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1.
N Engl J Med ; 381(19): 1820-1830, 2019 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-31562798

RESUMO

BACKGROUND: Long-term outcomes after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents, as compared with coronary-artery bypass grafting (CABG), in patients with left main coronary artery disease are not clearly established. METHODS: We randomly assigned 1905 patients with left main coronary artery disease of low or intermediate anatomical complexity (according to assessment at the participating centers) to undergo either PCI with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). The primary outcome was a composite of death, stroke, or myocardial infarction. RESULTS: At 5 years, a primary outcome event had occurred in 22.0% of the patients in the PCI group and in 19.2% of the patients in the CABG group (difference, 2.8 percentage points; 95% confidence interval [CI], -0.9 to 6.5; P = 0.13). Death from any cause occurred more frequently in the PCI group than in the CABG group (in 13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI, 0.2 to 6.1). In the PCI and CABG groups, the incidences of definite cardiovascular death (5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI, -1.4 to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4 percentage points; 95% CI, -1.3 to 4.2) were not significantly different. All cerebrovascular events were less frequent after PCI than after CABG (3.3% vs. 5.2%; difference, -1.9 percentage points; 95% CI, -3.8 to 0), although the incidence of stroke was not significantly different between the two groups (2.9% and 3.7%; difference, -0.8 percentage points; 95% CI, -2.4 to 0.9). Ischemia-driven revascularization was more frequent after PCI than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to 10.0). CONCLUSIONS: In patients with left main coronary artery disease of low or intermediate anatomical complexity, there was no significant difference between PCI and CABG with respect to the rate of the composite outcome of death, stroke, or myocardial infarction at 5 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776.).


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Intervenção Coronária Percutânea , Idoso , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Everolimo/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Isquemia Miocárdica/terapia , Razão de Chances , Acidente Vascular Cerebral/epidemiologia
2.
Angiol Sosud Khir ; 25(3): 39-52, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31503246

RESUMO

Ischemic cardiomyopathy is becoming a leading cause of morbidity and mortality in the whole world. Stem cell-based therapy is emerging as a promising option for treatment of ischemic cardiomyopathy. Several stem cell types, including cardiac-derived stem cells, bone marrow-derived stem cells, mesenchymal stem cells, skeletal myoblasts, CD34+ and CD133+ stem cells have been used in clinical trials. Clinical effects mostly depend on transdifferentiation and paracrine factors. One important issue is that a low survival and residential rate of transferred stem cells blocks the effective advances in cardiac improvement. Many other factors associated with the efficacy of cell replacement therapy for ischemic cardiomyopathy mainly including the route of delivery, the type and number of stem cell infusion, the timing of injection, patient's physical conditions, the particular microenvironment onto which the cells are delivered, and clinical conditions remain to be addressed. Here we provide an overview of modern methods of stem cell delivery, types of stem cells and discuss the current state of their therapeutic potential.


Assuntos
Cardiomiopatias , Infarto do Miocárdio , Isquemia Miocárdica , Transplante de Células-Tronco , Cardiomiopatias/terapia , Terapia Baseada em Transplante de Células e Tecidos , Humanos , Isquemia Miocárdica/terapia
3.
Undersea Hyperb Med ; 46(4): 483-494, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509904

RESUMO

The aim of this study was to establish the effect of combined therapy with hyperbaric oxygen (HBO2) therapy and verapamil, amlodipine or nicorandil on functional recovery and oxidative stress markers after ischemia in the isolated rat heart. The study included 48 rats (Wistar albino, male gender, eight weeks old, body weight 200±50g). All animals were exposed to HBO2 treatment over 14 days. Isolated heart rats were perfused by the Langendorff retrograde method at a constant coronary pressure of 70 cm H2O. After stabilization period the hearts were divided into the following groups: HBO2 group (animals exposed to only HBO2 preconditioning); HBO2 + verapamil; HBO2 + amlodipine; andHBO2 + nicorandil (animals pretreated with HBO2 and appropriate pharmacological agent). Afterward, the hearts in all groups were subjected to 20-minute global ischemia and 30-minute reperfusion. Parameters of heart function were registered, including maximum and minimum rate of pressure development, systolic and diastolic left ventricular pressure, heart rate and coronary flow. Levels of pro-oxidants such as index of lipid peroxidation, measured as thiobarbituric acid-reactive substances, nitrites, levels of superoxide anion radicals and hydrogen peroxide were determined in coronary venous effluent. Changes in cardiac tissue were evaluated by hematoxylin and eosin staining. Obtained results clearly indicate that blockage of calcium channel or the activation of adenosine triphosphate-sensitive potassium (KATP) in combination with HBO2 prevented ischemia/reperfusion-induced cardiac deleterious effects, thus contributing to improvement of functional recovery of the heart. However, future studies are certainly necessary for better understanding the mechanisms through which combination of these two maneuvers of preconditioning triggers cardioprotection.


