (UKE Hamburg) presents an abstract by Paul Haller, MD (UKE Hamburg) called Automatic LV Unloading using a Percutaneous Transvalvular Microaxial Flow Pump during VA-ECMO Support at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

CERAMICS: Best Practices for MCS Escalation and Management in AMI-CS

Mir Babar Basir, DO (Henry Ford Hospital) presents CERAMICS: Best Practices for MCS Escalation and Management in AMI-CS at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

Young Investigator Award: Trans-Valvular Unloading Reduces Anaerobic Glycolysis before Reperfusion and Preserves Energy Substrate Utilization after Reperfusion in Models of Acute Myocardial Infarction

Lija Swain, PhD (Tufts Medical Center) won the Young Investigator Award for the topic, Trans-Valvular Unloading Reduces Anaerobic Glycolysis before Reperfusion and Preserves Energy Substrate Utilization after Reperfusion in Models of Acute Myocardial Infarction at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

Best in Research Award: Mechanical LV Unloading Increases Coronary Flow by Prolonging Diastolic Phase

Tomoki Sakata, MD, PhD (Mt. Sinai) won the Best in Research Award for the topic, Mechanical LV Unloading Increases Coronary Flow by Prolonging Diastolic Phase at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

Left Ventricular Unloading Acutely Reduces Right Ventricular Preload in Patients with Acute Decompensated Heart Failure and Cardiogenic Shock

Kay Everett, MD, PhD (Tufts Medical Center) presents Left Ventricular Unloading Acutely Reduces Right Ventricular Preload in Patients with Acute Decompensated Heart Failure and Cardiogenic Shock at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

Panel Discussion: Non Cardiac Surgery Interventions on Patients Receiving Impella® Support

Panelists:
Nicolas Brozzi, MD (Cleveland Clinic Florida)
Raul Rosenthal, MD (Cleveland Clinic Florida)
Jaime Hernandez-Montfort, MD (Baylor Scott & White Health)
Ramachandra Reddy, MD (Baylor Scott & White Health)
Modesto J. Colón, MD (Banner Univ. Medical Center)
Radha S. Gopalan, MD (Banner Univ. Medical Center)

Cardiac Energetics and Systemic Perfusion with Veno-arterial ECMO versus Ecmella for Cardiogenic Shock in a Large Animal Model

Ann Banke, MD, PhD from Odense Univ. Hospital presents an abstract from Peter Frederiksen, MD, called Cardiac Energetics and Systemic Perfusion with Veno-arterial ECMO versus Ecmella for Cardiogenic Shock in a Large Animal Model at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

The Role of RV Reserve Assessment and LV Unloading to Predict Right Heart Failure after LVAD Implantation

Ryan Tedford, MD (Medical College of South Carolina) presents The Role of RV Reserve Assessment and LV Unloading to Predict Right Heart Failure after LVAD Implantation at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

Cardiac State Optimization to Promote Recovery during Extracorporeal Circulatory Support

Steve Keller, MD, PhD, MPhil (Johns Hopkins University) presents Cardiac State Optimization to Promote Recovery during Extracorporeal Circulatory Support at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

Reverse Remodeling in an Ovine Model of Ischemic Cardiomyopathy

Bart Meyns, PhD (KU Leuven) presents Reverse Remodeling in an Ovine Model of Ischemic Cardiomyopathy at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

Keynote Lecture | Decompensated Heart Failure, Taking the Acute out of Compensation

Biykem Bozkurt, MD, PhD (Editor-in-Chief, JACC: HF; Baylor College OF Medicine) presents the keynote lecture, Decompensated Heart Failure, Taking the Acute out of Compensation, at the 7th Annual A-CURE Symposium on November 4, 2022, in Chicago, IL.

Dr. Douglass Mann, Washington University School of Medicine in St. Louis

Dr. Mann’s keynote address at the 2019 A-CURE Symposium on myocardial recovery and reverse remodeling.

Dr. L. Christian Napp, Hannover Medical School

Dr. Napp speaking on how Impella-mediated ventricular unloading can be used to successfully bridge patients with Takotsubo Syndrome to recovery.

Dr. Jason Williams, Ocean Springs Hospital

Dr. Williams discussing the use of Impella 5.0 support to optimize patient outcomes in high-risk cardiac surgery.

