Eplerenone appears to reduce the risk of cardiovascular mortality and heart failure after a heart attack by more than one-third, according to research presented at the American College of Cardiology‘s 62nd Annual Scientific Session.
The REMINDER (Reduction of heart failure morbidity in patients with acute ST-elevation myocardial infarction) trial was a randomized, double-blind trial of 1,012 patients who had a heart attack caused by a complete blockage of one of the heart’s arteries. Patients had no signs or history of heart failure. They were given either eplerenone or placebo in addition to standard therapy. Overall, patients taking eplerenone were 38% less likely to have poor outcomes than those given a placebo.
Eplerenone counteracts a hormone called aldosterone, which can increase blood pressure.
“This is the first randomized trial to test a mineralocorticoid receptor agonist during the acute phase of heart attack, and the results suggest a clinical benefit,” said Gilles Montalescot, MD, PhD, lead investigator of the study and professor of cardiology and head of the Cardiac Care Unit at Piti–Salp-tri-re Hospital, Paris.
Ventricular re-modelling at its most exciting!
Ventrix, Inc. announced today that its VentriGel™cardiac repair scaffold safely and effectively mitigated left ventricular remodeling and improved cardiac function in pigs after myocardial infarction, or a heart attack. The findings, made during pre-clinical studies, were published today in the journal Science Translational Medicine. Based on these and other results, Ventrix will initiate a clinical trial for VentriGel later this year.
“These results give us strong validation that VentriGel has the potential to prevent the development of congestive heart failure in patients who are recovering from heart attack,” said Adam Kinsey, Ph.D., CEO of Ventrix. “We will continue to develop VentriGel for this indication, for which there is a very acute need and large market potential.”
As medical management and surgical tools have advanced, more and more patients are surviving heart attacks. However, damage to the heart during myocardial infarction can lead to a growth of dense scar tissue which cannot contribute to the pumping function of the heart. Over time, the heart wall will thin causing heart failure. Currently, the only successful treatments for end-stage heart failure are heart transplantation or left ventricular assist devices.
In the study, the VentriGel scaffold was injected into pigs two weeks following heart attack via a minimally-invasive catheter. Three months after injection, more cardiac muscle and less scar tissue was found in the VentriGel-treated group compared to controls that did not receive VentriGel. This led to significant improvements in contractility and cardiac function and prevented heart failure in treated animals. Ejection fraction, one measure of cardiac function, was significantly greater after delivery of VentriGel.
VentriGel is a biomaterial scaffold designed specifically for the repair of damaged myocardium (heart muscle). It is injected via catheter in a minimally-invasive procedure that does not require surgery or general anesthesia.
Pioneering new heart treatment
Carl Jordan, of Tunstall, below, is one of just 96 patients from 30 hospitals worldwide to take part in a trial in which he has been fitted with a pacemaker-like device to stimulate his heart.
The device – fitted under Mr Jordan’s collarbone during surgery at Liverpool Heart and Chest Hospital – aims to reduce the size of his heart. Mr Jordan, who has undergone 12 operations since his first heart attack in 2001, is currently unable to walk more than 70 yards without becoming breathless. He said: “It wasn’t an easy decision to take part in the study but one which I hope will improve my quality of life. I don’t mind being a guinea pig if it helps me, and potentially helps others.
“It was a privilege to be chosen but also frightening.” At the moment my heart is quite big and if it gets any bigger I am in serious trouble. The idea is that it will help shrink the heart so it doesn’t have to work so hard. In turn that will help my breathing.”
Mr Jordan suffered his first heart attack 11 years ago while working as a station manager for the ambulance service. He said: “I have dealt with hundreds of heart attack victims and I knew exactly what was happening to me.”
But just under two weeks after being discharged from hospital, he was readmitted after his health deteriorated. On the wards, Mr Jordan, who lives in May Avenue with wife Angela suffered another cardiac arrest. Mrs Jordan, a catering assistant, said: “We were told that he might not pull through as he was in such a bad way. It was such a scary time.”
