Outcome from balloon induced coronary artery dissection after intracoronary beta radiation.

OBJECTIVE: To evaluate the healing of balloon induced coronary artery dissection in individuals who have received beta radiation treatment and to propose a new intravascular ultrasound (IVUS) dissection score to facilitate the comparison of dissection through time. DESIGN: Retrospective study. SETTING: Tertiary referral centre. PATIENTS: 31 patients with stable angina pectoris, enrolled in the beta energy restenosis trial (BERT-1.5), were included. After excluding those who underwent stent implantation, the evaluable population was 22 patients. INTERVENTIONS: Balloon angioplasty and intracoronary radiation followed by quantitative coronary angiography (QCA) and IVUS. Repeat QCA and IVUS were performed at six month follow up. MAIN OUTCOME MEASURES: QCA and IVUS evidence of healing of dissection. Dissection classification for angiography was by the National Heart Lung Blood Institute scale. IVUS proven dissection was defined as partial or complete. The following IVUS defined characteristics of dissection were described in the affected coronary segments: length, depth, arc circumference, presence of flap, and dissection score. Dissection was defined as healed when all features of dissection had resolved. The calculated dose of radiation received by the dissected area in those with healed versus non-healed dissection was also compared. RESULTS: Angiography (type A = 5, B = 7, C = 4) and IVUS proven (partial = 12, complete = 4) dissections were seen in 16 patients following intervention. At six month follow up, six and eight unhealed dissections were seen by angiography (A = 2, B = 4) and IVUS (partial = 7, complete = 1), respectively. The mean IVUS dissection score was 5.2 (range 3-8) following the procedure, and 4.6 (range 3-7) at follow up. No correlation was found between the dose prescribed in the treated area and the presence of unhealed dissection. No change in anginal status was seen despite the presence of unhealed dissection. CONCLUSION: beta radiation appears to alter the normal healing process, resulting in unhealed dissection in certain individuals. In view of the delayed and abnormal healing observed, long term follow up is indicated given the possible late adverse effects of radiation. Although in this cohort no increase in cardiac events following coronary dissections was seen, larger populations are needed to confirm this phenomenon. Stenting of all coronary dissections may be warranted in patients scheduled for brachytherapy after balloon angioplasty.

The reactions of euthyroid and hyperthyroid glands to radioactive iodine.

BACKGROUND: Researchers generally assume that the thyroid gland reacts more or less comparably to external irradiation and radioactive iodine. DESIGN: The thyroid glands from 20 euthyroid patients and 20 hyperthyroid patients, all of which had been treated with radioactive iodine, were studied. RESULTS: The two groups manifested different reactions. Almost all the euthyroid glands displayed a fibrotic atrophic pattern, whereas the glands from the Graves' disease patients showed more adenomatous and Hashimoto lesions than atrophy. CONCLUSION: Differences in the reactivity of normal and hyperplastic follicles may cause different reactions to treatment with radioactive iodine.

The use of iatrogenic hypothyroidism to treat intractable angina.

An elderly man who had incapacitating angina, despite coronary artery surgery and maximal medical management was deliberately made hypothyroid with radio-iodine. Five years later he was virtually free of chest pain. There is still a limited number of patients in whom this is a useful form of therapy, despite the attendant morbidity of myxoedema.

[Effects of laser therapy in patients with functional class II-IV effort angina (using instrumental techniques of the study)]. / Effektivnost' lazernoi terapii u bol'nykh so stenokardiei napriazheniia II-IV funktsional'nogo klassa (s ispol'zovaniem instrumental'nykh metodov issledovaniia).

Infrared laser therapy using an arsenide-gallium laser was used in 54 patients aged 30-75 years who suffered from coronary heart disease. A positive clinical effect was achieved in 47 (87%) of 54 patients, as evidenced by the reduced number of nitroglycerin tablets used and improved bicycle ergometric, echo- and electrocardiographic parameters in the patients.

[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.

[Clinico-pathochemical substantiation of the exacerbation phenomenon in patients with ischemic heart disease during treatment with the helium-neon laser]. / Kliniko-patokhimicheskoe obosnovanie fenomena obostreniia u bol'nykh ishemicheskoi bolezn'iu serdtsa pri lechenii gelii-neonovym lazerom.

Some pathochemical mechanisms of coronary disease aggravation in the course of laser therapy were assessed by means of the measurement of erythrocyte membrane lipids and phospholipids as well as plasma alpha-tocopherol and diene conjugate levels. The aggravation was associated with an activation of metabolic processes aiming to produce regeneration of membrane structures. The regeneration takes place in the presence of chronic deficiency of total phospholipids and inadequate antioxidant protection of biomembranes, therefore complete stabilization and normalization of their composition and activity is impossible.

[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.

[Effect of membrane-stabilizing magnetolaser therapy on cardiodynamics in patients with ischemic heart disease]. / Vliianie membranostabiliziruiushchei magnitolazernoi terapii na kardiodinamiku u bol'nykh ishemicheskoi bolezn'iu serdtsa.

AIM: To evaluate cardiodynamic changes in response to magnetolaser therapy (MLT) and these changes links with lipid shifts in cell membrane. MATERIAL AND METHODS: The study enrolled 50 patients with effort angina (functional class II-III). Of them, 37 patients were exposed to 10-day courses of MLT, 13 patients were exposed to sham procedures. Before the treatment and 3 months after it measurements were made of lipid peroxidation (LPO) products, structure of erythrocytic membrane and cardiodynamic parameters. RESULTS: MLT resulted in a significant reduction of LPO products, stabilization of cell membrane structure and positive shifts in cardiodynamics. Correlation was found between the above parameters. CONCLUSION: Improvement of inotropic, diastolic functions of the myocardium and abatement of cardiac remodeling in coronary heart disease patients in response to MLT is realized primarily due to structural stabilization of cell membrane lipid biolayer.