Dr. Jaime Hernandez-Montfort, UTMB Health

Dr. Hernandez-Monfort disucssing the longitudinal impact of temporary mechanical circulatory support on durable ventricular assist device outcomes.

Dr. Bart Meyns, KU Leuven

Dr. Meyns speaking on the use of Impella support to vent VA-ECMO patients suffering from cardiogenic shock.

Jane Wilcox, MD | Northwestern University

Patient Identification and Fundamentals of Heart Recovery vs. Remission – Presented at A-CURE 2022.

Dr. Navin Kapur, Tufts Medical Center

Dr. Navin Kapur speaks on the relationship between acute cardiac unloading and renal function during myocardial ischemia.

Dr. Bernhard Schieffer, University Hospital Giessen and Marburg

Dr. Schieffer speaking on how Impella support during cardiogenic shock decreases renal resistive index after myocardial infarction and prevents acute kidney injury.

Lija Swain, PhD | Tufts Medical Center

Trans-Valvular Unloading Protects Against Myocardial Damage Before and After Reperfusion in Preclinical Models of Acute Myocardial Infarction – Presented at A-CURE 2022.

Tomoki Sakata, MD | Mt. Sinai

Impaired Diastolic Function Predicts Improved Ischemic Myocardial Flow Improvement with Mechanical LV Unloading – Presented at A-CURE 2022.

Dr. Carsten Tschöpe, Charite, CVK

Dr. Tschöpe discusses the use of prolonged Impella support to successfully bridge patients thru cardiogenic shock resulting from myocarditis.

Div Verma, MD | Yavapai Regional Medical Center

Impella®-Supported MitraClip in Cardiogenic Shock Patients Complicated with MR3+/4+ – Presented at A-CURE 2022.

David Joyce, MD | Medical College of Wisconsin

Mechanical Circulatory Support in Off-Pump CABG – Presented at A-CURE 2022.

Dr. Alexander Bernhardt, University Hospital Hamburg-Eppendorf

Dr. Bernhardt discussing long-term support with the surgically implanted Impella 5.0 and Impella 5.5 devices.

Enrico Romagnoli, MD | Gemelli University Hospital

Wall Motion Score Index (WMSI) in Revascularization and Ventricular Recovery – Presented at A-CURE 2022.

Dr. Bill O’Neill, Henry Ford Hospital

Dr. O’Neill speaking on the improved survival of AMI cardiogenic shock patients in the National Cardiogenic Shock Initiative resulting from the early deployment of Impella support prior to reperfusion.

Peter Frederiksen, MD | University of Southern Denmark

LV Strain under Impella RP Support in a Swine Model of Cardiogenic Shock – Presented at A-CURE 2022.

Sebastian Billig, MD | University Hospital Aachen

Promising First Results of a New Developed Percutaneous Left Ventricular Assist Device in a Large Animal Model of Cardiac Arrest – Presented at A-CURE 2022.

Opening Lecture: Dan Burkhoff, MD | Columbia University

Annual Update: The State of the Field in Cardiac Unloading – Presented at A-CURE 2022

A-CURE 2020 Highlights

2020 A-CURE Program

Bill O’Neill, MD | Henry Ford Health System

Update from the National Cardiogenic Shock Initiative – Presented at A-CURE 2020.

Bob Kloner | Huntington Medical Research Institute & Kiyo Ishikawa | Icahn School of Medicine

Bob Kloner (Huntington Medical Research Institute), Investigating Treatment with Therapeutic Hypothermia for Ischemia of the Heart & Kiyo Ishikawa (Icahn School of Medicine Mt. Sinai) Mechanical Left Ventricular Unloading and Therapeutic Hypothermia – Presented at A-CURE 2020.

Elric Zweck | Heinrich-Heine University, Dusseldorf

Identification of Three Phenotypes of Cardiogenic Shock – Presented at A-CURE 2020.

Herman Reichenspurner | University Hospital Hamburg-Eppendorf

Impella 5.5® as an Ideal Bridge to Left Ventricular Assist Device – Presented at A-CURE 2020.

Prof. Dr. med. Carsten Tschöpe, Charité, CVK: Ventricular Unloading and Inflammation – The Role of Impella in Myocarditis

Dr. Tschöpe speaking on how he used Impella support to bridge a patient through myocarditis.