Over the years he has undergone a dozen surgical procedures, including open heart surgery. He takes 34 tablets a day and needs to keep oxygen in the house and car.
Now the family are hoping the device – which is connected to the vagus nerve – will help improve his life. The device uses electrical pulses to stimulate the nerve to help improve cardiac function and life expectancy. It is aimed at protecting the heart from the effects of adrenaline, which causes the heart to work faster and enlarge.
Dr Jay Wright, a consultant cardiologist at Liverpool Heart and Chest Hospital, is leading the studyand he carried the operation on Mr Jordan. Dr Wright said: “This is a first in man study and if successful, will improve the quality of life for heart failure patients in the UK.”
Heart Failure Rehab rears its ugly head again
We presume this article rings bells with people?
More heart patients should benefit from cardiac rehabilitation, health campaigners have said. They made the plea after new figures showed just 3% of eligible patients with heart failure were offered this, compared to about two-thirds of those who have had either a heart attack or cardiac bypass surgery.
Across Scotland, a total of 65.2% of heart attack patients were referred for cardiac rehabilitation, as were 68.5% of people who had bypass surgery. But just 3.1% of those with heart failure were referred for rehabilitation, along with only 7.4% of those with unstable angina. Pumping Marvellous find this digraceful and this indicates the attitude towards Heart Failure and how to deal with the ever growing problem by the NHS.
While 7,845 heart attack patients were referred for rehabilitation between April 2010 and March 2011, only 144 people with heart failure and 340 with unstable angina were put forward.
The British Heart Foundation (BHF) Scotland and Chest, Heart and Stroke Scotland are now calling for more of these patents to benefit from the treatment. The two charities argued that rehabilitation only costed about £600 per patient, and could help save lives, with heart patients 30% less likely to die over a 10-year period if they have taken part in a cardiac rehab programme.
Ben McKendrick, senior policy and public affairs manager at BHF Scotland, said: “Cardiac rehab saves lives but there is an unacceptable gulf between the levels of support offered to patients with different heart conditions.
“When someone suffers a heart problem – be it angina, a heart attack or heart failure – they not only suffer a damaged heart but often a damaged spirit as well. Heart patients tell us that cardiac rehab helps mend that spirit and puts them on the road to living a full life again.”
Scottish Health Secretary Nicola Sturgeon said “excellent” progress had been made in offering rehabilitation. She said: “In 2007 around 45% of people in the clinical priority groups had access to cardiac rehabilitation, this figure has now risen to 65%. While this substantial increase is a great achievement, we recognise that there is still much more to do to help improve the quality of care for people living with heart failure.
“Our National Advisory Committee on heart disease will continue to work closely with cardiac services and the voluntary sector to take this forward. Our focus is not just on providing the best possible care in the acute setting, but also on helping people’s longer-term recovery in their own communities.”
Seaweed Juice may save Heart Attack patients?
An Australian grandmother had a liquid derived from seaweed injected into her heart, in a world-first procedure poised to dramatically boost heart attack survival rates. Pauline Fulton underwent the treatment in a Melbourne hospital two weeks ago, two days after she suffered a major heart attack. Dr. William van Gaal, a cardiologist who performed the procedure, said it could revolutionize treatment for heart attack patients and save lives.
But it was hoped the liquid, bio-absorbable cardiac matrix, would prevent the heart enlarging, and heart failure developing.
In the 30-minute procedure, van Gaal injected 0.13 fluid ounces of the “liquid device” into the blocked artery, which was absorbed by the damaged heart muscle.
It then formed a gel that acted as a scaffold to support the heart muscle as it recovered and prevented the organ becoming bigger, he said. After six weeks, the liquid device, which had no side-effects, would dissolve and be excreted from the body through the kidneys.
Standard treatment was to give patients tablets to prevent their heart enlarging, but they were not always effective, van Gaal said.
Fulton, 64, became the first of 300 patients who will have the experimental treatment in a worldwide study.