Assuntos
Bloqueadores dos Canais de Cálcio/uso terapêutico , Oxigenação Hiperbárica , Precondicionamento Isquêmico Miocárdico/métodos , Isquemia Miocárdica/terapia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Bloqueadores dos Canais de Potássio/uso terapêutico , Anlodipino/uso terapêutico , Animais , Pressão Sanguínea/efeitos dos fármacos , Terapia Combinada/métodos , Circulação Coronária , Coração , Frequência Cardíaca/efeitos dos fármacos , Precondicionamento Isquêmico Miocárdico/efeitos adversos , Peroxidação de Lipídeos , Masculino , Miocárdio/patologia , Nicorandil/uso terapêutico , Estresse Oxidativo , Ratos , Ratos Wistar , Recuperação de Função Fisiológica , Verapamil/uso terapêutico
4.
Zhongguo Zhen Jiu ; 39(8): 855-60, 2019 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-31397131

RESUMO

OBJECTIVE: To explore the action mechanism of acupoint selection along meridians to improve adenosine receptor in myocardial ischemia (MI) rats by comparing the effects of acupoint selection along meridians, acupoint selection at other meridians and non-acupoint on expression of adenosine receptor. METHODS: A total of 120 SD rats were randomly divided into a blank group, a sham operation group, a model group, an acupoint-selection-along-meridians (ASAM) group, an acupoint-selection-at-other-meridians (ASAOM) group and a non-acupoint group, 20 rats in each group. The model of MI was not made in the blank group; the left anterior descending coronary artery was not ligated after thoracotomy in the sham operation group; the model of MI was made but acupuncture was not given in the model group. After the model of MI was made, electroacupuncture (EA) was applied at "Neiguan" (PC 6) in the ASAM group, at "Hegu" (LI 4) in the ASAOM group, and at the area between the third and fourth metatarsal bone in the non-acupoint group. EA was given 20 min per treatment, once a day for 5 days. After treatment, the TTC staining was used to detect myocardial infarction, the Tunel method was used to detect cardiomyocyte apoptosis, and the immunohistochemistry was used to detect the expression of adenosine receptors A1, A2a and A2b. RESULTS: Compared with the blank group and the sham operation group, the percentage of myocardial infarction and apoptotic rate of myocardial cells in the model group were increased significantly (P<0.01). After EA treatment, compared with the model group, the percentage of myocardial infarction and apoptotic rate of myocardial cells in the ASAM group were decreased significantly (P<0.01), and the expression levels of adenosine receptors A1, A2a and A2b were increased significantly (P<0.01). The percentage of myocardial infarction and apoptotic rate of myocardial cells in the ASAM group were significantly lower than those in the ASAOM group and the non-acupoint group (P<0.01), and the expression levels of adenosine receptors A1, A2a and A2b in the ASAM group were significantly higher than those in the ASAOM group and non-acupoint group (P<0.01). CONCLUSION: Compared with acupoint selection at other meridians or non-acupoints, acupoint selection along meridians can effectively regulate the expression of adenosine receptors A1, A2a and A2b, improve the condition of myocardial infarction, inhibit myocardial cell apoptosis, and consequently protect ischemic myocardium.


