Author + information
- Received January 23, 2013
- Revision received February 22, 2013
- Accepted February 25, 2013
- Published online June 1, 2013.
- Hani N. Sabbah, PhD∗∗ (, )
- Mengjun Wang, MD∗,
- Ramesh C. Gupta, PhD∗,
- Sharad Rastogi, MD∗,
- Itamar Ilsar, DVM∗,
- Michael S. Sabbah, MSc∗,
- Smita Kohli, MD∗,
- Sam Helgerson, PhD† and
- Randall J. Lee, MD, PhD‡
- ↵∗Reprint requests and correspondence:
Dr. Hani N. Sabbah, Cardiovascular Research, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, Michigan 48202.
Objectives The study tested the hypothesis that augmentation of the left ventricular (LV) wall thickness with direct intramyocardial injections of alginate hydrogel implants (AHI) reduces LV cavity size, restores LV shape, and improves LV function in dogs with heart failure (HF).
Background Progressive LV dysfunction, enlargement, and chamber sphericity are features of HF associated with increased mortality and morbidity.
Methods Studies were performed in 14 dogs with HF produced by intracoronary microembolizations (LV ejection fraction [EF] <30%). Dogs were randomized to AHI treatment (n = 8) or to sham-operated control (n = 6). During an open-chest procedure, dogs received either intramyocardial injections of 0.25 to 0.35 ml of alginate hydrogel (Algisyl-LVR, LoneStar Heart, Inc., Laguna Hills, California) or saline. Seven injections were made ∼1.0 to 1.5 cm apart (total volume 1.8 to 2.1 ml) along the circumference of the LV free wall halfway between the apex and base starting from the anteroseptal groove and ending at the posteroseptal groove. Hemodynamic and ventriculographic measurements were made before treatment (PRE) and repeated post-surgery for up to 17 weeks (POST).
Results Compared to control, AHI significantly reduced LV end-diastolic and end-systolic volumes and improved LV sphericity. AHI treatment significantly increased EF (26 ± 0.4% at PRE to 31 ± 0.4% at POST; p < 0.05) compared to the decreased EF seen in control dogs (27 ± 0.3% at PRE to 24 ± 1.3% at POST; p < 0.05). AHI treatment was well tolerated and was not associated with increased LV diastolic stiffness.
Conclusions In HF dogs, circumferential augmentation of LV wall thickness with AHI improves LV structure and function. The results support continued development of AHI for the treatment of patients with advanced HF.
- animal models
- congestive heart failure
- functional mitral regurgitation
- left ventricular function
- pressure-volume relationship
The study was supported, in part, by research grants from LoneStar Heart, Inc. and National Heart, Lung, and Blood InstitutePO1 HL074237-09. Dr. Sabbah has received research grants from and is a consultant to LoneStar Heart, Inc. At the time of research Dr. Helgerson was an employee of Lonestar Heart, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 23, 2013.
- Revision received February 22, 2013.
- Accepted February 25, 2013.
- American College of Cardiology Foundation