Mark Anderson | Hackensack Meridian School of Medicine

A New Strategy for the Treatment of Patients with Type 1 Cardiorenal Syndrome with Impella® – Presented at A-CURE 2020.

Left ventricular support by catheter-mounted axial flow pump reduces infarct size

OBJECTIVES: We sought to investigate the effect of a catheter-mounted microaxial blood pump (Impella, Aachen, Germany) on myocardial infarct size. BACKGROUND: The small rotary blood pump Impella provides unloading of the left ventricle and is introducible via the femoral artery.

Navin Kapur | Tufts Medical Center

A New Role for Circulatory Support Devices to Limit Ischemia-Reperfusion Injury – Presented at A-CURE 2020.

Zach George | University of South Carolina

ST-Segment Elevation MI-Door-to-Unload (STEMI-DTU) Trial Updates – Presented at A-CURE 2020.

Early Assistance With Left Ventricular Assist Device Limits Left Ventricular Remodeling After Acute Myocardial Infarction in a Swine Model

Although left ventricular assist devices (LVADs) have been commonly used for patients with cardiogenic shock after acute myocardial infarction (AMI), their effects on post-AMI prognosis remain to be elucidated.

Dan Burkhoff | Columbia

The State of the Field: Our Current Understanding of Ventricular Unloading – Presented at A-CURE 2020.

Jakob Josiassen | Copenhagen University Hospital: Abstract Finalist

Impella RP® vs. Pharmacological Vasoactive Treatment in Profound Cardiogenic Shock Due to Acute Ischemic Occlusion of the Right Coronary Artery: Ventricular Unloading and End-Organ Perfusion in a Large Animal Model – Presented at A-CURE 2020.

Kay Everett | Beth Israel Deaconess Medical Center: Abstract Finalist

Acute Hemodynamic Effects of Pre-Emptive Impella® Unloading Before Venoarterial Extracorporeal Membrane Oxygenation in a Preclinical Model of Acute MI – Presented at A-CURE 2020.

Lija Swain | Tufts Medical Center: Abstract Finalist

Left Ventricular Unloading Protects Against Both Ischemia and Reperfusion Injury – Presented at A-CURE 2020.

Left Ventricular Unloading Using an Impella CP Improves Coronary Flow and Infarct Zone Perfusion in Ischemic Heart Failure

Background-—Delivering therapeutic materials, like stem cells or gene vectors, to the myocardium is difficult in the setting of ischemic heart failure because of decreased coronary flow and impaired microvascular perfusion (MP). The aim of this study was to determine if mechanical left ventricular (LV) unloading with the Impella increases coronary flow and MP in a subacute myocardial infarction.

Left Ventricular Mechanical Unloading by Total Support of Impella in Myocardial Infarction Reduces Infarct Size, Preserves Left Ventricular Function, and Prevents Subsequent Heart Failure in Dogs

Left Ventricular Mechanical Unloading by Total Support of Impella in Myocardial Infarction Reduces Infarct Size, Preserves Left Ventricular Function, and Prevents Subsequent Heart Failure in Dogs

Left Ventricular Unloading Using an Impella CP Improves Coronary Flow and Infarct Zone Perfusion in Ischemic Heart Failure

Journal of the American Heart Association

JAHA, 2018 Journal of the American Heart Association

Left Ventricular Unloading Using an Impella CP Improves Coronary Flow and Infarct Zone Perfusion in Ischemic Heart Failure

Circulation Heart Failure, May 2018

Left Ventricular Mechanical Unloading by Total Support of Impella in Myocardial Infarction Reduces Infarct Size, Preserves Left Ventricular Function, and Prevents Subsequent Heart Failure in Dogs

Dr. Babar Basir, Henry Ford Hospital

Dr. Babar Basir speaking on improving clinical outcomes by applying a new algorithm for patient selection in the Detroit Cardiogenic Shock Initiative

Dr. Kiyotake Ishikawa, Icahn School of Medicine at Mount Sinai

Left ventricular unloading leading to unloading of the left atria, and subsequent inhibition of atrial arrhythmia due to decrease atrial wall stress.