Assuntos
Eletroacupuntura , Meridianos , Isquemia Miocárdica/terapia , Pontos de Acupuntura , Animais , Humanos , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Receptores Purinérgicos P1
5.
J Cardiovasc Comput Tomogr ; 13(3): 11-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31040061

RESUMO

AIMS: This study describes the real-world referral pattern of patients to a CT myocardial perfusion service, the technical issues associated with providing the service, the results of the studies, and the subsequent downstream utilization of other investigations, and patient outcomes. METHODS AND RESULTS: 115 consecutive patients underwent CTA, dynamic rest and dipyridamole-stress perfusion scanning. There were 29 (25%) and 14 (12%) patients who had reversible defects and fixed defects respectively, indicating abnormal flow reserve and previous infarction respectively. In the patients with fixed defects, delayed hyperenhancement was noted in all, indicative of prior infarction, scarring and non-viability. With the existing CTA Appropriateness Criteria, the categorization of "Appropriate," "Of Uncertain Appropriateness", and "Inappropriate" would have been applied to 25%, 25% and 50% of the present studies respectively. Up to 72% could have been referred for ischemia evaluation with other modalities of functional imaging after the non-diagnostic CT angiogram. Follow up was complete in 113 subjects (98%) over a period of 14 ±â€¯8 months. In the 29 patients with abnormal flow reserve and CAD, 62% underwent invasive angiography and 94%, angioplasty within a 90-day period. In the patients who underwent angioplasty, all remained free of myocardial infarction or death and 88% remained free of myocardial infarction, death or readmission over a mean of 14 ±â€¯8 months. CONCLUSION: A CT-myocardial perfusion service provided measures of ischemia and infarct detection over that of CTA alone. The information was utilized clinically by doctors to support a strategy of referral to revascularization versus conservative medical management.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Circulação Coronária , Vasos Coronários/diagnóstico por imagem , Hemodinâmica , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Idoso , Tomada de Decisão Clínica , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Valor Preditivo dos Testes , Prognóstico , Encaminhamento e Consulta , Sistema de Registros , Reprodutibilidade dos Testes , Fatores de Tempo
6.
Pacing Clin Electrophysiol ; 42(5): 530-536, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30839112

RESUMO

BACKGROUND: The importance of interlead electrical delays (IEDs) in the presence of scar tissue for response to cardiac resynchronization therapy (CRT) in patients with ischemic cardiomyopathy is poorly described. METHODS: Sixty-eight CRT patients with ischemic cardiomyopathy and left bundle branch block were included. IEDs, the time between sensing of native impulse at the RV lead and LV lead, were measured at implantation and after 8 months. Magnetic resonance imaging was used for assessment of scar tissue. Echocardiographic response was defined as ≥ 15% decrease in left ventricular end-systolic volume. New York Heart Association (NYHA) class, Minnesota Living with Heart Failure Questionnaire, and 6-minute walk-test were used to assess clinical response. RESULTS: A total of 44 patients (65 %) were responders to CRT. At implantation, IEDs were significantly longer among responders compared to nonresponders (RV-LV-IED: 87 ms ± 33 ms vs 65 ms ± 47 ms, P < 0.05), most evident in patients with QRS < 150 ms. Responders had less myocardial scar tissue than nonresponders (1 ± 0.5 vs 1.4 ± 0.6, P = 0.01). However, in the multivariate model including QRS duration and scar tissue, IEDs were independently associated with LV remodeling after CRT: odds ratio 3.99 [95% confidence interval 1.02-15.7] (P = 0.04). During the course of treatment, no changes were observed in IEDs among echocardiographic responders. CONCLUSION: RV-LV-IED was an independent marker of response in CRT patients with ischemic cardiomyopathy even in the presence of scar tissue and may be particularly useful in patients with QRS < 150 ms. CRT did not influence this measurement over time.


Assuntos
Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/métodos , Cicatriz/fisiopatologia , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Cicatriz/diagnóstico por imagem , Dinamarca , Ecocardiografia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Prospectivos , Inquéritos e Questionários , Suécia , Remodelação Ventricular , Teste de Caminhada
7.
Int Heart J ; 60(2): 264-270, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30799376

