Radiomic Phenotype of Periatrial Adipose Tissue in the Prognosis of Late Postablation Recurrence of Idiopathic Atrial Fibrillation.

The aim of the study is to find new predictors of postablation atrial fibrillation (AF) recurrence in patients with lone AF using a texture analysis of the periatrial adipose tissue (PAAT) of the left atrium. Materials and Methods: Forty-three patients admitted for lone AF catheter ablation, who had undergone multispiral coronary angiography, were enrolled in the study. PAAT segmentation was performed using 3D Slicer application followed by extraction of 93 radiomic features. At the end of the follow-up period, patients were divided into 2 groups depending on the presence or absence of AF recurrence. Results: 12 months of follow-up after catheter ablation, postablation AF recurrence was reported in 19 out of 43 patients. Of 93 extracted radiomic features of PAAT, statistically significant differences were observed for 3 features of the Gray Level Size Zone matrix. At the same time, only one radiomic feature of PAAT, Size Zone Non Uniformity Normalized, was an independent predictor of postablative recurrence of AF after catheter ablation and 12 months of follow-up (McFadden's R2=0.451, OR - 0.506, 95% CI: 0.331‒0.776, p<0.001). Conclusion: The radiomic analysis of periatrial adipose tissue may be considered as a promising non-invasive method for predicting adverse outcomes of the catheter treatment, which opens the possibilities for planning and correction of patient management tactics after intervention.

Cardiac 123I-mIBG scintigraphy for prediction of catheter ablation outcome in patients with atrial fibrillation.

BACKGROUND: Previous studies show inconsistent results on the role of innervation imaging (with 123I-mIBG) in predicting late atrial fibrillation (AF) recurrence after catheter ablation (CA). These studies included patients with paroxysmal AF and studied prognostic value of post-CA I-123-mIBG parameters. Current study investigated the ability of pre CA 123-I-mIBG imaging to predict late AF recurrence in patients with persistent AF. METHODS: 123I-mIBG cardiac imaging was performed before CA in 82 patients with persistent AF. Patient was followed for 12 months. RESULTS: Multivariable analysis demonstrated that late heart-to-mediastinum ratio (H/Mlate) and washout rate (WR) were independent predictors of AF recurrence. ROC-curve analysis data showed that H/Mlate <1.6 (sensitivity 73.53%, specificity 81.3%, AUC 0.792, P < .001) and WR > 25.11 (sensitivity 70.6%, specificity 70.8.3%, AUC 0.712, P < .001) indicate high probability of AF relapses during 12 months after CA. CONCLUSION: Pre-CA parameters of global cardiac sympathetic activity estimated by 123I-mIBG scintigraphy are associated with late AF relapses in persistent AF patients with normal LVEF and absence of significant CAD.

[Visualisation and Radiofrequency Ablation of Sympathetic Innervation Loci in the Left Atrium in Patients with Paroxysmal Atrial Fibrillation].

INTRODUCTION: A novel cardiac gamma camera utilizes the radiopharmaceutical Iodine-123-Meta-iodobenzylguanidine (123I-MIBG) to visualize cardiac sympathetic innervation. Physiological accumulation of 123I-mIBG provides an anatomical quantitative determination of the structures of the autonomic nervous system (ANS) with discrete uptake areas (DUA) of sympathetic activity located in the left atrium (LA) corresponding to the main ganglionic plexi (GP) clusters that could not previously be visualized. AIM: to visualize the DUA of the heart in patients with paroxysmal atrial fibrillation (AF) and to assess the effect of radiofrequency ablation (RFA) on DUA in LA. MATERIALS AND METHODS: Computed tomography (CT) of the heart and radionuclide imaging with 123I-mIBG were performed in 15 patients with paroxysmal AF. The results of the study were combined with preliminary taken CT images to create a detailed anatomical map of the sympathetic activity of the heart. The processed images were combined with the 3D reconstruction of the LA, obtained with the navigation system (CARTO 3, CARTO RMT). In DUA, high-frequency stimulation (HFS) followed by RF ablation was performed using the current recommended parameters. RESULTS: Forty-eight DUA (median 3 [3; 3]) were identified. Average activity of DUA was 1315 [1171; 1462] cnt / sec / ml. Positive response to HFS in the DUA was obtained in 8 (53.3 %) patients. Prior to ablation, no response was received to HFS in areas of LA outside the DUA. After ablation, there was no response to HFS in the DUA sites. At repeated scans 3 DUA (median 0 [0; 0]; p<0.001 compared with preoperative data) were observed. Activity of DUA significantly decreased to 819 [684; 955] cnt / sec / ml (p<0.001 as compared with preoperative data). Thirteen of 13 of 15 patients (87 %) had no AF / AT / AFL recurrences for 6 month follow up. CONCLUSION: In patients with AF, the areas of sympathetic activity in LA can be visualized by physiological localized uptake of 123I-mIBG. Radiofrequency catheter ablation can target the identified sympathetic innervation structures in AF patients precisely and effectively.