It could be routine treatment within three years, van Gaal said.
Heart Repair Shop
Stem cells grown from patients’ own cardiac tissue can heal damage once thought to be permanent after a heart attack, according to a study that suggests the experimental approach may one day help stave off heart failure.
In a trial of 25 heart-attack patients, 17 who got the stem cell treatment showed a 50 percent reduction in cardiac scar tissue compared with no improvement for the eight who received standard care. The results, from the first of three sets of clinical trials generally needed for regulatory approval, were published today in the medical journal Lancet.
“The findings in this paper are encouraging,” Deepak Srivastava, director of the San Francisco-based Gladstone Institute of Cardiovascular Disease, said in an interview. “There’s a dire need for new therapies for people with heart failure”
The study, by researchers from Cedars-Sinai Heart Institute in Los Angeles and Johns Hopkins University in Baltimore, tested the approach in patients who recently suffered a heart attack, with the goal that repairing the damage might help stave off failure. While patients getting the stem cells showed no more improvement in heart function than those who didn’t get the experimental therapy, the theory is that new tissue regenerated by the stem cells can strengthen the heart, said Eduardo Marban, the study’s lead author.
“What our trial was designed to do is to reverse the injury once it’s happened,” said Marban, director of Cedars- Sinai Heart Institute. “The quantitative outcome that we had in this paper is to shift patients from a high-risk group to a low- risk group.”
The stem cells were implanted within five weeks after patients suffering heart attacks. Doctors removed heart tissue, about the size of half a raisin, using a minimally invasive procedure that involved a thin needle threaded through the veins. After cultivating the stem cells from the tissue, doctors reinserted them using a second minimally invasive procedure. Patients got 12.5 million cells to 25 million cells.
A year after the procedure, six patients in the stem cell group had serious side effects, including a heart attack, chest pain, a coronary bypass, implantation of a defibrillator, and two other events unrelated to the heart. One of patient’s side effects were possibly linked to the treatment, the study found.
While the main goal of the trial was to examine the safety of the procedure, the decrease in scar tissue in those treated merits a larger study that focuses on broader clinical outcomes, researchers said in the paper.
“If we can regenerate the whole heart, then the patient would be completely normal,” Marban said. “We haven’t fulfilled that yet, but we’ve gotten rid of half of the injury, and that’s a good start.”
While the study resulted in patients having an increase in muscle mass and a shrinkage of scar size, the amount of blood flowing out of the heart, or the ejection fraction, wasn’t different between the control group and stem-cell therapy group. The measurement is important because poor blood flow deprives the body of oxygen and nutrients it needs to function properly, Srivastava said.
“The patients don’t have a functional benefit in this study,” said Srivastava, who wasn’t not involved in the trial. The technology is being developed by closely held Capricor Inc., which will further test it in 200 patients for the second of three trials typically required for regulatory approval.
A sticking plaster to heal damaged hearts has been created by scientists. Packed full of healthy heart cells, it could be used to shore up areas damaged by heart attacks, cutting the odds of further ill health.
To create the inch-long patch – which is as thin as a human hair and resembles a black sticking plaster – the U.S. researchers first built a scaffold of extra-thin carbon fibres.
In experiments in a dish, healthy heart muscle, nerve and other cells ‘crawled’ on to the framework, repairing damage to the heart. In other words, it was able to bring regions of the heart left ‘dead’ by heart attack back to life, the journal Acta Biomaterialia reports.
David Stout, the study’s lead author, said: ‘This whole idea is to put something where dead tissue is to help regenerate it, so that eventually you have a healthy heart.’
Other materials were not as successful. The researchers believe the carbon fibres worked because they conduct electricity well. The first animal tests will take place this year but it is likely to be ten to 15 years before the plasters are routinely used to patch human hearts. Researcher Thomas Webster of Brown University, Rhode Islamd said ‘When someone has a heart attack, part of the heart dies. The heart compensates for that, placing it under more strain. ‘What we wanted to do was develop a material that could be inserted wherever the damage is, maybe through a catheter or small tube, so that new, healthy tissue can grow on top of it.’
