Comparison of Direct Anti-Fibrotic Therapy with ACE Inhibition on Ventricular Function and Remodelling Following Myocardial Infarction

Abstract

364 Comparison of Direct Anti-Fibrotic Therapy with ACE Inhibition on Ventricular Function and Remodelling Following Myocardial Infarction Maros Elsik 1,∗, Yuan Zhang2, Bing Wang1, Richard Gilbert 3, Henry Krum1, Darren J. Kelly 2 1DEPM Monash University, Melbourne, Victoria, Australia; 2 Department of Medicine, St Vincent’s Hospital, Melbourne, Victoria, Australia; 3 University of Toronto, Toronto, Canada Introduction: Reactive myocardial fibrosis contributes to adverseventricular remodelingandheart failure.Wecompared FT-011 (FT) (Fibrotech,Melbourne), which has been shown to have antifibrotic properties, to standard therapy and combination therapy to test the hypothesis that preventing reactive fibrosis improves cardiac function. Methods: Sprague Dawley rats underwent ligation of the left anterior descending artery to induce myocardial infarction (MI) (or sham procedure). Twenty-eight days treatment with vehicle (V), FT or Perindopril (P) commenced 1-weekpost surgery. Left ventricular (LV) size and function was assessed with echocardiography (days 2 and 35). Total collagen (TC) content and collagen types I and III (C-I and C-III) were analysed histologically. Results: MIs were of comparable size in all groups. TC was reduced with active treatment—FT: 1.5%, P: 1.54% vs. V: 2.23%, p< 0.05 for all as was C-I and C-III. This was 365 A Single-Hospital Experience with 29 Continuous-Flow Left Ventricular Assist Devices Alasdair Watson1,∗, Paul Jansz2, Emily Granger 2, Alan Farnsworth2, Carmen Axisa2, Eugene Kotlyer 2, Anne Keogh2, Christopher Hayward2, Peter Macdonald1, Phillip Spratt 2 1 Transplant Program, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; 2 Heart & Lung Transplant Unit, St Vincent’s Hospital, Sydney, NSW, Australia Background: We embarked upon our continuous-flow LVAD program in November 2005. The aim of this study was to report the outcome of all patients receiving such a device. Results: 29 continuous-flow LVADs were implanted at our institution between November 2004 and February 2008. These consisted of 23 Ventrassist and 6Heartware devices, 23 intended as bridge-to-transplantation (17 Ventrassist and 6 Heartware) and 6 as destination. Patients in the “bridge” group consisted of 18 males and 5 females; all 6 “destination” patients weremales. “Destination” patients were significantly older than “bridge” patients (69.7± 1.4 years vs. 48.5± 3.3 years, p= 0.003). Mean ICU stay was 292.3 h for the entire group (range 48.0–968.0), and hospital stay 39.5 days (range 18–108). There were 2 in-hospital deaths in the “bridge” group. associated with reduction of LV size and an improvement inLVfunction (see table).Theheart, bodyand lungweights were also reduced.Correlating collagenandEF (spearman r= 0.66, p< 0.05), confirmed that a reduction of collagen is associated with functional improvement. Group EF% FAC% mLVESDcm LVESA (cm2) LVEDV (cm3) LVESV (cm3) Sham+V 66.50(2.5) 55.17(3.03) 0.51(0.03) 0.50(0.04) 0.55(0.03) 0.18(0.02) MI+V 40.68(3.12)# 29.56(2.13)# 0.79(0.04)# 0.90(0.06)# 0.82(0.07)* 0.50(0.05)** MI+FT 52.85(3.51)* 36.67(2.57)* 0.68(0.03)* 0.72(0.05)* 0.71(0.03) 0.37(0.04) MI+P 52.83(3.9)* 38.78(2.74)* 0.71(0.03)* 0.70(0.06)* 0.67(0.04) 0.33(0.04)* Mean (S.E.M.). EF: ejection fraction; FAC: fractional area change; LVESD: LV end systolic diameter; LVESA: LV end systolic area; LVEDVolume, LVESVolume. *p< 0.05, #p< 0.01, **p< 0.001. MI+V vs. sham. Other groups compared to MI+V. Conclusion: FT-011 reduces pathological deposition of collagen and improves ventricular function post MI. Its effects are comparable to perindopril. FT-011 reduces collagen deposition and ventricular remodelling independent of renin angiotensin aldosterone inhibition. doi:10.1016/j.hlc.2008.05.365 All other patients were discharged home, often to remote rural areas. In the “bridge” group nine patients received a heart transplant after 305.8 days (range 72–794). There was one late death after 751 days. The remaining 11 patients are alive and awaiting transplantation, with mean follow-up 315.2 days (range 10–844). Actuarial survival at 12 months was 91% and at 24 months 73%. In the “destination” group there was 1 late death after 619 days. The remaining 5 patients remain alive and well after a mean of 520.8 days (range 309–654). Conclusion: Continuous-flow LVADs provide an effective meansof circulatory support in selectedpatientswithendstage heart failure, the vast majority of whom are able to be discharged home. doi:10.1016/j.hlc.2008.05.366 366 Experience with Ultrafiltration via Venous Access in Refractory Congestive Heart Failure Christine Bourgault ∗, Jay Baumwol, Peter MacDonald St Vincent Hospital, Sydney, NSW, Australia Background: The treatment of some patients with severe congestive heart failure can be challenging, as they can be resistant to diuretics. Ultrafiltration (UF) is now considered a useful alternative therapy for this group of patients; however it continues to be underutilised. Objective: The aim of this study is to evaluate the efficacy and safety of UF via venous access in patients with refractory heart failure.