Cardiovascular event risk estimated after coronary revascularization and optimal medical therapy: J-ACCESS4 prognostic study.

BACKGROUND: An assessment of cardiac events and survival using quantitative gated myocardial single-photon emission computed tomography (SPECT) (J-ACCESS) associated several risk factors with cardiac events in Japan. The clinical course after revascularization and/or optimal medical therapy (OMT) was followed in patients with coronary artery disease (CAD) at moderate-to-high risk estimated by software incorporating the J-ACCESS risk model. The present study aimed to determine the relevance of changes in estimated risk to outcomes of these therapies. METHODS: This study included 494 patients with possible or definite CAD who underwent initial pharmacological stress 99mTc-tetrofosmin myocardial perfusion SPECT (MPS) before and eight months after therapy. Major cardiac event risk during 3 years of follow-up was calculated using an equation based on that in the J-ACCESS study. Patients with ≥ 10% cardiac event risk estimated at the first MPS (n = 31) were analyzed and followed up for at least 1 year. RESULTS: Estimated risk was reduced by ≥ 5% in 14 patients (45%) after therapy. During a follow-up period of 22.1 ± 6.7 months, one patient without such reduction had a major cardiac event. Mean %summed stress scores significantly decreased from baseline to follow-up in patients with and without risk reduction. Left ventricular ejection fraction (LVEF [%]) at rest was significantly increased at the second, compared with the first MPS between patients with, than without risk reduction (57 ± 17 vs. 45 ± 16%, p = 0.001 and 50 ± 11 vs. 49 ± 9%, p = 0.953, respectively). CONCLUSIONS: A reduction in cardiac ischemia and an increase in LVEF by revascularization and/or OMT were necessary to avoid cardiac events among patients with moderate-to-high estimated risk, and changes in event risk were quantifiable.

Cumulative radiation exposure and cancer risk of patients with ischemic heart diseases from diagnostic and therapeutic imaging procedures.

OBJECTIVES: To present a detailed analysis of the cumulative radiation exposure and cancer risk of patients with ischemic heart diseases (IHD) from diagnostic and therapeutic imaging. METHODS: For 1219 IHD patients, personal and examination data were retrieved from the information systems of a university hospital. For each patient, cumulative organ doses and the corresponding effective dose (E) resulting from all imaging procedures performed within 3 months before and 12 months after the date of the diagnosis were calculated. The cumulative lifetime attributable risk (LAR) of the patients to be diseased by radiation-related cancer was estimated using sex-, age-, and organ-specific risk models. RESULTS: Among the 3870 procedures performed in the IHD patients, the most frequent were radiographic examinations (52.4%) followed by coronary catheter angiographies and percutaneous cardiac interventions (41.3%), CT scans (3.9%), and perfusion SPECT (2.3%). 87% of patient exposure resulted from heart catheter procedures. E and LAR were significantly higher in males than females (average, 13.3 vs. 10.3 mSv and 0.09 vs. 0.07%, respectively). Contrary to the effective dose, the cancer risk decreased markedly for both sexes with increasing age. CONCLUSIONS: Although IHD patients were partially exposed to considerable amounts of radiation, estimated LARs were small as compared to their baseline risk to develop cancer in the remaining life.

[Potentials of combined non-medication therapy of arterial hypertension associated with ischemic heart disease].

The objective of the present work was to develop methods and a scientifically sound rationale for the optimization of clinical results of the treatment of patients presenting with arterial hypertension (AH) associated with coronary heart disease (CHD) using red and infra-red (IR) low-intensity laser irradiation. The study included a total of 90 patients of working age (62.2% of men and 37.8% of women) having AH associated with coronary heart disease and abnormal blood lipid spectrum. They were allocated to three groups each comprising 30 patients matched for age, sex, severity of clinical conditions, and character of maintenance medicamental therapy. Patients of group 1 were treated by intravenous blood irradiation with laser light; those in group 2 were given similar treatment in combination with external low-intensity IR laser therapy; patients of group 3 received basal medicamental therapy. The study allowed the clinical value of different variants of low-intensity laser therapy to be assessed as regards efficiency of correction of hypersympaticotony, disturbances of lipid metabolism, and refractoriness to pharmaceutical products as well as improved tolerance of physical exercises, anti-hypertensive, anti-ischemic, and anti-anginal effects, diastolic function, and quality of life as targets of the comprehensive rehabilitative program designed for patients with AH associated with coronary heart disease. An optimized therapeutic modality is proposed for patients presenting with these pathologies based on the application of the low-intensity laser irradiation regime characterized by mutual amplification and complementary action of red and infrared lights.