RESUMO

The utilization of electronic medical records and multimodal medical data is an ideal approach to build a real-time and precision registry type study with a smaller effort and cost, which may fill a gap between evidence-based medicine and the real-world clinical practice. The Japan Ischemic heart disease Multimodal Prospective data Acquisition for preCision Treatment (J-IMPACT) project aimed to build an clinical data registry system that electronically collects not only medical records, but also multimodal data, including coronary angiography and percutaneous coronary intervention (PCI) report, in standardized data formats for clinical studies.The J-IMPACT system comprises the standardized structured medical information exchange (SS-MIX), coronary angiography and intervention reporting system (CAIRS), and multi-purpose clinical data repository system (MCDRS) interconnected within the institutional network. In order to prove the concept, we acquired multimodal medical data of 6 consecutive cases that underwent PCI through the J-IMPACT system in a single center. Data items regarding patient background, laboratory data, prescriptions, and PCI/cardiac catheterization report were correctly acquired through the J-IMPACT system, and the accuracy of the multimodal data of the 4 categories was 100% in all 6 cases.The application of J-IMPACT system to clinical studies not only fills the gaps between randomized clinical trials and real-world medicine, but may also provide real-time big data that reinforces precision treatment for each patient.


Assuntos
Angiografia Coronária/estatística & dados numéricos , Confiabilidade dos Dados , Sistemas Computadorizados de Registros Médicos , Isquemia Miocárdica , Intervenção Coronária Percutânea/estatística & dados numéricos , Idoso , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Japão/epidemiologia , Masculino , Sistemas Computadorizados de Registros Médicos/organização & administração , Sistemas Computadorizados de Registros Médicos/normas , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/terapia , Estudos Prospectivos , Melhoria de Qualidade , Sistema de Registros/estatística & dados numéricos , Resultado do Tratamento
11.
Int J Cardiovasc Imaging ; 35(6): 1163-1167, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30680654

RESUMO

The purpose of this study was to assess the prognostic value of ultra-low dose thallium myocardial perfusion imaging. Three hundred and sixty-six patients (245 men) underwent ultra-low dose stress-redistribution imaging on CZT SPECT camera GE Discovery NM 530c. The stress test was performed by bicycle ergometry or regadenoson injection. The activity of 0.5 MBq (0.014 mCi) Tl-201 chloride per kilogram of body weight was administered. The stress images were acquired immediately and redistribution images were taken after 3 h. Patient follow-up was focused on combined end-point (death, myocardial infarction, unstable angina, revascularization and hospitalization for heart failure). Data analysis was performed from hospital database, with a mean period 23 months. Patients with revascularization within 1 month after SPECT was excluded as revascularization for diagnosis. Ischaemia on SPECT was found in 72 patients, 294 patients were without ischaemia. In patients with ischaemia there were 21 (29.2%) subjects with cardiac events, and 23 (7.9%) in patients without ischaemia (HR 4.15, 95% CI 2.30-7.51, p < 0.0001). Ultra-low dose thallium perfusion imaging using CZT camera provides very good prognostic results in assessment of myocardial ischaemia.


Assuntos
Cádmio , Circulação Coronária , Câmaras gama , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/instrumentação , Doses de Radiação , Compostos Radiofarmacêuticos/administração & dosagem , Telúrio , Radioisótopos de Tálio/administração & dosagem , Tomografia Computadorizada de Emissão de Fóton Único/instrumentação , Zinco , Idoso , Progressão da Doença , Desenho de Equipamento , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Imagem de Perfusão do Miocárdio/efeitos adversos , Imagem de Perfusão do Miocárdio/métodos , Projetos Piloto , Valor Preditivo dos Testes , Prognóstico , Purinas/administração & dosagem , Pirazóis/administração & dosagem , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Compostos Radiofarmacêuticos/efeitos adversos , Reprodutibilidade dos Testes , Radioisótopos de Tálio/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único/efeitos adversos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Vasodilatadores/administração & dosagem
12.
Int J Cardiovasc Imaging ; 35(5): 965-971, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30661139

