Devices for Diastolic Dysfunction: The Golden Parachute?

12th Biennial Meeting of the International Andreas Gruentzig Society:  Rio de Janeiro - February 2-6, 2014

From SESSION 9: Emerging Therapies

Moderator:  Dennis Goodman
Panelists:    Dieter Liermann, Jeff Marshall, Klaus Mathias, Brian O’Murchu, Souheil Saddekni, Richard Shaw, Jim Zidar

Framing the question at hand, what is the state of the current knowledge?

Over 5.7 million people in US and 20 million people worldwide suffer from heart failure and about half of these suffer from Heart Failure with Preserved Ejection Fraction (HFpEF).  Most drug trials have shown minimal beneficial effects, and attention has turned to possible device therapy.  The CORolla is an elastic device implanted in the LV through transapical approach or percutaneous approach.  The device applies direct internal expansion forces distributed on the LV wall and the septum. Clinical studies are in progress.  The ImCardia device is an elastic expanding device that is attached to external LV surface through off pump procedure.  A study in patients admitted for AVR secondary to aortic stenosis showed trends to improvement in diastolic dysfunction after 24 months.

What are the Gaps in the current knowledge?

CHF with preserved EF is not always synonymous with diastolic dysfunction. There are many causes for diastolic dysfunction including HTN, valvular heart disease, infiltrative or restrictive cardiomyopathies, calcium overload,  magnesium deficiency, etc.  and any treatment will have to address the underlying cause.

Our Summary and Recommendations:

No devices (or drugs) have yet emerged with significantly positive impact on diastolic dysfunction.  Further research with Parachute Venrtricular Positioning Devices is needed.  We suggest careful assessment of diastolic outcomes in device treatment for systolic dysfunction. Alternate therapies including renal denervation, CRT and gene therapy need to be explored. Treatment of underlying causes and ultimately “Prevention” is the best therapy we have to offer our patients currently.