Dr. Mark Anderson, Hackensack University Medical Center

Dr. Mark Anderson speaking the clinical experience and data of the novel right ventricular support device, Impella RP.

Dr. Kapildeo Lotun, University of Arizona

Dr. Kapildeo Lotun on the use of Impella support during cardiac arrest in the catheterization lab to bridge patients to recovery

Total mechanical energy of a ventricle model and cardiac oxygen consumption

Mechanical energy (ENG) required by a time-varying elastance model of the ventricle was compared with oxygen consumption per beat (VO2) of the canine left ventricle contracting under a variety of loading conditions.

Dr. Daniel Scheiber, University Hospital Dusseldorf

Dr. Daniel Scheiber speaking on the effects of long-term ventricular unloading on myocardial mitochondrial ROS production.

Relation between left ventricular oxygen consumption and pressure-volume area in conscious dogs

BACKGROUND: The relation between left ventricular (LV) oxygen consumption (MVO2) and pressure-volume area (PVA) developed in isolated hearts provides a powerful method to understand cardiac energetics.

Dr. Ralf Westenfeld, University Hospital Dusseldorf

Impella support improves pulmonary congestion in patients treated for cardiogenic shock

Effect of reduced aortic compliance on cardiac efficiency and contractile function of in situ canine left ventricle

This study tests the hypothesis that arterial vascular stiffening adversely influences in situ left ventricular contractile function and energetic efficiency. Ten reflex-blocked anesthetized dogs underwent a bypass operation in which a Dacron graft was sewn to the ascending aorta and connected to the infrarenal abdominal aorta via a plastic conduit.

The science behind percutaneous hemodynamic support: a review and comparison of support strategies

Patients in a variety of cardiovascular disease states may benefit from temporary percutaneous cardiac support, including those in acute decompensated heart failure, fulminant myocarditis, acute myocardial infarction with or without cardiogenic shock and those undergoing high-risk percutaneous coronary intervention.

Dr. Carlos del Rio, MyoKardia and QTest Labs

The Paradoxical Energetic Energetic Costs of Acute Mechanical Unloading

Transvalvular Ventricular Unloading Before Reperfusion in Acute Myocardial Infarction

Journal of the American College of Cardiology

Dr. Jacob Moller, University of Odense Denmark

Comparative hemodynamics of ECMO and Impella support in a model of cardiogenic shock

Total Mechanical Unloading Minimizes Metabolic Demand of Left Ventricle and Dramatically Reduces Infarct Size in Myocardial Infarction

BACKGROUND: Left ventricular assist device (LVAD) mechanically unloads the left ventricle (LV). Theoretical analysis indicates that partial LVAD support (p-LVAD), where LV remains ejecting, reduces LV preload while increases afterload resulting from the elevation of total cardiac output and mean aortic pressure, and consequently does not markedly decrease myocardial oxygen consumption (MVO2).

Avoiding hemodynamic collapse during high-risk percutaneous coronary intervention: Advanced hemodynamics of impella support

The rate of performing primary percutaneous coronary intervention in patients with complex coronary artery disease is increasing. The use of percutaneous mechanical circulatory support devices provides critical periprocedural hemodynamic support.

Mechanically unloading the left ventricle before coronary reperfusion reduces left ventricular wall stress and myocardial infarct size

BACKGROUND: Ischemia/reperfusion injury worsens infarct size, a major determinant of morbidity and mortality after acute myocardial infarction (MI).

Effects of mechanical left ventricular unloading by Impella on left ventricular dynamics in high-risk and primary percutaneous coronary intervention patients

OBJECTIVES: We studied online left ventricular (LV) dynamic effects of mechanical LV unloading directly after percutaneous coronary intervention (PCI). BACKGROUND: Limited clinical information is available on the direct LV dynamic consequences of LV unloading in patients undergoing high-risk PCI and primary PCI for acute ST-elevation myocardial infarction.

3-D MRI assessment of regional left ventricular systolic wall stress in patients with reperfused MI

The goal of this study was to assess the regional variations of end-systolic wall stress in patients with reperfused Q wave acute myocardial infarction (AMI), with the use of a three-dimensional (3-D) approach.

