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.

[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.

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.

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.

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.

Angiogenesis and expression of tenascin after transmural laser revascularization.

Transmyocardial revascularization (TMR) with CO2-laser equipment is an alternative approach in the treatment of patients with severe ischemic cardiac disease. Several studies concerning morphological features after TMR document a strong transmyocardial injury, but little is known about wound healing in laser-induced alterations of the cardiac skeleton and their putative role for angiogenesis and endothelialization. The present study was conducted to establish a useful immunohistochemical marker for detection of these laser-induced injuries and to analyze starting points of angiogenesis in human myocardium after TMR. Our data show that tenascin labeling is a useful immunohistochemical approach to detect laser-alterated segments of the cardiac skeleton as well as laser-induced fibrosis. Starting points of the angiogenetic process are seen throughout the margins of laser-induced lesions where myocardial capillaries are found. Disrupted vessels located within laser-alterated connective tissue septa are not major starting points for endothelialization of laser-induced lesions and for capillary sprouts. In comparison to laser-induced fibrosis, induction and promotion of angiogenesis by laser radiation is weak.

[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.

[A quantitative analysis of the ultrastructures of the blood polymorphonuclear neutrophils in patients with ischemic heart disease after a session of intravenous laser therapy]. / Kolichestvennyi analiz ul'trastruktur polimorfnoiadernykh neitrofilov krovi u bol'nykh ishemicheskoi bolezn'iu serdtsa posle seansa vnutrivennoi lazerterapii.

Circulating neutrophilic granulocytes before and after laser therapy were studied in 10 patients with ischemic heart disease and 5 healthy persons. The patients had severe cytoplasm vacuolization, specific granules number increase, a decrease in thickness of the submembranous actin layer and decrease of surface = volume ratio. Neutrophils indices in patients with ischemic heart disease become closer to those in donor cells after blood irradiation with a helium-neon laser. The results indicate a normalizing effect of helium-neon laser irradiation on the mechanisms of non-specific reactivity in some forms of ischemic heart disease.

[The effect of transvenous laser therapy on lipid peroxidation function in patients with ischemic heart disease]. / Vliianie transvenoznoi lazernoi terapii na sostoianie perekisnogo okisleniia lipidov u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The papers deals with changes in the levels of lipid peroxidation products in patients with stable angina of effort, which occurred with intravenous helium-neon blood irradiation. The therapy was highly effective in patients with lower functional classes and persons with normal circulation, resulting in a reduction in lipid peroxidation intensity. Predictors are recommended to determine the efficiency and expediency of laser therapy in patients with coronary heart disease.

[Role of trace elements in the development of chronic ischemic heart disease]. / Rol' mikroélementov v razvitii khronicheskoi ishemicheskoi bolezni serdtsa.

It was shown that determination of erythrocyte superoxide dismutase activity proves to be the adequate test of antioxidant protection under chronic coronary heart disease as well as the reliable laboratory test for the control of the effect of prophylactic ultra-violet radiation.

[Changes in the lipid content of the blood and erythrocyte membrane in patients with IHD under the influence of quantum therapy]. / Izmeneniia soderzhaniia lipidov krovi i éritrotsitarnoi membrany u bol'nykh IBS pod vliianiem kvantovoi terapii.

Laser therapy of coronary patients significantly diminished total cholesterol, low and very low density lipoproteins, triglycerides and atherogenic index persisting for 3-6 months. Primary changes in the structure of the lipid bilayer of a red cell membrane in response to laser radiation are considered to be an effect of the physical factor characterized by activation of lipid peroxidation, phospholipolysis, by growth of membrane cholesterol content (phase I). Mobilization of the adaptive mechanisms was accompanied by positive shifts in the structure pattern of a biomembrane with return to initial condition by the end of the therapy course (phase II). Further (III) phase of subcellular changes resultant from quantum effects lasted for 3 months and brought activation of the antioxidant system, reorganization of phospholipid membrane composition, an increase in osmotic resistance of red cells. This may produce a positive tendency in IHD.

[The stress-modulating effects of laser therapy in IHD patients]. / Stress-moduliruiushchie éffekty lazeroterapii u bol'nykh IBS.

Dependence of the response to helium-neon laser therapy (LT) on initial level and changes of blood plasma hydrocortisone (HC), testosterone (T), diene conjugates (DC) concentration, general antioxidant activity (AOA) of blood plasma, TxB and 6-keto-PGF were estimated in 147 patients with ischemic heart disease and stable angina. The response to LT was observed in patients with high levels of HC, T, AOA and 6-keto-PGF1 alpha. A significant increase of DC was noted in these patients too. The minimal level of HC. T and AOA was recorded in patients with negative clinical effect. The treatment only aggravated HC, T and AOA deficiency and raised DC and TxB level. The findings suggest that the effect of LT is based on modulation of nonspecific adaptive mechanisms.

[The effect of laser irradiation of the blood on the adenosine triphosphatase activity of the erythrocyte membranes and on the cardiac activity indices in patients with ischemic heart disease]. / Vliianie lazernogo oblucheniia krovi na aktivnost' adenozintrifosfataz membrany eritrotsitov i pokazateli serdechnoi deiatel'nosti u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The activity of potassium, sodium, magnesium and Ca-ATP-ase of the erythrocytic membrane, index of erythrocyte deformability, changes of the hemodynamics and some cardiac function during bicycle ergometry [correction of veloergometry] tests before and after a course of laser irradiation of the blood were studied in 36 patients with exertion stenocardia. It was established that laser therapy is accompanied by increase of the activity of ATP-ase, index of erythrocyte deformability and positive changes of the cardial function. The possibility is discussed of improving the cardiac function under the effect of laser irradiation as a result of optimization of the structural-functional organization of the cellular membrane.

[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 therapy in the treatment of patients with ischemic heart disease in a therapeutic department]. / Lazeroterapiia v lechenii bol'nykh ishemicheskoi bolezn'iu serdtsa v usloviiakh terapevticheskogo otdeleniia.

Influence of the intravenous (a 30-min exposure) laser therapy with the use of apparatus AFL-2 (8-12 sessions) on patients suffering from the ischemic heart disease of different functional categories has been studied. Blood viscosity and lipoproteins were measured in 48 patients. Positive effect of the treatment was determined from decreased number of daily attacks of angina and reduction of nitro-glycerine tablets uptake by 50% and more ("good"), by 30-50% ("adequate") and less than 30% ("inadequate"). "Good" or "adequate" clinical effects were noted in 91% of the patients. Most probably, the positive effect is linked with improvement in rheologic blood properties.

[The effect of different types of laser therapy on the reactivity of the peripheral blood neutrophils in patients with ischemic heart disease]. / Vliianie razlichnykh vidov lazerterapii na reaktivnost' neitrofilov perifericheskoi krovi u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The responses to laser therapy (intravenous, continuous skin exposure without a magnet, magnetic laser therapy) of 83 patients with coronary heart disease aged 50-80 demonstrated the advantages of noninvasive laser irradiation of blood. Myeloperoxidase activity may serve a criterion for estimating the number of irradiation procedures needed.

[Microcirculatory changes in patients with ischemic heart disease under the influence of laser irradiation]. / Izmenenie mikrotsirkuliatsii u bol'nykh ishemicheskoi bolezn'iu serdtsa pod vliianiem lazernogo oblucheniia.

As shown by conjunctival biomicroscopy, microcirculatory picture in 176 patients with coronary heart disease (CHD) compared to that of 76 healthy controls exhibited gross changes in the terminal vascular bed. 36 CHD patients have received laser treatment. Positive trends correlating with clinical response were registered in these laser-treated 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.