RESUMO

Evaluation of atypical presentation of angina chest pain in emergency department is difficult. Hospitalization of this patient may impose additional costs and waste the time, early discharge may lead to miss the patients. The aim of this study was to determine volubility of Single Photon Emission Computed Tomography (SPECT) in management of patients admitted to emergency department with atypical manifestations of angina pain, un-diagnostic Electrocardiogram (ECG) and negative enzyme. Half of 100 patients admitted to emergency department with atypical chest pain and un-diagnostic ECG who were candidate for admission, underwent ECG gated resting SPECT. According to the results of SPECT, low risk patient discharged after negative stress SPECT. All discharged patients were followed up for major cardiac events (cardiac death, nonfatal myocardial infarction and repeat admission for congestive heart failure) for 12 months. According to rest SPECT Myocardial Perfusion Imaging (MPI), about 70% of patients in case group was low risk and 30% of them had moderate or high risk. Case group represented lower hospitalization rate and lower need for Coronary Artery Angiography (CAG) in comparison with control group. Mean cost in case group was significantly lower than control group (175.15$ vs. 391.33$, P < 0.001). In one year follow- up no cases of mortality or major cardiovascular events as cardiac infraction were found in discharged patients in case group. our study showed that rest SPECT fulfillment in admitted patients in emergency department was validated method for assessing patients' risk which avoids unnecessary hospitalizations and additional costs.


Assuntos
Angina Pectoris/diagnóstico por imagem , Eletrocardiografia , Serviço Hospitalar de Emergência , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada de Emissão de Fóton Único , Angina Pectoris/fisiopatologia , Angina Pectoris/terapia , Estudos de Casos e Controles , Tomada de Decisão Clínica , Diagnóstico Precoce , Hospitalização , Humanos , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Fatores de Risco , Fatores de Tempo , Procedimentos Desnecessários
13.
Int J Cardiol ; 274: 271-278, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30301563

RESUMO

BACKGROUND: Hyperbaric oxygen (HBO) could improve wound healing by enhancement of angiogenesis. The effect of HBO on metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), a proangiogenic long noncoding RNA, and on endothelial cell-derived exosome is unknown. We aim to investigate both whether MALAT1 is altered in human coronary artery endothelial cells (HCAECs)-derived exosomes in response to HBO as well as the molecular regulatory mechanisms of MALAT1 in HCAECs under HBO treatment. METHODS AND RESULTS: HCAECs were cultured and HBO was applied at 2.5 atmosphere absolute (ATA) in a hyperbaric chamber. Exosomes were extracted from culture media. A rat model of hind-limb ischemia was performed by ligation of the right femoral artery. HBO at 2.5 ATA significantly increased MALAT1 expression in HCAECs and HCAECs-derived exosomes. MALAT1 suppressed miR-92a expression in HCAEC-derived exosomes under HBO. Silencing MALAT1 by MALAT1 siRNA significantly inhibited KLF2 mRNA expression induced by HBO, as did MiR-92a. MiR-92a significantly decreased KLF2 luciferase activity in HCAECs under HBO. HBO and HBO-induced exosomes significantly increased cell proliferation and the capillary-like network formation of HCAECs. MALAT1 siRNA and miR-92a overexpression significantly attenuated the cell proliferation and tube formation caused by HBO-induced exosome. HBO and HBO-induced exosomes significantly improved neovascularization in a rat model of hind-limb ischemia. CONCLUSIONS: HBO upregulates MALAT1 to suppress miR-92a expression and counteracts the inhibitory effect of miR-92a on KLF2 expression in HCAECs to enhance neovascularization. HBO-induced derivation of exosomes from HCAECs enhances angiogenesis. Exosomes containing MALAT1 might serve as a valuable therapeutic tool for neovascularization by HBO.


Assuntos
Vasos Coronários/metabolismo , Endotélio Vascular/metabolismo , Oxigenação Hiperbárica/métodos , MicroRNAs/genética , Isquemia Miocárdica/genética , RNA Longo não Codificante/genética , Animais , Western Blotting , Proliferação de Células , Células Cultivadas , Vasos Coronários/patologia , Modelos Animais de Doenças , Endotélio Vascular/patologia , Exossomos/metabolismo , Humanos , Masculino , MicroRNAs/biossíntese , Isquemia Miocárdica/patologia , Isquemia Miocárdica/terapia , Neovascularização Fisiológica/genética , RNA/genética , RNA Longo não Codificante/metabolismo , Ratos , Ratos Wistar , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa
14.
Am J Physiol Heart Circ Physiol ; 316(1): H1-H9, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30379567