Left ventricular wall stress as a direct correlate of cardiomyocyte apoptosis in patients with severe dilated cardiomyopathy

BACKGROUND: Apoptosis has been implicated as a possible mechanism in the development of heart failure (HF), but the mechanisms involved remain unclear.

JACC, 2018: Journal of the American College of Cardiology

BACKGROUND Heart failure after an acute myocardial infarction (AMI) is a major cause of morbidity and mortality worldwide. We recently reported that activation of a transvalvular axial-flow pump in the left ventricle and delaying myocardial reperfusion, known as primary unloading, limits infarct size after AMI.

Declining In-Hospital Mortality and Increasing Heart Failure Incidence in Elderly Patients With First Myocardial Infarction

OBJECTIVES: The purpose of this study was to examine the long-term incidence of heart failure (HF) in elderly patients with myocardial infarction (MI). BACKGROUND: In-hospital HF is common after MI and is associated with poor short-term prognosis.

Dr. Joseph Hill, MD, PhD “Heart Failure: The Path Ahead”

Dr. Hill's Keynote Address at the 2016 A-CURE Symposium in Rome

Mechanical Pre-Conditioning With Acute Circulatory Support Before Reperfusion Limits Infarct Size in Acute Myocardial Infarction

This study tested the hypothesis that first reducing myocardial work by unloading the left ventricle (LV) with a novel intracorporeal axial flow catheter while delaying coronary reperfusion activates a myocardial protection program and reduces infarct size.

International Cardiology Review on A-CURE 2016

A summary of the talks given at the 1st Annual A-CURE Symposium in Rome, Italy, in August of 2016.

Dr. Valentin Fuster MD, PhD speaks at The 2017 A-CURE Symposium

Dr. Fuster gives the Keynote Address at the 2017 A-CURE Symposium

Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With VA-ECMO

Schrage, B., et al. (2020). Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality.

Left Ventricular Assist Devices for Acute Myocardial Infarct Size Reduction: Meta-analysis

Miyashita, S., et al. (2021). We conducted a meta-analysis of preclinical studies that tested left ventricular assist device (LVAD) therapy for reducing myocardial infarct size in experimental acute myocardial infarction (AMI). The meta-analysis showed that infarct size was significantly decreased by LVAD support compared to control animals.

Percutaneous cardiac support during myocardial infarction drastically reduces mortality: perspectives from a swine model

Acute myocardial infarction (AMI) with cardiogenic shock (CS) remains the leading cause of in-hospital death in acute coronary syndromes. In the AMI-CS pig model we tested the efficacy of temporary percutaneous cardiorespiratory assist device (PCRA) in rescuing the failing heart and reducing early mortality.

Dr. Patrick Hunziker, University Hospital Basel, Switzerland

Cardiac Unloading and Recovery in Cardiogenic Shock: From Disease Modeling to Real Patients

Mark Anderson, MD, Einstein Healthcare Network

Cardiac Unloading and Myocardial Recovery: Clinical Utility from a Surgeon's Perspective

Dr. Takahiro Arimura, Kyushu University

Neuromechanical Unloading for Acute Myocardial Ischemia Synergistically, Strikingly Reduces Infarct Size and Prevents Heart Failure in the Long Term

Ryan Tedford, MD, Johns Hopkins School of Medicine

Mechanical Support for Right-sided and Bi-ventricular Failure

Derek Hausenloy, MD, PhD, Duke National University Singapore Reducing Myocardial Infarct Size: Translational Challenges and Opportunities

Dr. Hausenloy provides insights into translational opportunities in the field of ischemia reperfusion injury at the 2016 A-CURE Symposium.

Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States

Shah, M., Patnaik, S., Patel, B., Ram, P., Garg, L., Agarwal, M., Agrawal, S., Arora, S., Patel, N., Wald, J., Jorde, U.

Innovation Lecture: Navin Kapur, MD | Tufts Medical Center

Current Understanding of the Molecular Mechanisms of Unloading & Recovery: Past, Present, and Future – Presented at A-CURE 2022.