[Laser Doppler fluometry in assessment of endothelium state in patients with coronary heart disease and its correction by intravenous laser irradiation of blood].

Influence of laser therapy on vascular endothelium function in patients with stable angina pectoris, detected by the method of laser Doppler fluorimetry, was studied. 77patients with stable angina pectoris were divided into 2 groups. In control group only medicamentous therapy was used, in main group a course of intravenous blood laser irradiation was carried out additionally. The increase of initially decreased mean index of microcirculation and index of microcirculation after acetylcholine iontophoresis was noticed. Tendency to increase of endothelial oscillations and capillary blood flow under influence of intravenous blood laser irradiation was noticed too. Laser therapy can be considered an effective method of increase of endothelial functional activity in patients with stable angina pectoris.

Effect of low-intensity laser irradiation and wideband red light on experimentally ischemized myocardium.

The effect of helium-neon laser irradiation and wideband red light on electrical activity of open rat heart was examined after experimentally produced ischemia. The red light applied with the help of optical fibers modified parameters of cardiac electrical activity and intensity of lipid peroxidation in the myocardium. The effects of laser and red light irradiation differed significantly.

Clinical and experimental applications of NIR-LED photobiomodulation.

This review presents current research on the use of far-red to near-infrared (NIR) light treatment in various in vitro and in vivo models. Low-intensity light therapy, commonly referred to as "photobiomodulation," uses light in the far-red to near-infrared region of the spectrum (630-1000 nm) and modulates numerous cellular functions. Positive effects of NIR-light-emitting diode (LED) light treatment include acceleration of wound healing, improved recovery from ischemic injury of the heart, and attenuated degeneration of injured optic nerves by improving mitochondrial energy metabolism and production. Various in vitro and in vivo models of mitochondrial dysfunction were treated with a variety of wavelengths of NIR-LED light. These studies were performed to determine the effect of NIR-LED light treatment on physiologic and pathologic processes. NIRLED light treatment stimulates the photoacceptor cytochrome c oxidase, resulting in increased energy metabolism and production. NIR-LED light treatment accelerates wound healing in ischemic rat and murine diabetic wound healing models, attenuates the retinotoxic effects of methanol-derived formic acid in rat models, and attenuates the developmental toxicity of dioxin in chicken embryos. Furthermore, NIR-LED light treatment prevents the development of oral mucositis in pediatric bone marrow transplant patients. The experimental results demonstrate that NIR-LED light treatment stimulates mitochondrial oxidative metabolism in vitro, and accelerates cell and tissue repair in vivo. NIR-LED light represents a novel, noninvasive, therapeutic intervention for the treatment of numerous diseases linked to mitochondrial dysfunction.

Are neutrons involved in the pathogenesis of life-threatening cardiac arrhythmias?

Geomagnetic fields protect the earth from the adverse effects of cosmic rays, whose activity can be indirectly measured by monitoring the level of neutrons in the environment. The number and days of discharges from automatic implantable cardioverter defibrillators (ICD) in patients with cardiac arrhythmias are inversely correlated with the daily level of geomagnetic activity (GMA). The aim of the present was to determine whether neutron levels on days of AICD discharges are higher than average. Days on which discharges occurred were recorded in 31 patients bearing ICDs for managing ischemic cardiomyopathy. Daily neutron levels obtained from the monitoring data of the Russian Academy of Sciences in Moscow were analyzed using Student's t test. The mean (+/-SD) daily neutron level for the 1096-day period was 8299.29 +/- 294.236 imp/min (median 8252), and for days of ACID discharge, 8423.93 +/- 274.187 imp/min (median 8443) (p = 0.0002). The mean neutron activity on days of AICD discharges in response to ventricular disturbances was significantly higher than the mean level over the 1096-day study period. Whether this relation is a direct result of low GMA or due to an independent role of neutrons in the pathogenesis and timing of cardiac arrhythmias is unknown.

