Mode-of-action of the PROPELLA concept in fulminant myocarditis

F Spillmann, S Van Linthout, G Schmidt, O Klein, N Hamdani, T Mairinger, F Krackhardt, B Maroski, T Schlabs, S Soltani, S Anker, EV Potapov, D Burkhoff, B Pieske and C Tschope
Eur Heart J 2019

AIMS: Haemodynamic load induces cardiac remodelling via mechano-transduction pathways, which can further trigger inflammatory responses. We hypothesized that particularly in an inflammatory disorder such as myocarditis, a therapeutic strategy is required which, in addition to providing adequate circulatory support, unloads the left ventricle, decreases cardiac wall stress, and mitigates inflammatory responses.

METHODS AND RESULTS: Axial flow pumps such as the Impella systems comply with these requirements. Here, we report a potential mode-of-action of prolonged Impella support (PROPELLA concept) in fulminant myocarditis, including a decrease in cardiac immune cell presence, and integrin alpha1, alpha5, alpha6, alpha10 and beta6 expression during unloading.

CONCLUSION: PROPELLA may provide benefits beyond its primary function of mechanical circulatory support in the form of additional disease-altering effects, which may contribute to enhanced myocardial recovery/remission in patients with chronic fulminant myocarditis.

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