[The intracardiac laser irradiation of the blood in correcting left ventricular dysfunction in progressive stenocardia]. / Vnutriserdechnoe lazernoe obluchenie krovi v korrektsii levozheludochkovoi disfunktsii pri progressiruiushchei stenokardii.

The authors studied the effect of intracardiac irradiation of blood with a low intensity Helium-Neon laser on the pumping function of left ventricle in 73 patients with progressive angina pectoris. 47 patients underwent a course of laser hemotherapy while being given medicamentous therapy, the remaining 26 received nitrates, calcium antagonists and analgesics. Employment of laser light irradiation was associated with more satisfactory clinical effect than that in patients who had not had the procedure. It has also been established that intracardiac laser light irradiation of blood makes for the improvement of the characteristics of the intracardiac haemodynamics by diminishing the volumes and augmenting the left ventricular (LV) ejection fraction. Beneficial effect of laser hemotherapy on the intracardiac haemodynamics characteristics results from the stabilizing influence the method exerts on LV regional contractility and appear to be associated with its anti-ischemic effect.

[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.

[A comparative analysis of the results of using different methods of helium-neon laser therapy in patients with stable stenocardia]. / Porivnial'nyi analiz rezul'tativ vykorystannia riznykh sposobiv heliievo-neonovoï lazeroterapiï u khvorykh na stabil'nu stenokardiiu.

Based on the findings from the examination of 133 patients with stable angina pectoris, it was shown that He-Ne laser therapy with the irradiation being applied to the liver projection area in combination with the prolonged-action nitrates is superior to similar application of irradiation to the precordial region and Head's zones or intravenous irradiation of blood. Revealed in the examination of the above patients was a reaction of antiproteolytic enzymes to He-Ne laser therapy, which appeared to be varying with methods of laser therapy. It is suggested that a reaction of the realization of the components of proteolysis might be involved in the realization of therapeutic effect of the He-Ne laser energy in patients with ischemic heart disease.

[The clinical efficacy of a one-time course of infrared laser irradiation in stenocardia patients based on 6-month follow-up data]. / Klinicheskaia éffektivnost' odnokratnogo kursa infrakrasnogo lazernogo oblucheniia bol'nykh stenokardiei po dannym shestimesiachnogo nabliudeniia.

As shown by a 6-month follow-up of anginal patients exposed to a single 10-day course of infrared laser radiation, the antianginal effect of this laser treatment manifested 1 month after the end of the radiation, was registered in 80-82% of the patients and persisted after 6-month follow-up in 62.5% of the patients. The therapeutic effect was the highest in patients with severe coronary insufficiency.

[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.

[The laser therapy of patients with hypertension in combination with coronary insufficiency]. / Lazerterapiia u bol'nykh gipertonicheskoi bolezn'iu v sochetanii s koronarnoi nedostatochnost'iu.

Hypertensive patients with coronary insufficiency have received infrared (lambda = 0.85 microns) laser radiation to the skin. The treatment is shown to have antianginal, antihypertensive effects, to improve cardiac performance, myocardial contractility, to increase myocardial, coronary and aerobic reserves. This clinicofunctional efficacy is accompanied by positive shifts in lipid metabolism, lipid peroxidation activity, antioxidant defense, hemocoagulation and microcirculation.

[The dynamics of the clinico-functional indices in patients with ischemic heart disease under the influence of repeated courses of laser therapy]. / Dinamika kliniko-funktsional'nykh pokazatelei bol'nykh ishemicheskoi bolezn'iu serdtsa pod vliianiem povtornykh kursov lazernoi terapii.

Repeated courses of laser therapy given to patients with ischemic heart disease, angina of effort class I-IV for 2 years brought about stabilization of coronary insufficiency and improvement of clinical and functional conditions. Microcirculatory picture of the bulbar conjunctiva, coronary reserve improved. The treatment had also a hypotensive effect.

[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.

Relationship of dyspnea vs. typical angina to coronary artery disease severity, burden, composition and location on coronary CT angiography.

OBJECTIVE: Symptom presentations suspicious for coronary artery disease (CAD) vary widely. While dyspnea is associated with worse prognosis than typical angina (TypAng) for patients referred for non-invasive CAD imaging, the relation of dyspnea vs. TypAng to adverse measures of CAD prognosis-including severity, burden, composition, and myocardium at risk-has not been examined. METHODS: We studied 1443 consecutive individuals without known CAD (mean 61 ± 13 years, 61.6% men) undergoing coronary computed tomographic angiography (CCTA) who presented with dyspnea (n = 170), TypAng (n = 249) or no dyspnea or TypAng (n = 1024). Multivariable logistic regression was performed to evaluate the association of dyspnea or TypAng to obstructive CAD (≥70% stenosis), plaque burden (total segments with plaque), composition (noncalcified, partially calcified) and location (proximal, mid, or distal location in a coronary artery). RESULTS: By multivariable logistic regression, both dyspnea (OR1.9, 95% CI 1.1-3.3, p = 0.02) and TypAng (OR1.9, 95% CI 1.2-3.1, p = 0.01) were associated with obstructive CAD as compared to individuals without dyspnea or TypAng, while dyspnea (OR1.8, 95% CI 1.1-3.1, p = 0.02), but not TypAng (OR1.1, 95% CI 0.7-1.6, p = 0.76) was associated with plaque in the proximal portions of coronary arteries. Neither symptom type was associated with differences in plaque burden nor composition. CONCLUSION: Both dyspnea and TypAng are associated with higher rates of obstructive CAD compared to those without dyspnea or TypAng, but only dyspnea is associated with coronary plaque in proximal vessel portions.