RESUMO

Ischemic heart diseases (IHD) cause millions of deaths around the world annually. While surgical and pharmacological interventions are commonly used to treat patients with IHD, their efficacy varies from patient to patient and is limited by the severity of the disease. One promising, at least theoretically, approach for treating IHD is induction of coronary collateral growth (CCG). Coronary collaterals are arteriole-to-arteriole anastomoses that can undergo expansion and remodeling in the setting of coronary disease when the disease elicits myocardial ischemia and creates a pressure difference across the collateral vessel that creates unidirectional flow. Well-developed collaterals can restore blood flow in the ischemic area of the myocardium and protect the myocardium at risk. Moreover, such collaterals are correlated to reduced mortality and infarct size and better cardiac function during occlusion of coronary arteries. Therefore, understanding the process of CCG is highly important as a potentially viable treatment of IHD. While there are several excellent review articles on this topic, this review will provide a unified overview of the various aspects related to CCG as well as an update of the advancements in the field. We also call for more detailed studies with an interdisciplinary approach to advance our knowledge of CCG. In this review, we will describe growth of coronary collaterals, the various factors that contribute to CCG, animal models used to study CCG, and the cardioprotective effects of coronary collaterals during ischemia. We will also discuss the impairment of CCG in metabolic syndrome and the therapeutic potentials of CCG in IHD.


Assuntos
Circulação Colateral , Circulação Coronária , Isquemia Miocárdica/fisiopatologia , Neovascularização Fisiológica , Animais , Vasos Coronários/metabolismo , Vasos Coronários/fisiologia , Vasos Coronários/fisiopatologia , Humanos , Microvasos/metabolismo , Microvasos/fisiologia , Microvasos/fisiopatologia , Isquemia Miocárdica/terapia
16.
Minerva Cardioangiol ; 67(1): 64-72, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30260145

RESUMO

BACKGROUND: Aim of this study is to verify the potential advantages and benefits of bone-marrow derived autologous stem cells implantation associated to surgical left ventricular restoration (SVR), to report a new modality of cell delivery to myocardium, and to identify possible side effects of this procedure. METHODS: Between March 2007 and March 2013, 30 patients affected by ischemic dilative cardiomyopathy who received a SVR operation were enrolled in the study. The population was divided in two groups:16 patients were randomly assigned to receive stem cells therapy in addition to SVR (groupA), 14 patients received a placebo (group B). The two groups were homogeneous in respect of age, gender, preoperative NYHA class, mitral incompetence and left ventricular sizes and volumes. The patients were evaluated by echo and pet-scan before surgery and at 6 months follow-up, and by echo at subsequent follow-up. RESULTS: Overall 30 days-in hospital mortality was 0 for the entire cohort. At last follow-up ejection fraction increased from 25.3% before surgery to 36.3% in group A, and from 31.8% to 45.6% in group B. Reduction of LVEDD was 6% in group A, 9% in group B. ESLVV and EDLVD decreased more significantly in patients receiving stem cells (55% vs. 35%). Late cardiac mortality at 9 years follow-up was similar in the two groups of patients. No early or late adverse reaction nor cases of infections were observed. CONCLUSIONS: Patients affected by ischemic cardiomyopathy have a favourable outcome after SVR. A higher reduction of LVEDV and LVESV assessed by CT-Scan evaluation in patients receiving cell therapy, when compared to control group, encourages the evolution and refinement of myocardial regenerative therapy added to SVR.


Assuntos
Isquemia Miocárdica/terapia , Transplante de Células-Tronco/métodos , Disfunção Ventricular Esquerda/terapia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Estudos Prospectivos , Regeneração , Resultado do Tratamento , Disfunção Ventricular Esquerda/etiologia
17.
Ups J Med Sci ; 124(1): 70-77, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30265179