[Radiofrequency Pulmonary Artery Ablation for Treatment of Residual Pulmonary Hypertension After Pulmonary Endarterectomy].

OBJECTIVE: to assess the safety and efficiency of radiofrequency pulmonary artery ablation for treatment of residual pulmonary hypertension after pulmonary endarterectomy. MATERIAL AND METHODS: Radiofrequency pulmonary artery denervation (PADN) was performed in 16 patients (10 men, mean age 39 years [26; 51]). Indication for PADN was mean pulmonary artery pressure (PAP) >25 mm Hg with absence of proximal pulmonary artery lesion according to computer tomography. PADN procedure was performed with nonfluoroscopic 3D navigation system. RESULTS: After PADN mean PAP decreased from 37.3 mm Hg [29; 38] to 24.6 mm Hg [17; 30] (p=0.01); pulmonary vascular resistance decreased from 672 dyn·s·c -5 [387; 566] to 386 dyn·s·c -5 [155; 449] (р=0.02); cardiac output increased from 3.4 l / min [3.2; 3.4] to 3.5 l / min [3.2; 4.0] (p=0.4); 6­minute walk test distance increased from 427 meters [352; 510] to 447 meters [370; 525] (p=0.16), respectively. CONCLUSION: Initial results allow to assume that radiofrequency pulmonary artery denervation combined with optimal medical therapy may take its rightful place in the treatment of this category of patients.

Radiofrequency Pulmonary Artery Ablation for Treatment of Residual Pulmonary Hypertension After Pulmonary Endarterectomy.

OBJECTIVE: to assess the safety and efficiency of radiofrequency pulmonary artery ablation for treatment of residual pulmonary hypertension after pulmonary endarterectomy. MATERIAL AND METHODS: Radiofrequency pulmonary artery denervation (PADN) was performed in 16 patients (10 men, mean age 39 years [26; 51]). Indication for PADN was mean pulmonary artery pressure (PAP) >25 mm Hg with absence of proximal pulmonary artery lesion according to computer tomography. PADN procedure was performed with nonfluoroscopic 3D navigation system. RESULTS: After PADN mean PAP decreased from 37.3 mm Hg [29; 38] to 24.6 mm Hg [17; 30] (p=0.01); pulmonary vascular resistance decreased from 672 dyn∙s∙c-5 [387; 566] to 386 dyn∙s∙c-5 [155; 449] (р=0.02); cardiac output increased from 3.4 l/min [3.2; 3.4] to 3.5 l/ min [3.2; 4.0] (p=0.4); 6-minute walk test distance increased from 427 meters [352; 510] to 447 meters [370; 525] (p=0.16), respectively. CONCLUSION: Initial results allow to assume that radiofrequency pulmonary artery denervation combined with optimal medical therapy may take its rightful place in the treatment of this category of patients.

Effect of Vascular Endothelial Growth Factor and Erythropoietin on Functional Activity of Fibroblasts and Multipotent Mesenchymal Stromal Cells.

The study examined the effect of VEGF and erythropoietin on proliferative and migratory activities of skin fibroblasts and multipotent mesenchymal stromal cells of human adipose tissue. VEGF stimulated proliferation and migration of fi broblasts, but produced no significant effect on functional activity of multipotent mesenchymal stem cells. Erythropoietin stimulated proliferation of both cell types, but did not affect their migration.

