Impact of concomitant vasoactive treatment and mechanical left ventricular unloading in a porcine model of profound cardiogenic shock

Udesen, Nanna Louise Junker; Helgestad, Ole Kristian Lerche; Banke, Ann; Frederiksen, Peter H; Josiassen, Jakob; Jensen, Lisette Okkels; Schmidt, Henrik; Edelman, Elazer R.; Chang, Brian Y.; Ravn, Hanne Berg; Møller, Jacob Eifer

doi:10.1186/s13054-020-2816-8

Cited by 30 publications

(23 citation statements)

References 33 publications

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“…For severe cytokine storms, simple glucocorticoids cannot suppress the inflammation efficiently, so potent blood purification measures such as an artificial liver system are essential. 98 The processes of urgent antishock therapy mainly contain complements of blood volume, improving cardiac contractility and vascular activity, thus vasoactive agents and positive inotropic drugs such as epinephrine, dopamine, and norepinephrine 99 are necessary for first aid of critical COVID-19 patients. For patients with severe kidney damage, we should actively search for the primary cause and pay attention to the water, electrolyte, and acid-base balance.…”

Section: Remediesmentioning

confidence: 99%

The epidemiology and therapeutic options for the COVID-19

Shao

Wang

et al. 2020

Precision Clinical Medicine

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Abstract An outbreak of coronavirus disease 2019 (COVID-19), a disease caused by a novel pneumonia virus, has affected over 200 countries and regions worldwide. With the increasing number of patients and deaths, WHO have declared it as a global pandemic currently, indicating a third large-scale epidemic coronavirus has appeared since the emergence of severe acute respiratory syndrome coronavirus (SARS) and Middle-East respiratory syndrome (MERS) in the twenty-first century. Considering the great harm it has caused, researchers throughout the world have been chasing to exploit the pathophysiology, characteristics, and potential remedies for COVID-19 to better battle the outbreak. Therefore, the current study revisits advances of the virology, epidemiology, clinical features, therapeutic options, and prevention of COVID-19. The features of asymptomatic carriers are also been explored.

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Section: Remediesmentioning

confidence: 99%

The epidemiology and therapeutic options for the COVID-19

Shao

Wang

et al. 2020

Precision Clinical Medicine

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“…Finally, as we were unable to detect any alcohol plasma concentrations in animals, an inhibition of baroreflex bradycardia through GABA receptors by ethanol injection 32 is highly unlikely. It should be noted that an absence of compensatory tachycardia has been widely reported by others developing animal model of CS 7,33,34 . Lastly, five animals received epinephrine.…”

Section: Discussionmentioning

confidence: 67%

A total closed chest sheep model of cardiogenic shock by percutaneous intracoronary ethanol injection

Rienzo

Imbault

Boustani

et al. 2020

Sci Rep

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To develop a reproducible and stable closed chest model of ischemic cardiogenic shock in sheep, with high survival rate and potential insight into human pathology. We established a protocol for multi-step myocardial alcoholisation of the left anterior descending coronary artery by percutaneous ethanol injection. A thorough hemodynamic assessment was obtained by invasive and non-invasive monitoring devices. Repeated blood samples were obtained to determine haemoglobin and alcohol concentration, electrolytes, blood gas parameters and cardiac troponin I. After sacrifice, tissue was excised for quantification of infarction and histology. Cardiogenic shock was characterized by a significant decrease in mean arterial pressure (− 33%), cardiac output (− 29%), dP/dt max (− 28%), carotid blood flow (− 22%), left ventricular fractional shortening (− 28%), and left ventricle end-systolic pressure-volume relationship (− 51%). Lactate and cardiac troponin I levels increased from 1.4 ± 0.2 to 4.9 ± 0.7 mmol/L (p = 0.001) and from 0.05 ± 0.02 to 14.74 ± 2.59 µg/L (p = 0.001), respectively. All haemodynamic changes were stable over a three-hour period with a 71% survival rate. The necrotic volume (n = 5) represented 24.0 ± 1.9% of total ventricular mass. No sham exhibited any variation under general anaesthesia. We described and characterized, for the first time, a stable, reproducible sheep model of cardiogenic shock obtained by percutaneous intracoronary ethanol administration. Five to 10% of patients presenting with acute myocardial infarction (AMI) develop cardiogenic shock (CS). This population has a high mortality rate (40%-50%) 1 , despite the improvement in survival due to primary reperfusion therapy, optimal pharmacological treatment, intra-aortic balloon pumping and the use of short-term mechanical circulatory support (STMCS) 1. Insights into the pathophysiology of CS remain crucial to the development of new approaches, either pharmacological or mechanical, to reduce local and systemic effects of CS, and to appraise safety and efficacy of novel procedures prior to clinical translation. In this context, large animal models may provide a heuristic methodology to test pathophysiological hypotheses and new therapeutic procedures. These models should mimic human pathology, be reproducible, allow for control of the extent of ischemia, rely on minimally invasive techniques, require short preparation time and easy animal management, lead to impaired cardiac function and be cost-effective. Several models of myocardial infarction exist and are based on coronary artery ligation, coronary artery occlusion (by angiography balloon catheter or embolization), or intra-coronary alcoholisation. However, the current large animal models are suboptimal for several reasons, e.g. high mortality

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“…85-23, revised 1985). Six Danish Landrace female pigs were studied ( 14 ). Animals were selected based on the availability of serum samples for further analysis.…”

Section: Methodsmentioning

confidence: 99%

miRNA-200b—A Potential Biomarker Identified in a Porcine Model of Cardiogenic Shock and Mechanical Unloading

Riehle

Sieweke

Bakshi

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCardiogenic shock (CS) alters whole body metabolism and circulating biomarkers serve as prognostic markers in CS patients. Percutaneous ventricular assist devices (pVADs) unload the left ventricle by actively ejecting blood into the aorta. The goal of the present study was to identify alterations in circulating metabolites and transcripts in a large animal model that might serve as potential prognostic biomarkers in acute CS and additional left ventricular unloading by Impella ® pVAD support.MethodsCS was induced in a preclinical large animal model by injecting microspheres into the left coronary artery system in six pigs. After the induction of CS, mechanical pVAD support was implemented for 30 min total. Serum samples were collected under basal conditions, after the onset of CS, and following additional pVAD unloading. Circulating metabolites were determined by metabolomic analysis, circulating RNA entities by RNA sequencing.ResultsCS and additional pVAD support alter the abundance of circulating metabolites involved in Aminoacyl-tRNA biosynthesis and amino acid metabolism. RNA sequencing revealed decreased abundance of the hypoxia sensitive miRNA-200b following the induction of CS, which was reversed following pVAD support.ConclusionThe hypoxamir miRNA-200b is a potential circulating marker that is repressed in CS and is restored following pVAD support. The early transcriptional response with increased miRNA-200b expression following only 30 min of pVAD support suggests that mechanical unloading alters whole body metabolism. Future studies are required to delineate the impact of serum miRNA-200b levels as a prognostic marker in patients with acute CS and pVAD unloading.

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Impact of concomitant vasoactive treatment and mechanical left ventricular unloading in a porcine model of profound cardiogenic shock

Cited by 30 publications

References 33 publications

The epidemiology and therapeutic options for the COVID-19

The epidemiology and therapeutic options for the COVID-19

A total closed chest sheep model of cardiogenic shock by percutaneous intracoronary ethanol injection

miRNA-200b—A Potential Biomarker Identified in a Porcine Model of Cardiogenic Shock and Mechanical Unloading

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