Nicolas Brozzi, MD | Cleveland Clinic Florida

High-Risk Non-Cardiac Surgery: Successful Bridging of Morbidly Obese Patients to HTx – Presented at A-CURE 2022

Kay Everett, MD, PhD | Tufts Medical Center

Combining VA-ECMO and Impella (EC-Pella) Before Reperfusion Mitigates Left Ventricular Injury Due to VA-ECMO in Acute Myocardial Infarction – Presented at A-CURE 2022

Ed Soltesz, MD | Cleveland Clinic

Mechanical Circulatory Support in High-Risk CABG – Presented at A-CURE 2022.

Keynote Lecture: Clyde Yancy, MD | Northwestern University

The Treatment of Stage D Heart Failure: Devices, Drugs, Biology, and Genes – Evidence and Guidelines – Presented at A-CURE 2022.

Young Investigator Award: Renata Mazurek, MD | Mt. Sinai

Negative Effects of Acute Reloading after Mechanical Left Ventricle Unloading for Acute Myocardial Infarction in a Pig Model – Presented at A-CURE 2022.

Dr. Howard Chen, Tufts University Medical Center

Dr. Chen speaking on the detection autophagy in myocardial I/R injury and the impact of Impella-mediate ventricular unloading.

Dr. Nanna Udesen, Odense University Hospital

Dr. Udeson speaking on her pre-clinical investigations on the effect of concomitant vasoactive treatments combined with mechanical support on left ventricular function and end organ perfusion.

ESC, 2018 Mechanical circulatory support as bridge to urgent structural intervention

A 79-year-old woman was admitted in the emergency department as late comer in cardiogenic shock due to subacute nonST-elevation myocardial infarction, which clinically occurred 8 days prior.

Andreas Schäfer, MD | Hannover Medical Center

Complete Revascularization and Acute Unloading Prior to PCI Increases Survival in AMI-CGS – Presented at A-CURE 2022.

Dr. Heimo Ehmke, Univeristy Center Hamburg-Eppendorf

Dr. Ehmke presenting his preclinical data investigating how cardiac unloading reverses infarction-induced changes in gene expression.

Carsten Tschöpe, MD | Charité – Universitätsmedizin Berlin

Effect of Ventricular Unloading on Heart Recovery – Presented at A-CURE 2022.

Feasibility of Early Mechanical Support During Mechanical Reperfusion of Acute Myocardial Infarct Cardiogenic Shock

Although only preliminary, initial experience suggests that rapid door-to-support times are feasible. This approach results in the rapid reversal of the shock state in most patients, allowing operators to obtain TIMI flow grade III rates comparable to those in patients with non-shock ST-segment elevation MI and may improve survival. Given these encouraging pilot data, a large formal quality initiative entitled the Detroit Cardiogenic Shock Initiative has been launched.

Hemodynamic Support With a Microaxial Percutaneous Left Ventricular Assist Device (Impella) Protects Against Acute Kidney Injury in Patients Undergoing High-Risk Percutaneous Coronary Intervention

Acute kidney injury (AKI) is common during high-risk percutaneous coronary intervention (PCI), particularly in those with severely reduced left ventricular ejection fraction. The impact of partial hemodynamic support with a microaxial percutaneous left ventricular assist device (pLVAD) on renal function after high-risk PCI remains unknown.

Eugene Braunwald, MD, Harvard University

Acute MI to Heart Failure: The Past, Present, and Future

Improved Regional Myocardial Blood Flow, Left Ventricular Unloading, and Infarct Salvage Using an Axial-Flow, Transvalvular Left Ventricular Assist Device

The concept of salvage of ischemic myocardial tissue by reperfusion therapy has been suggested by animal1 and human2 studies. Some investigators have reported that the level of collateral flow to the bed at risk determines ultimate infarct size3 others have suggested that the amount of collateral flow and degree of functional recovery are not correlated.4

The Current Use of Impella 2.5 in Acute Myocardial Infarction Complicated by Cardiogenic Shock: Results from the USpella Registry

Prompt revascularization with percutaneous coronary intervention (PCI) has significantly reduced the incidence of cardiogenic shock (CS) and improved survival in the setting of acute myocardial infarction (AMI).1,2

Left Ventricular Support by Catheter-Mounted Axial Flow Pump Reduces Infarct Size

The transvalvular assist device Impella (Aachen, Germany) is a potent, miniaturized pump that offers the possibility of unloading the left ventricle (LV) via the femoral placement (1). In vivo and clinical use of this device has indicated that the pump produces a mean flow of 4.2 l/min at maximal rotational speed (2).

