Novel sirolimus-eluting stent Prolim® with a biodegradable polymer in the all-comers population: one year clinical results with quantitative coronary angiography and optical coherence tomography analysis.

BACKGROUND: The aim of this study was to assess the safety and the efficacy of the novel sirolimus-eluting Prolim® stent with a biodegradable polymer in the all-comers population. METHODS: We prospectively enrolled all patients with stable coronary artery disease or acute coronary syndrome treated with Prolim® stent between January and December 2013 in two interventional cardiology centers in Poland. Angiographic control was planned at 12 months, in which 15 % of patients (randomly chosen) underwent optical coherence tomography imaging. The primary end-point was the cumulative rate of cardiac death, myocardial infarction, and target lesion revascularization at 12 months. RESULTS: There were 204 patients enrolled, in whom 238 Prolim® stents were deployed (1.17 stent per patient). The mean age was 68 ± 10 years and 32.8 % were females. The examined stent was implanted in 5.9 % in STEMI patients, in 21.6 % - in NSTE-ACS and in 72.5 % - in patients with stable coronary artery disease. The Prolim® stent was most frequently implanted in right coronary artery (38.2 %) followed by left anterior descending artery (34.0 %). The cumulative major adverse cardiovascular events rate at 12 months was 6.9 %, and the clinically-driven target lesion revascularization rate - 5.4 %. At 12 months in quantitative coronary angiography the late lumen loss was 0.21 ± 0.18 mm, and in optical coherence tomography the mean neointima burden was 24.6 ± 8.6 %. CONCLUSIONS: Sirolimus-eluting Prolim® stent with a biodegradable polymer is a feasible device with a very good safety profile and long-term clinical effectiveness. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02545985 .

[Acute myocardial infarction in pregnant woman]. / Ostry zawal serca u kobiety w ciazy.

The article presents a case of 30-year-old patient at her 30th week of pregnancy who was admitted to our clinic with non-ST elevation myocardial infarction resulting from coronary artery embolism. A successful recanalisation of the occluded artery by balloon angioplasty was performed.

Desmin expression in human cardiomyocytes and selected clinical and echocardiographic parameters in patients with chronic heart failure.

BACKGROUND: Desmin, one of the basic muscular-specific structural proteins, is believed to play an important role in the progression of heart failure (HF). The function of desmin in cardiomyocytes is still unclear. Mechanical, structural and regulatory functions are postulated. Regulatory function of desmin seems the most interesting. Desmin might be involved in the regulation of gene expression, myofibrillogenesis and intercellular signalling, and be responsible for shape and tension of the cell membrane and other organelles. Abnormal accumulation of desmin may disturb the function of myofibrils, lead to unusual tension of sarcolemma and atypical distribution of organelles (nucleus), and impair intra- and intercellular communication. AIM: Evaluation of desmin expression in specimens derived from right ventricular myocardium during endomyocardial biopsy (EMB). METHODS: The study population consisted of 135 patients (86.7% males, mean age 49.4 +/- 14.1 years) presenting with clinical symptoms of HF and LVEF < 45%. During EMB 3-4 samples were taken from the right ventricular myocardium. The immunohistochemical studies of the endomyocardial specimens included immunostaining with desmin-specific antibodies. The study population was divided into three groups: I - 48 patients with normal expression of desmin, II - 54 patients with increased expression and accumulation of desmin and III - 33 patients with low expression of desmin in cardiomyocytes. RESULTS: The LVEF was significantly higher in group I than in groups II and III. The LV diameter was significantly lower in group I than in groups II and III. Functional status according to NYHA class was the worst in group I compared to group II and III. These differences were statistically significant. CONCLUSION: Evaluation of desmin distribution in specimens derived from the right ventricular myocardium may be useful as an objective tool in the assessment of left ventricle status.

Is diagnostic myocardial biopsy useful in the XXI century?

BACKGROUND: Progress in non-invasive diagnostic techniques such as ultrasonography, computerised tomography or magnetic resonance caused a significant decrease in the use of diagnostic myocardial biopsy (DMB). However, recent advances in molecular biology and widening knowledge about the role of new biochemical markers gives hope for more detailed assessment of cardiomyocyte pathophysiology, based on the proper examination of myocardial biopsy specimen. AIM: To assess current usefulness of DMB in the diagnosis of various myocardial disorders and monitoring after heart transplantation. METHODS: DMB was performed in 104 patients (84.6% males) with a clinical diagnosis of idiopathicdilated cardiomyopathy (35.6%), post-inflammatory dilated cardiomyopathy (22.1%), restrictive cardiomyopathy (2.9%), post-infarction myocardial injury (17.3%), ventricular arrhythmias resistant to treatment (2.9%), cardiac tumour (0.96%), suspected arrhythmogenic right ventricular dysplasia (0.96%) and with transplanted heart (17.3%). In each patient 3-4 specimens of the right ventricular cardiac muscle were taken. Immunohistochemical reactions were used to assess the presence of desmin. Myocarditis was diagnosed on the basis of morphological assessment of specimens stained with HE, Mallory trichome and immunohistochemical methods which identified lymphocytes T (CD3, OPD 4, UCHL1), endothelium (CD34) and antigen MHC II (DP, QR). In addition, specimens suggesting laminopathy or amyloidosis were examined under electron microscope. RESULTS: DMB revealed the absence of desmin (19.2%), abnormal concentration of desmin (21.1%), myocarditis (19.2%), so-called vascular myocardial injury (16.3%), other proteinopathies (2.3%), amyloidosis (1.9%), connective tissue diseases (0.96%), arrhythmogenic right ventricular dysplasia (0.96%), toxic injury (0.96%) and normal myocytes (0.96%). CONCLUSIONS: Our results suggest that complex analysis of myocardial biopsy specimen provides detailed information of the pathogenesis of cardiac disorders. However, further progress in molecular biology is needed to achieve more complete diagnosis.