RESUMO

BACKGROUND: The aim was to determine the association between atrial fibrillation (AF) and outcome in patients undergoing coronary artery bypass grafting (CABG). METHODS: All patients undergoing CABG between January 2010 and June 2013 were identified in the Swedish Heart Surgery Registry. Outcomes studied were all-cause mortality, cardiovascular mortality, myocardial infarction, congestive heart failure, ischemic stroke, and recurrent AF. Patients with history of AF prior to surgery (preoperative AF) and patients without history of AF but with AF episodes post-surgery (postoperative AF) were compared to patients with no AF using adjusted Cox regression models. RESULTS: Among 9,107 identified patients, 8.1% (n = 737) had preoperative AF, and 25.1% (n = 2,290) had postoperative AF. Median follow-up was 2.2 years. Compared to no AF, preoperative AF was associated with higher risk of all-cause mortality, adjusted hazard ratio with 95% confidence interval (HR) 1.76 (1.33-2.33); cardiovascular mortality, HR 2.43 (1.68-3.50); and congestive heart failure, HR 2.21 (1.72-2.84). Postoperative AF was associated with risk of all-cause mortality, HR 1.27 (1.01-1.60); cardiovascular mortality, HR 1.52 (1.10-2.11); congestive heart failure, HR 1.47 (1.18-1.83); and recurrent AF, HR 4.38 (2.46-7.78). No significant association was observed between pre- or postoperative AF and risk for myocardial infarction and ischemic stroke. CONCLUSIONS: Approximately 1 in 3 patients undergoing CABG had pre- or postoperative AF. Patients with pre- or postoperative AF were at higher risk of all-cause mortality, cardiovascular mortality, and congestive heart failure, but not of myocardial infarction or ischemic stroke. Postoperative AF was associated with higher risk of recurrent AF.


Assuntos
Fibrilação Atrial/terapia , Ponte de Artéria Coronária/métodos , Vasos Coronários/cirurgia , Idoso , Fibrilação Atrial/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/terapia , Período Pré-Operatório , Modelos de Riscos Proporcionais , Recidiva , Sistema de Registros , Risco , Suécia/epidemiologia , Resultado do Tratamento
18.
J Cardiothorac Vasc Anesth ; 33(3): 702-709, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30054187

RESUMO

OBJECTIVES: To compare the effects of nicorandil and nitroglycerin on arterial oxygenation during two-lung ventilation (TLV) and one-lung ventilation (OLV) in patients with risk factors for myocardial ischemia. DESIGN: A prospective, randomized, double-blind study. SETTING: A tertiary care hospital. PARTICIPANTS: Fifty-six patients scheduled for elective video-assisted thoracic surgery were assigned randomly to either the nicorandil group or the nitroglycerin group. INTERVENTIONS: Patients in the nicorandil group received a bolus dose of nicorandil, 0.08 mg/kg during induction of anesthesia, followed by a continuous infusion at a rate of 0.08 mg/kg/h. Patients in the nitroglycerin group received a continuous infusion of nitroglycerin at a rate of 1 µg/kg/min from the induction of anesthesia. MEASUREMENTS AND MAIN RESULTS: Arterial blood gas analysis was performed at the following points: before induction of anesthesia; during TLV; at 5, 10, 20, and 30 minutes after the initiation of OLV. PaO2 at TLV (479.7 ± 57.1 v 408.2 ± 70.9 mmHg, p < 0.001); and at 5 minutes (344.8 ± 85.1 v 282.6 ± 85.8 mmHg, p = 0.012), 20 minutes (215.7 ± 103.0 v 158.2 ± 74.5 mmHg, p = 0.027), and 30 minutes (198.8 ± 103.5 v 147.5 ± 64.1 mmHg, p = 0.039) after OLV was significantly higher in the nicorandil group than in the nitroglycerin group. CONCLUSION: This study demonstrated that oxygenation during TLV and OLV was significantly higher in patients receiving nicorandil than in those receiving nitroglycerin.


Assuntos
Isquemia Miocárdica/sangue , Isquemia Miocárdica/terapia , Nicorandil/administração & dosagem , Nitroglicerina/administração & dosagem , Ventilação Monopulmonar/métodos , Artéria Pulmonar/efeitos dos fármacos , Vasodilatadores/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Gasometria/métodos , Método Duplo-Cego , Feminino , Humanos , Masculino , Isquemia Miocárdica/diagnóstico , Estudos Prospectivos , Artéria Pulmonar/metabolismo , Fatores de Risco , Resultado do Tratamento
19.
Int J Cardiol ; 277: 47-53, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30093138

