# Percutaneous Left Ventricular Unloading for Cardiogenic Shock: Beyond Acute Hemodynamic Support

> **NIH NIH R01** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2022 · $423,750

## Abstract

PROJECT SUMMARY:
 Cardiogenic shock develops in 7-10% of patients with acute Myocardial Infarction (MI), and has a high
mortality ranging 50-70%. Short-term Left Ventricular (LV) unloading is a new concept that became a reality
with the recent emergence of powerful percutaneous Left Ventricular Assist Devices (pLVAD)s, which offers
significant promise for improving the outcomes of the patients with cardiogenic shock. Several clinical and pre-
clinical studies demonstrated clear improvement in hemodynamics using these devices, however no clinical
studies have so far shown improvement in 30-day clinical outcome. Current data suggest that pLVADs improve
hemodynamics and very acute clinical outcome (~24hr), but the functional recovery of injured heart during LV
support is often not sufficient to maintain the hemodynamics after the devices are removed, resulting in only
slowing of the death.
 Large amount of research focus on short-term LV unloading is on the acute changes in hemodynamics
and when, how, and to whom we introduce these devices. In contrast, little is studied on how we exit from
these device therapies. Here, in order to maximize the benefit of pLVADs use for cardiogenic shock, we
propose to study key elements that may influence functional recovery of native heart after LV unloading with
pLVADs. Specifically, we propose to study 1) impact of LV re-loading, 2) impact of cardiac molecular
alterations associated with LV unloading, and 3) adjunctive approach to boost cardiac functional recovery.
 Our central hypothesis is that initiation of LV unloading as well as re-loading negatively influence
cardiac function, and additional therapy is required to improve the clinical outcomes of patients with
cardiogenic shock treated with pLVADs. To test our central hypothesis we propose below Specific Aims.
Specific Aim 1. Define the impact of LV re-loading
Specific Aim 2. Define the impact of LV unloading on post-translational modification in key
cardiac proteins
Specific Aim 3. Use gene therapy to promote myocardial recovery
 Our study will increase the understanding of molecular changes in the heart after LV unloading and re-
loading. As we foresee increase in pLVADs use for patients with cardiogenic shock, identifying the potential
harm and developing ways to improve current low survival with short-term LV unloading has a significant
clinical impact.

## Key facts

- **NIH application ID:** 10319941
- **Project number:** 5R01HL139963-05
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Kiyotake Ishikawa
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $423,750
- **Award type:** 5
- **Project period:** 2017-12-15 → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10319941

## Citation

> US National Institutes of Health, RePORTER application 10319941, Percutaneous Left Ventricular Unloading for Cardiogenic Shock: Beyond Acute Hemodynamic Support (5R01HL139963-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10319941. Licensed CC0.

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