Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

Luca Rosalia; Caglar Ozturk; Saeed Shoar; Yiling Fan; Grainne Malone; Faisal H Cheema; Claire Conway; Robert A Byrne; Garry P Duffy; Andrew Malone; Ellen T Roche; Aamir Hameed

doi:10.1016/j.jacbts.2021.06.002

Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

JACC Basic Transl Sci. 2021 Aug 4;6(9-10):772-795. doi: 10.1016/j.jacbts.2021.06.002. eCollection 2021 Sep-Oct.

Authors

Luca Rosalia^{1

2}, Caglar Ozturk², Saeed Shoar³, Yiling Fan⁴, Grainne Malone⁵, Faisal H Cheema^{3

6}, Claire Conway⁵, Robert A Byrne^{7

8}, Garry P Duffy^{5

9

10

11

12}, Andrew Malone⁵, Ellen T Roche^{1

2

4}, Aamir Hameed^{5

12}

Affiliations

¹ Health Sciences and Technology Program, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
² Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
³ HCA Healthcare, Houston, Texas, USA.
⁴ Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
⁵ Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
⁶ University of Houston, College of Medicine, Houston, Texas, USA.
⁷ Department of Cardiology, Mater Private Hospital, Dublin, Ireland.
⁸ Cardiovascular Research, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
⁹ Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland.
¹⁰ Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
¹¹ Advanced Materials for Biomedical Engineering and Regenerative Medicine, Trinity College Dublin, and National University of Ireland Galway, Galway, Ireland.
¹² Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.

Abstract

Characterized by a rapidly increasing prevalence, elevated mortality and rehospitalization rates, and inadequacy of pharmaceutical therapies, heart failure with preserved ejection fraction (HFpEF) has motivated the widespread development of device-based solutions. HFpEF is a multifactorial disease of various etiologies and phenotypes, distinguished by diminished ventricular compliance, diastolic dysfunction, and symptoms of heart failure despite a normal ejection performance; these symptoms include pulmonary hypertension, limited cardiac reserve, autonomic imbalance, and exercise intolerance. Several types of atrial shunts, left ventricular expanders, stimulation-based therapies, and mechanical circulatory support devices are currently under development aiming to target one or more of these symptoms by addressing the associated mechanical or hemodynamic hallmarks. Although the majority of these solutions have shown promising results in clinical or preclinical studies, no device-based therapy has yet been approved for the treatment of patients with HFpEF. The purpose of this review is to discuss the rationale behind each of these devices and the findings from the initial testing phases, as well as the limitations and challenges associated with their clinical translation.

Keywords: BAT, baroreceptor activation therapy; CCM, cardiac contractility modulation; CRT, cardiac resynchronization therapy; HF, heart failure; HFmEF, heart failure with mid-range ejection fraction; HFpEF; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; IASD, Interatrial Shunt Device; LAAD, left atrial assist device; LAP, left atrial pressure; LV, left ventricular; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; NYHA, New York Heart Association; PCWP, pulmonary capillary wedge pressure; QoL, quality of life; TAA, transapical approach; atrial shunt devices; electrostimulation; heart failure devices; heart failure with preserved ejection fraction; left ventricular expanders; mechanical circulatory support; neuromodulation.

Publication types

Review