While it would be best to insert the device soon after a heart attack, it may still help if it is put in up to several years later, Dr Webster added.
The approach is one of several being explored around the world.
The charity is pursuing the idea of heart patches as well as pills to trick the organ into healing itself, and injections of stem cells. Launching the appeal earlier this year, Professor Peter Weissberg, the BHF’s medical director, said: ‘The biggest issue that still eludes us is how to help people once their heart has been damaged by a heart attack.
‘Scientifically, mending human hearts is an achievable goal and we really could make recovering from a heart attack as simple as getting over a broken leg.’
Can Heart Damage Improve after Stem Cell Treatment
According to a small clinical trial published in Circulation Research: Journal of the American Heart Association it can.
We hope you can read behind the medical speak but this is definitely a step in the right direction.
Researchers have shown for the first time that stem cells injected into enlarged hearts reduced heart size, reduced scar tissue and improved function to injured heart areas.
Researchers said that while this research is in the early stages, the findings are promising for the more than five million Americans who have enlarged hearts due to damage sustained from heart attacks. These patients can suffer premature death, have major disability and experience frequent hospitalizations. Options for treatment are limited to lifelong medications and major medical interventions, such as heart transplantation, according to Joshua M. Hare, M.D., the study’s senior author and professor of medicine and director of the Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, University of Miami in Miami, Florida.
Using catheters, researchers injected stem cells derived from the patient’s own bone marrow into the hearts of eight men (average age 57) with chronically enlarged, low-functioning hearts.
“The injections first improved function in the damaged area of the heart and then led to a reduction in the size of the heart. This was associated with a reduction in scar size. The effects lasted for a year after the injections, which was the full duration of the study,” Hare said.
Specifically, researchers found:
- Heart size decreased an average of 15 percent to 20 percent, which is about three times what is possible with current medical therapies.
- Scar tissue decreased by an average of 18.3 percent.
- And there was dramatic improvement in the function, or contraction, of specific heart areas that were damaged.
“This therapy improved even old cardiac injuries,” Hare said. “Some of the patients had damage to their hearts from heart attacks as long as 11 years before treatment.”
The researchers had used two different types of bone marrow stem cells in their study — mononuclear or mesenchymal stem cells. The study lacked the power to determine if one type of cell works better than the other. All patients in the study benefited from the therapy and tolerated the injections with no serious adverse events.
Hare’s study assessed the effect of stem cell injections differently from other studies of post-heart attack stem cell treatment. His team measured contractility, scar size and structural changes of the heart.
“Studies of bone marrow cell therapy for ischemic heart disease in animals have shown improved ejection fraction (the amount of blood the heart can pump). However, this measurement has not reliably translated to early phase studies in humans,” Hare said. “Ejection fraction may not be the best way to measure the success of stem cell therapy in the human heart.”
Hare also said their findings suggest that patients’ quality of life could improve as the result of this therapy because the heart is a more normal size and is better functioning. “But, we have yet to prove this clinical benefit – this is an experimental therapy in phase one studies. These findings support further clinical trials and give us hope that we can help people with enlarged hearts.”
Co-authors are Adam R. Williams, M.D.; Barry Trachtenberg, M.D.; Darcy L. Velazquez, R.N., B.S.N.; Ian McNiece, Ph.D.; Peter Altman, Ph.D.; Didier Rouy, M.D., Ph.D.; Adam M. Mendizabal, M.S.; Pradip M. Pattany, Ph.D.; Gustavo A. Lopera, M.D.; Joel Fishman, M.D., Ph.D.; Juan P. Zambrano, M.D. and Alan W. Heldman M.D. Author disclosures are on the manuscript.
The University of Miami Interdisciplinary Stem Cell Institute, BioCardia (makers of the catheter used) and the National Institutes of Health funded the study.