RESUMO

BACKGROUND: There have been limited and conflicting results regarding the prognostic impact of revascularization treatment on the long-term clinical outcomes of silent ischemia. The current study aimed to determine whether revascularization treatment compared with medical treatment (MT) alone reduces long-term risk of cardiac death of asymptomatic patients with objective evidence of inducible myocardial ischemia. METHODS: A total of 1473 consecutive asymptomatic patients with evidence of inducible myocardial ischemia were selected from a prospective institutional registry. All patients showed at least 1 epicardial coronary stenosis with ≥50% diameter stenosis in coronary angiography. Patients were classified according to their treatment strategies. The primary outcome was cardiac death up to 10 years. RESULTS: Among the total population, 709 patients (48.1%) received revascularization treatment including percutaneous coronary intervention (PCI, n = 558) or coronary artery bypass graft surgery (CABG, n = 151), with the remaining patients (764 patients, 51.9%) receiving MT alone. During the follow-up period, the revascularization treatment group showed a significantly lower risk of cardiac death compared with the MT alone group (25.4% vs. 33.7%, HR 0.624, 95%CI 0.498-0.781, p < 0.001). Among revascularized patients, patients with negative non-invasive stress test results after revascularization showed significantly lower risk of cardiac death compared to those with residual myocardial ischemia (8.9% vs. 18.7%, HR 0.406, 95% CI 0.175-0.942, p = 0.036). CONCLUSIONS: In patients with silent myocardial ischemia, revascularization treatment was associated with significantly lower long-term risk of cardiac death compared with the MT alone group. The current results support contemporary practice of ischemia-directed revascularization, even in patients with silent myocardial ischemia.


Assuntos
Doenças Assintomáticas/terapia , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/terapia , Revascularização Miocárdica/tendências , Idoso , Doenças Assintomáticas/mortalidade , Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Isquemia Miocárdica/mortalidade , Revascularização Miocárdica/mortalidade , Intervenção Coronária Percutânea/mortalidade , Intervenção Coronária Percutânea/tendências , Inibidores da Agregação de Plaquetas/administração & dosagem , Estudos Prospectivos , Sistema de Registros , Tomografia Computadorizada de Emissão de Fóton Único/mortalidade , Tomografia Computadorizada de Emissão de Fóton Único/tendências , Resultado do Tratamento
20.
J Interv Card Electrophysiol ; 54(2): 161-170, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30471050

RESUMO

PURPOSE: To compare lead failure manifestation and lead performance of the Biotronik Linox/Sorin Vigila defibrillator lead (Linox group) with the St. Jude Medical Riata/Riata ST (Riata group) and Medtronic Sprint Fidelis defibrillator leads (Fidelis group). METHODS: We assessed the performance of all aforementioned leads implanted at our center and investigated the manifestation of lead failures. RESULTS: Of 93 Linox, 86 Riata, and 81 Fidelis leads implanted at our center, 11 (12%), 22 (26%), and 25 (31%) leads failed during a median follow-up of 46, 61, and 84 months, respectively. Inappropriate shocks were delivered in 64% (Linox), 5% (Riata), and 32% (Fidelis) of lead failures; a device alert was noted in none (Linox), 5% (Riata), and 52% (Fidelis); and lead failure was a coincidental finding in 36% (Linox), 91% (Riata), and 16% (Fidelis) of cases (p < 0.001). Non-physiological high rate signals were observed in 73% (Linox), 27% (Riata), and 80% (Fidelis) of lead failures (p = 0.001) and damaged lead integrity was found in 36% (Linox), 73% (Riata), and 24% (Fidelis) of cases (p = 0.064). Lead survival at 5 years was 88%, 92%, and 71% for Linox, Riata, and Fidelis group, respectively. CONCLUSIONS: The most frequent clinical manifestation of lead failure was inappropriate shocks for Linox, coincidental finding for Riata and device alert for Fidelis leads. Non-physiological high rate signals were frequently observed in Linox and Fidelis lead failures whereas in Riata lead failures, a damaged lead integrity was the predominant finding.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Eletrodos Implantados/efeitos adversos , Desenho de Equipamento/métodos , Análise de Falha de Equipamento , Segurança de Equipamentos/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/métodos , Cardiomiopatia Dilatada/terapia , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/terapia , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Estados Unidos
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