Adjunctive Left Venticular Unloading During Myocardial Reperfusion Plays a Major Role in Minimizing Myocardial Infarct Size

Although prompt institution of reperfusion following coronary artery occlusion has been shown to limit myocardial infarct size, significant “reperfusion injury” may result.

Abiomed Receives FDA IDE Approval for Initiation of Door to Unloading (DTU) Prospective Feasibility Study

Impella® heart pumps are not currently approved for use in STEMI patients without cardiogenic shock. The STEMI patient segment is contributing to the growing heart failure population and represents a potential new patient indication that may benefit from Impella pump unloading the left ventricle.

Improving left ventricular unloading following prolonged cardiac arrest using a minimally invasive left ventricular assist device: a prospective animal study in pigs

Cardiopulmonary resuscitation (CPR) is an emergency procedure deployed when a patient suffers cardiac arrest (CA). Compared to conventional CPR, improved survival is observed after CA when CPR is conducted in the presence of a minimally invasive left ventricular assist device, Impella 2.5 (iCPR).

Kenji Sunagawa, MD, PhD, Kyushu University

Neuromechanical Unloading for Acute Myocardial Infarction

James Udelson, MD, Tufts Univeristy Medical Center

Incorporating Infarct Size Into Trial Composite Endpoints: Implications for Unloading Trials.

William O’Neill, MD, Henry Ford Health System

Acute Unloading in the Setting of AMI Complicated by Cardiogenci Shock

Navin Kapur, MD, Tufts University Medical Center

Primary Left Ventricular Unloading and the Mechanical Conditioning Hypothesis

Understanding the Pressure-Volume Loop

FDA approves the Door To Unloading clinical study investigating the feasibility of primary ventricular unloading in the clinical setting

A-CURE Working Group faculty members Navin Kapur, William O’Neill, and Jeff Moses have been selected as steering committee members for upcoming DTU trial.

Dr. Daniel Burkhoff, MD, PhD Columbia University

The Science Behind Acute Ventricular and Myocardial Unloading

Relationship Between Therapeutic Effects on Infarct Size in Acute MI and One-year Outcomes: Patient-Level Analysis of Randomized Clinical Trials

Infarct size (IS) after MI is related to long-term outcomes. Whether a change in IS from an intervention is related to the intervention’s effect on outcomes is unknown. A therapy-induced change in IS is related in direction and/or magnitude to the outcome effect of that therapy.

LV Unloading using an Impella CP Reduces Wall Stress and Improves Coronary Flow and Perfusion in Infarcted Myocardium

LV unloading may improve coronary perfusion by increasing cardiac output and reducing LV wall stress. Whether sustained LV unloading improves myocardial perfusion in a post-MI setting remains uncertain.

LV Unloading using Impella CP Improves LA Pressure, Function, and Stiffness

The impact of pLVAD on LA function and stiffness in HF remains unclear.

Inhibition of the inflammatory injury following myocardial ischemia-reperfusion in the mouse

Reperfusion is effective in reducing ischemic injury in acute myocardial infarction (AMI). Ischemia, however, triggers a secondary injury, known as reperfusion injury, contributing to the overall infarct size.

To Have Clinical Value, Future Cardioprotective Interventions Must Provide Additive Protection To That From a P2Y12 Receptor Antagonist

Patients with AMI are treated with P2Y12 receptor antagonists to suppress platelet aggregation. Although P2Y12 antagonists are used for their anticoagulant effect, our studies reveal that they are also potent postconditioning-mimetics.

LV Unloading using Imepella Reduces LA Pressure and Volume Overload in Chronic Mitral Regurgitation

Mitral regurgitation is a common presentation in patients administered due to the decompensated chronic heart failure. Whether an LV-to-aorta pLVAD can be effective in relieving LA overload remains unclear.

Feasibility and Effectiveness of a Multidisciplinary Team Approach in Refractory Cardiogenic Shock Requiring Mechanical Circulatory Support: A Pilot Prospective Study

The diversity in both the etiology and the clinical course of refractory cardiogenic shock makes the management of this critical condition challenging.

