Dermal filler injection: a novel approach for limiting infarct expansion.
BACKGROUND
Early infarct expansion after coronary occlusion compromises contractile function in perfused myocardial regions and promotes adverse long-term left ventricular (LV) remodeling. We hypothesized that injection of a tissue-expanding dermal filler material into a myocardial infarction (MI) would attenuate infarct expansion and limit LV remodeling.


METHODS
Fifteen sheep were subjected to an anteroapical MI involving approximately 20% of the LV followed by the injection of 1.3 mL of a calcium hydroxyapatite-based dermal filler into the infarct. Real-time three-dimensional echocardiography was performed at baseline, 30 minutes after MI, and 15 minutes after injection to assess infarct expansion. Sixteen additional sheep were subjected to the same infarction and followed echocardiographically and hemodynamically for 4 weeks after MI to assess chronic remodeling. Eight animals had injection with dermal filler as described above immediately after MI, and 8 animals were injected with an equal amount of saline solution.


RESULTS
All animals exhibited infarct expansion soon after coronary occlusion. The regional ejection fraction of the apex became negative after infarction, consistent with systolic dyskinesia. Injection of the dermal filler converted the apical wall motion from dyskinetic to akinetic and resulted immediately in significant decreases in global, regional, and segmental LV volumes. Chronically, relative to saline control, dermal filler injection significantly reduced LV end-systolic volume (62.2 +/- 3.6 mL versus 44.5 +/- 3.9 mL; p < 0.05) and improved global ejection fraction (0.295 +/- 0.016 versus 0.373 +/- 0.017; p < 0.05) at 4 weeks after infarction.


CONCLUSIONS
Injection of an acellular dermal filler into an MI immediately after coronary occlusion reduces early infarct expansion and limits chronic LV remodeling.
Ryan
Liam P
LP
Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Matsuzaki
Kanji
K
Noma
Mio
M
Jackson
Benjamin M
BM
Eperjesi
Thomas J
TJ
Plappert
Theodore J
TJ
St John-Sutton
Martin G
MG
Gorman
Joseph H
JH
Gorman
Robert C
RC
D000818:Animals; D001707:Biopsy, Needle; D003879:Dermatologic Agents / Q000494:pharmacology; D004195:Disease Models, Animal; D018450:Disease Progression; D017886:Durapatite / Q000494:pharmacology*; D017548:Echocardiography, Transesophageal; D005782:Gels / Q000494:pharmacology; D007150:Immunohistochemistry; D015552:Injections, Intralesional; D008297:Male; D008863:Microspheres; D009200:Myocardial Contraction / Q000187:drug effects; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D011336:Probability; D011897:Random Allocation; D012016:Reference Values; D012680:Sensitivity and Specificity; D020257:Ventricular Remodeling / Q000187:drug effects* / Q000502:physiology
D003879:Dermatologic Agents; D005782:Gels; D017886:Durapatite