Abstract| Volume 23, ISSUE 10, SUPPLEMENT , S36, October 2017

β-blocker Combined with Left Ventricular Assist Device Synergistically Reduces Myocardial Oxygen Consumption in Acute Myocardial Infarction

      Background: Reducing myocardial oxygen consumption (MVO2) in acute myocardial infarction (AMI) decreases infarct size. Although β-blocker reduces MVO2 through its negative chronotropic/inotropic effects, the same mechanisms could destabilize hemodynamics. If we can prevent the hemodynamic destabilization, we can maximize the benefit of β-blocker to spare MVO2. Left ventricular assist device (LVAD) is known to unload LV, reduce MVO2 and stabilize hemodynamics. We hypothesized that the combination of LVAD and landiolol, a short acting intravenous β-blocker, synergistically reduces MVO2 without hemodynamic destabilization in AMI. Methods: In 5 mongrel dogs, we occluded the left circumflex coronary artery for 1 hour, and measured MVO2 (Fick's rule) and hemodynamics. We compared those parameters among 4 conditions; Control, LVAD (transvascular LVAD, Impella), landiolol with LVAD (5 and 40 µg/kg/min). Results: Landiolol (40 µg/kg/min) reduced heart rate (−22 ± 5%, P < .01), decreased mean arterial pressure (−27 ± 16 mmHg, P < .05) and increased LV end-diastolic pressure: (18.6 ± 5.0 vs. 14.3 ± 5.3 mmHg, P < .05). LVAD reduced MVO2 by 26 ± 26% compared with Control. The combination of LVAD with 5 and 40 µg/kg/min of landiolol further reduced MVO2 by 40 ± 20% and 50 ± 18%, respectively, without compromising hemodynamics. Conclusions: The combination of LVAD and landiolol synergistically reduced MVO2 without worsening hemodynamics. This powerful oxygen sparing effect of combination treatment may well be translated into the reduction of infarct size. This strategy will provide a new therapeutic option in AMI.
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