Methods and systems for utilizing myocardial strain imaging in an inverse framework to identify mechanical properties of the heart and to determine structural and functional milestones for the development and progression to heart failure.
Drug-coated balloon (DCB) percutaneous interventional therapy allows for durable reopening of the narrowed lumen via physical tissue expansion and local anti-restenosis drug delivery, providing an alternative to traditional uncoated balloons or a permanent indwelling implant such as a conventional metallic drug-eluting stent. While DCB-based treatment of peripheral arterial disease (PAD) has been incorporated into clinical guidelines, DCB use has been recently curtailed due to reports that showed evidence of increased mortality risk in patients treated with paclitaxel (PTX)-coated balloons. Given the United States Food and Drug Administration's 2019 consequent warning regarding PTX-eluting DCBs and the subsequent marked reduction in clinical DCB use, there is now a critical need to better understand the compositional and mechanical factors underlying DCB efficacy and safety. Most work to date on DCB refinement has focused on designing both the enabling balloon catheter and alternate coatings composed of various drugs and excipients, followed by device evaluation in preclinical and clinical studies. We contend that improvement in DCB performance will require a better understanding of the biophysical factors operative during and following balloon deployment, and moreover that the elaboration and demonstrated control of these factors are needed to address current concerns with DCB use. This article provides a perspective on the biophysical interactions that govern DCB performance and offers new design strategies for the development of next-generation DCB devices.
Strategic delivery of hydrogels to the newly formed myocardial infarction (MI) is an area of active investigation and offers high target specificity for releasing a small molecule therapeutic payload. This study examined the effects of delayed post-MI delivery (pigs, 3 days post-MI) of a shear-thinning hydrogel which encapsulated and released a small molecule matrix metalloproteinase inhibitor. The results demonstrated the feasibility and efficacy of targeted delivery of a shear-thinning injectable hydrogel containing a small molecule matrix metalloproteinase inhibitor to attenuate post-MI remodeling.
