In a major advancement for the treatment of severe heart attack patients, a team of MIT researchers has developed a predictive test that determines how patients will react to mechanical heart pumps, commonly used during cardiogenic shock. The research promises to enhance the medical community's ability to tailor treatments to individual patient needs, potentially preventing a common and dangerous imbalance between the heart's left and right ventricles, according to MIT News.
Annually, around 50,000 U.S. citizens are struck with cardiogenic shock, which can result from a severe heart attack when the heart fails to supply sufficient blood to the body. Mechanical pumps or ventricular assist devices (VADs) are often employed as a temporary solution for these critical patients. However, nearly half of these patients experience ventricular balance disruptions, with current methods offering limited predictive capacity for these complications, as reported by the findings published in Science Translational Medicine.
Kimberly Lamberti, an MIT graduate student and lead author of the study, emphasized the value of the new test, “As we improve the mechanistic understanding of how these technologies interact with the native physiology, we can improve device utility. And if we have more algorithms and metrics-based guidance, that will ease use for clinicians. This will both improve outcomes across these patients and increase use of these devices more broadly,” Lamberti told MIT News.
The challenges often occur when a percutaneous VAD is used to aid a failing left ventricle, which pumps blood to the majority of the body, while the right ventricle pumps blood to the lungs. The left and right ventricles should work in tandem, but the introduction of a VAD can disrupt this balance leading to right heart failure in up to 43 percent of patients. Elazer Edelman, the Edward J. Poitras Professor in Medical Engineering and Science at MIT and senior author of the paper, praised the study for providing straightforward guidelines as to how to deal with the exploding use of these valuable mechanical devices, according to MIT News.
In their research, the team uncovered that the response of the right ventricle to the VAD is largely dependent on the pulmonary vascular system's adaptability to changes in blood volume and flow. By measuring pulmonary vascular compliance, and how it adjusts to increased blood flow, clinicians may essentially predict if a patient's right heart will require additional support. This revelation stems from studies on both animal models and a dataset of human patients who have used left VADs.
Lamberti outlined a process by which the compliance of the pulmonary vascular system can be assessed dynamically with a common pulmonary artery catheter and the VAD itself. “We created this way to dynamically test the system while simultaneously maintaining support of the heart,” Lamberti explained to MIT News. This assessment could indicate the necessity for right ventricular support early on, avoiding further complications.
The research has the potential to deeply impact the medical field, providing physicians with a more concrete evidence base for their decisions regarding the use of mechanical pumps. The MIT team intends to pursue further animal studies and collaborations with device manufacturers to test the clinical validity of their findings. This study was supported by grants from the National Heart, Lung, and Blood Institute, the National Institute of General Medical Sciences, and Abiomed.