[Efficacy of laser therapy in patients with ischemic heart disease]. / Effektivnost' lazeroterapii bol'nykh ishemicheskoi bolezn'iu serdtsa.

Modification of erythrocytic membrane and the trend in clinicofunctional indices were studied in 93 patients with angina of effort (FC i-IV) in the course of treatment with laser radiation (group 1) and imitation of laser radiation (group 2). In patients of group 1 the treatment resulted in stabilization of cell membrane accompanied with positive cardiodynamic changes.

[Antioxidant action and therapeutic efficacy of laser irradiation of blood in patients with ischemic heart disease]. / Antioksidantnoe deistvie i terapevticheskaia effektivnost' lazernogo oblucheniia krovi u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Laser irradiation in therapeutic doses (gamma = 632.8 nm, 14 mW) has an antioxidant effect in blood irradiation in vitro as shown by activation of superoxide dismutase (SOD) which is a key enzyme of the antioxidant system (AOS) and suppression of lipid peroxidation. Adjuvant supravascular He-Ne laser irradiation of blood in combined therapy of 82 patients with ischemic heart disease (IHD) produces a positive trend in the clinical picture, hemostasis, lipid metabolism, blood SOD activity. Thereby, this method of laser hemotherapy is recommended for use in IHD patients. The dependence of the treatment results on the initial blood AOS necessitates consideration of AOS state in deciding on laser therapy in this group of patients.

[Use of infrared laser therapy in patients with ischemic heart disease associated with diabetes mellitus type 2 in health resort]. / Infrakrasnaia lazerterapiia u bol'nykh ishemicheskoi bolezn'iu serdtsa, assotsiirovannoi s sakharnym diabetom tipa 2, v usloviiakh kurorta.

Infrared laser therapy (300 Hz) combined with balneotherapy and patients' education is more effective than standard sanatorium rehabilitation in patients with ischemic heart disease associated with diabetes mellitus type 2. 81.8% patients showed good response manifesting in less frequent anginal attacks, episodes of pain and painless ischemia and lower doses of antianginal drugs. Systolic and diastolic arterial pressure lowered by 18 and 10 mm Hg on the average, respectively. Multimodality rehabilitation of IHD patients with type 2 diabetes mellitus improves hemostasis, carbohydrate and lipid metabolism. Coronary circulation response lasted for 24 weeks.

[The efficiency of low-intensity laser radiation in the treatment of arterial hypertension complicated by ischemic heart disease]. / Effektivnost' ispol'zovaniia nizkointensivnogo lazernogo izlucheniia pri lechenii arterial'noi gipertonii i ee sochetaniia s ishemicheskoi bolezn'iu serdtsa.

The efficiency of low-intensity laser radiation (LILR) was studied in the treatment of 291 patients with arterial hypertension and ischemic heart disease. Clinical grounds are given for use of LILR red and infrared rays in rehabilitation of hypertensive patients with ischemia. The rehabilitation regimens can be differentiated according to the disease severity, type of hemodynamics, state of cerebral circulation.

[Evaluation of quantum therapy for the treatment of stable angina]. / Otsinka efektyvnosti vplyvu kvantovoï terapiï na perebig stabil'noï stenokardiï.