Study of Cytokine Profile of Cultured "Early" and "Late" Endothelial Progenitor Cells in Peripheral Blood of Chronic Heart Failure Patients after Mobilization Course with Granulocyte Colony-Stimulating Factor.

The effect of cell culturing protocol with various adhesion proteins and different culture time on the profile of cytokine and growth factors produced by endothelial progenitor cells harvested after mobilization with granulocyte colony-stimulating factor was examined in patients with chronic heart failure. The endothelial progenitor cells cultured on fibronectin or gelatin produced a broad and overall similar spectrum of cytokines and growth factors, the levels of which depended on the culture time. On culture day 16, the cells grown on fibronectin diminished the production of cytokines and growth factors (IL-10, IL-18, IL-8, erythropoietin, and VEGF), while the cells grown on gelatin down-regulated the synthesis of TNF-α, IL-8, and erythropoietin, although they up-regulated the production of IL-10, IL-18, and VEGF.

Effect of morphofunctional properties of mobilized progenitor cells of patients with chronic heart failure on the efficiency of autologous intramyocardial cell transplantation.

We studied the phenotype and cytokine production in peripheral blood mononuclear cells mobilized from the bone marrow after administration of granulocyte colony-stimulating factor (G-CSF) and the relationship of these parameters with clinical efficacy of autologous intramyocardial injection of donor cells in patients with chronic heart failure. We found that mononuclear cells contain endothelial progenitor cells and are capable of producing pleiotropic cytokines exhibiting angiogenic and cardioprotective properties. High concentration of cells with of CD34+ and CD34+/CD133+ phenotype in the cell transplant and enhanced production of IL-10, TNF-α, and granulocyte-macrophage-CSF by blood mononuclear cells mobilized from the bone marrow can contribute to improvement of myocardial perfusion and increase in left ventricular ejection fraction after intramyocardial transplantation and can serve as predictors of high efficiency of cell therapy. Peripheral blood is an available source of progenitor cells, while mononuclear cells after administration of granulocyte-CSF can produce a reparative effect on ischemic myocardium.

[The use of implantable devices for long-term monitoring of cardiac rhythm after surgical treatment of atrial fibrillation in patients with ischemic heart disease].

We present in this paper experience of the use of implantable devices for long-term monitoring of cardiac rhythm after one stage operation of coronary artery bypass grafting (CABG) and radiofrequency ablation of atrial fibrillation (AF) source and results of a prospective randomized study, in which we included patients (n=95) with persistent AF and ischemic heart disease. These patients were randomized into 3 groups: with radiofrequency isolation of ostia of pulmonary veins (group 1, n=31), radiofrequency modified mini-maze procedure (group 2, n=30); CABG without AF elimination (control group 3, n=34). Implantable devices Reveal XT were used in 53 patients (21, 25, and 7 in groups 1, 2, and 3, respectively). According to data obtained with these devices AF was absent in 86.7, 95.6, 53%, and in 80, 86.2, 44.1% of patients in groups 1, 2, 3 after 1 and 2 years after operation, respectively). In 24% of patients Reveal devices also registered asymptomati-c arrhythmias. The use of implantable devices for monitoring of rhythm allowed to detect such arrhythmia and to provide timely correction of therapy.

Phenotype of peripheral blood cells mobilized by granulocyte colony-stimulating factor in patients with chronic heart failure.

Administration of granulocyte CSF preparation to patients with chronic heart failure produced a hemostimulating effect and increased the content of leukocytes and neutrophils in the peripheral blood. Granulocyte CSF induced mobilization of bone marrow progenitor cells into the peripheral blood. The content of hemopoietic CD34(+)progenitor cells, which attained 0.42% (0.25-0.64) by the end of mobilization, inversely correlated with the number of myocardial infarctions. Administration of granulocyte CSF not only led to mobilization of bone marrow hemopoietic cells, but also increased the pool of endothelial progenitor cells in the peripheral blood: the content of CD34(+)/CD133(+)and CD34(+)/KDR(+)attained 0.02% (0.013-0.075) and 0.1% (0.05-0.20), respectively. Peripheral blood is an available source of progenitor cells, while mononuclear cells after administration of granulocyte CSF can produce a reparative effect on ischemic myocardium.