Hydrostatic pressure gradient ultrafiltration device: A novel approach for extracellular fluids removal

This study explored the concept of a novel intra peritoneal absorption chamber for fluids removal through the peritoneal membranes. Fluid overload is a common & challenging clinical problem in acutely decompensated heart failure patients (ADHF).

Prognostic relevance of intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: Nationwide population study in Taiwan

Intra‐aortic balloon pump (IABP) is the most widely used form of mechanical circulatory support in patients with cardiogenic shock.

Association between left ventricular global longitudinal strain and acute pulmonary edema caused by increased left ventricular afterload in patients with STEMI

Acute pulmonary edema (APE) is common complication after ST elevation myocardial infarction (STEMI) and often associated with poor prognosis.

A new animal model for investigation of mechanical unloading in hypertrophic and failing hearts: combination of transverse aortic constriction and heterotopic heart transplantation

Previous small animal models for simulation of mechanical unloading are solely performed in healthy or infarcted hearts, not representing the pathophysiology of hypertrophic and dilated hearts emerging in heart failure patients.

Potential of Regenerative Therapy with Medical Assist Devices

Heart failure continues to be the leading cause of morbidity and mortality not only in the United States but throughout the world.

Assessment of Impella position on supine chest X-ray in the intensive care unit. Introduction and applicability of the Aortic Valve Location Ratio

Maintaining correct Impella position is a key factor for optimal functioning of the Impella device. The aortic valve is an important landmark for correct positioning.

Jane Wilcox, MD | Northwestern University

Patient Identification and Fundamentals of Heart Recovery vs. Remission – Presented at A-CURE 2022.

Distinguished Lecture: Emma Birks, MD, PhD | University of Kentucky

Heart Recovery: Insights from RESTAGE-HF – Presented at A-CURE 2022.

Manreet Kanwar, MD | Allegheny Health Network

Clinical Experience of a Real World Heart Recovery Program – Presented at A-CURE 2022.

Best in Research Award: Tharusan Thevathasan, MD | Charité – Universitätsmedizin Berlin

Treatment with Impella and Veno-Arterial Extracorporeal Membrane Oxygenation During Cardiac Arrest Improves Survival: A Multicenter Cohort Study – Presented at A-CURE 2022.

What is acute cardiac unloading?

Acute cardiac unloading is any maneuver, therapy, or intervention that decreases the power expenditure of the ventricle and limits the hemodynamic forces that lead to ventricular remodeling after insult or
injury to the heart.

Daniel Burkhoff, MD, PhD: The Science Behind Acute Ventricular and Myocardial Unloading

Dr. Dan Burkhoff speaking on the science behind acute ventricular unloading and myocardial recovery at the 2016
A-CURE Symposium.

James Udelson, MD, speaking on Infarct Size as an endpoint in clinical trials

Incorporating Infarct Size Into Trial Composite Endpoints: Implications for Unloading Trials

Hemodynamics of Mechanical Circulatory Support

An increasing number of devices can provide mechanical circulatory support (MCS) to patients with acute hemodynamic compromise and chronic end-stage heart failure.

Dr. Dan Burkhoff, Columbia University

Dr. Daniel Scheiber speaking at the 2019 A-CURE Symposium on the state of the field of unloading research.

Journal of Cardiovascular Transnational Research Special Issue: Acute Ventricular Unloading

In this issue of the Journal of Cardiovascular and Translational Research (JCTR) 10 articles focused on new and emerging topics in the field of mechanical unloading are presented including state-of-the-art reviews and new primary pre-clinical and clinical reports.

Dan Burkhoff, MD, PhD, Columbia University Perspective on Acute Unloading

Dan Burkhoff speaks on the hemodynamics of acute unloading and the important clinical implications at A-CURE 2017.

International Cardiology Review on A-CURE 2016

A summary of the talks given at the 1st Annual A-CURE Symposium in Rome, Italy, in August of 2016.

Dr. Elazer Edelman, MIT & Harvard University

Dr. Edelman at the the 2017 A-CURE Symposium speaking on device-based approaches to monitor cardiac function of patients on Impella support.

Harvi App

This first of its kind iPad app is an interactive simulation-based textbook of cardiovascular physiology and hemodynamics. The textbook is divided into 4 parts and will cover a full range of topics relevant to the understanding of hemodynamics in health and disease.