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Return to New Therapies for Heart Failure Overview

More on New Therapies for Heart Failure

New Therapies for Heart Failure

Left Ventricular Assist Devices (LVAD), Drugs for Renal Complications, and a Gene Therapy Trial Known as CUPID

New York (Jul 16, 2009)

Illustration of human heart

Doctors at NewYork-Presbyterian Hospital have new treatment options for patients suffering from heart failure: left ventricular assist devices (LVAD), drugs for renal complications, and a multicenter intracoronary gene therapy trial known as CUPID (Calcium Up-Regulation by Percutaneous Administration of Gene Therapy in Cardiac Disease).

Heart Failure Epidemic Among Americans

Heart failure is epidemic among Americans – half a million people are diagnosed with it each year and it tops the list of reasons for hospital visits in those over 65. "The good news is that current treatments have extended the life expectancy of people with heart failure," said Ulrich Jorde, MD, a cardiologist at NewYork-Presbyterian Hospital. And researchers have these promising new treatments in development that could improve quality of life during those years.

"Repeated heart attacks cause most cases of chronic heart failure," said Dr. Jorde. Each attack "progressively reduces cardiac strength as measured by left ventricular ejection fraction. Patients with a low ejection fraction may have problems in performing their daily activities." As the condition progresses other organs suffer. "The real problems arise when the heart cannot do its job and the other organs, specifically the kidney, begin to suffer also. That's when you're going down the road."

Therapies for Heart Failure

To slow the progression of heart failure cardiologists use three basic treatment approaches:

  • Pharmaceutical therapy including ACE inhibitors, diuretics, vasodilators, beta-blockers, calcium channel blockers, potassium, and cholesterol lowering drugs
  • Pacemakers
  • Surgical interventions including valve surgery, coronary revascularization, heart transplant, and left ventricular assist devices (LVAD)

Lifestyle changes including exercising more, reducing salt intake, managing stress, treating depression, and losing weight can also help.

These therapies have extended the life expectancy of most people with chronic heart failure, and the annual mortality rate has fallen from 52 percent to less than 20 percent in the past decade. "Patients are living longer, but often live for years with very weak hearts," said Dr. Jorde, "and eventually they become maxed out on therapies." Doctors at NewYork-Presbyterian's Columbia Center for Advanced Cardiac Care specialize in seeing patients at this stage of the disease.

"When people come to see us they usually have failed standard therapy or they are not doing well for some other reason. Our first step is to make sure that the standard therapies have been appropriately employed – and two of three times that's the case. Patients at this stage of the disease have fewer treatment options, so it is critical that they see a specialist who is up to date and who offers the full range of available treatments," he said.

Heart Transplants and LVAD's

A heart transplant is an option for some patients, and NewYork-Presbyterian performs more transplants – between 80 to 120 each year – than any other center in the country. But the number of transplants has remained steady at about 2,000 each year in the US over the last decade while the number of heart failure patients has grown. "There is a significant donor shortage and the demand for donor organs far outstrips the supply. Until the advent of assist devices patients waiting for a transplant would simply have died," Dr. Jorde said. "There are also many patients for whom a transplant would not be a good idea. For both of these groups of patients we now have left ventricular assist device (LVAD) pumps," he said.

Researchers at NewYork-Presbyterian are testing the third generation of LVADs in clinical trials. These are significantly smaller than the first pumps, which gives them several advantages, he said. "The new pumps have a much lower risk of infection, they are not audible like the larger pumps are, and they have a longer life span – probably at least five years versus one to two for the older pumps." These new LVADs should be available for use outside of clinical trials by 2010, he added.

Once patients reach the point where they come into the ER with renal complications from heart failure their prognosis is not good. "One in ten patients who come into the ER with acute heart failure and renal complications are discharged and die within the next three months," Dr. Jorde said. Standard therapy is a diuretic such as furosemide (Lasix). NewYork-Presbyterian researchers are testing new medications in this acute setting in heart failure patients who are coming to the hospital for the first time. "We're employing a new strategy at time of presentation. We're currently testing two new agents to possibly prevent or treat renal complications." The two agents include KW-3902 (rolofylline), a novel adenosine A1-receptor antagonist and the hormone relaxin.

New Gene Therapy Clinical Trial for Heart Failure

NewYork-Presbyteran researchers are also participating in a multicenter intracoronary gene therapy trial (CUPID: Calcium Up-Regulation by Percutaneous Administration of Gene Therapy in Cardiac Disease). End-stage heart failure is associated with low cardiac levels of SERCA2a, an enzyme that coordinates the flux of calcium ions in and out of the cardiac muscle cells, thereby regulating the contraction and relaxation of the heart. Researchers are assessing the effectiveness of resupplying the heart with a functional gene for SERCA2a through a single injection of the gene into the coronary artery. "This is really investigational at this point, but we believe it is safe," Dr. Jorde said.

Donna M. Mancini, MD is the contact for the gene therapy clinical trial.

Ulrich Jorde, MD is an Assistant Attending Physician at NewYork-Presbyterian Hospital/Columbia University Medical Center, and an Assistant Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons.

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