A total of 68 patients have been examined. Of these, 21 had functional class (FC) I stabile angina, 23 presented with FC II angina, 24 had FC III angina. Instituted in the control group patients (n = 30) was standard antianginal therapy (SAT). Laser therapy against the background of SAT employed has been found to improve the functional state of the myocardium, enhance tolerance to physical loads, improve indices for intracardiac hemodynamics. He-Ne laser irradiation has an analgecizing effect. Patients with FC I-III exertional angina can derive benefit from laser therapy due to its cardioprotective effect. Positive hemodynamic shifts were accompanied by improvement in general health of patients manifested by lower frequency of angina attacks and episodes of pain-free ischemia of the myocardium. Laser therapy had an effect on relation between painful and painless ischemia of the myocardium as evidenced by a predominant decrease in pain-free episodes of myocardial ischemia, this being regarded as a prognostically favourable fact.

[Laser irradiation in the treatment of ischemic heart disease]. / Lazernoe obluchenie v lechenii ishemicheskoi bolezni serdtsa.

Cardiodynamic changes due to beta-blocker carvedilol and low-intensity infrared laser radiation were compared in 115 patients with ischemic heart disease (IHD). The comparison has shown a similar positive effect on heart contractility and diastolic function. This gave arguments for feasibility of laser beam usage as a neurohormonal modulator in IHD patients to reduce cardiac remodulation and prevent cardiac failure.

Intracoronary beta-irradiation with a liquid (188)re-filled balloon: six-month results from a clinical safety and feasibility study.

BACKGROUND: Coronary irradiation is a new concept to reduce restenosis. We evaluated the feasibility and safety of intracoronary irradiation with a balloon catheter filled with (188)Re, a liquid, high-energy beta-emitter. METHODS AND RESULTS: Irradiation with 15 Gy at 0.5-mm tissue depth was performed in 28 lesions after balloon dilation (n=9) or stenting (n=19). Lesions included 19 de novo stenoses, 4 occlusions, and 5 restenoses. Irradiation time was 515+/-199 seconds in 1 to 4 fractions. There were no procedural complications. One patient died of noncardiac causes at day 23. One asymptomatic patient refused 6-month angiography. Quantitative angiography after intervention showed a reference diameter of 2. 77+/-0.35 mm and a minimal lumen diameter of 2.36+/-0.43 mm. At 6-month follow-up, minimal lumen diameter was 1.45+/-0.88 mm (late loss index 0.57). Target lesion restenosis rate (>50% in diameter) was low (12%; 3 of 26). In addition, we observed 9 stenoses at the proximal or distal end of the irradiation zone, potentially caused by the short irradiation segment and the decreasing irradiation dose at its borders ("edge" stenoses). The total restenosis rate was 46% and was significantly lower (29% vs 70%, P=0.042) when the length of the irradiated segment was more than twice the lesion length. CONCLUSIONS: Coronary irradiation with a (188)Re-filled balloon is technically feasible and safe, requiring only standard percutaneous transluminal coronary angioplasty techniques. The target lesion restenosis rate was low. The observed edge stenoses appear to be avoidable by increasing the length of the irradiated segment.

[Mechanism of laser radiation action at tissue and cellular levels]. / Mekhanizm deistviia lazernogo oblucheniia na tkanevom i kletochnom urovniakh.

The paper describes the action of low-intensity laser radiation (LILR) and high-intensity one (HILR) on biological tissues. LILR produces its action on cells by changing the membranous formations-receptors and ion channels. At cardiac surgery, HILR stimulates uncontractile myocardial elements, by inducing the secretion of biologically active substances and the activation of enzyme systems that ensure the implementation of neoangiogenesis in the ischemic myocardium.

[The mechanisms of the development of secondary exacerbation during laser therapy in patients with ischemic heart disease and the possible ways to prevent it]. / Mekhanizmy razvitiia vtorichnogo obostreniia pri lazerterapii u bol'nykh ishemicheskoi bolezn'iu serdtsa i vozmozhnye puti ego profilaktiki.

In view of possible exacerbation of ischemic heart disease in laser therapy as a result of structural modification of biomembranes it is suggested to prevent secondary exacerbation by combination of laser therapy with membranoprotectors including antioxidants, lipase inhibitors, phospholipases and essential phospholipids.