Parachute device improves hemodynamic effects of LV volume reduction

A small study showed that the Parachute device increased the synchronicity of contraction, with observed leftward shifts of the pressure-volume (PV) loop and end-systolic pressure volume relationship (ESPVR), when used in a group of patients with aneurismal apices secondary to myocardial infarction.

The research paper was published online May 10 in Structural Heart, the new journal from the Cardiovascular Research Foundation.

 “The Parachute device improved synchronous contraction and enhanced ventricular-arterial interaction likely due to LV reverse remodeling,” wrote lead author Tiffany Patterson, with cardiovascular division of the Rayne Institute BHF Centre of Research Excellence at King’s College in London, and colleagues.

The study cohort comprised 10 patients, who were enrolled between December 2013 and May 2015, at one site in Belgium and another in England. The patients had all been diagnosed with symptomatic ischemic heart failure of New York Heart Association (NYHA) classes II to IV with left ventricular (LV) antero-apical wall motion abnormalities. Each of them had undergone a successful Parachute implantation.

The researchers analyzed data on six of the patients, after others were excluded for reasons such as having to have the Parachute explanted and death. These six patients underwent six-month invasive repeat hemodynamic assessment with simultaneous LV pressure-volume loop analysis.

“Pressure-volume analysis showed that both immediately after and at six months following implant, the Parachute device reduced chamber volume, and enhanced pressure generation with a later increase in stroke volume,” the researchers wrote. “We also saw increased SW/PVA ratio indicating a greater proportion of ventricular work expressed externally suggestive of improved contractility and LV energy transfer as underlying mechanism of improved hemodynamics.”

The authors stated that in the end, it’s the impact of the therapy on pump performance measures such as stroke volume and pressure generation that have clinical significance.

“It is significant that, on average, the shifts in ESPVRs and EDPVRs we observed were associated with increases in pressure generation and increased stroke volumes,” wrote Patterson et al. 

Looking ahead, they said, it remains for the ongoing large-scale Parachute IV study to establish the role of this novel therapeutic approach in the treatment of patients with ischemic heart failure.