ГИБРИДНАЯ СТРАТЕГИЯ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА В СРАВНЕНИИ С АОРТОКОРОНАРНЫМ ШУНТИРОВАНИЕМ У ПАЦИЕНТОВ С МНОГОСОСУДИСТЫМ ПОРАЖЕНИЕМ КОРОНАРНОГО РУСЛА ПРИ СТАБИЛЬНОЙ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА, 30-ДНЕВНЫЕ РЕЗУЛЬТАТЫ
Abstract Purpose To study the peculiarities of the content of leptin and the leptin receptor in adipocyte culture of subcutaneous (SAT), epicardial (EAT) and perivascular (PVAT) adipose tissue and the expression of their genes. Methods 29 patients with coronary heart disease were examined. Adipocytes were isolated from SAT, EAT and PVAT samples obtained during coronary artery bypass grafting, followed by evaluation (after 24 hours) of the leptin concentration (Human resistin ELISA, R&D Systems, USA) and leptin gene expression in cell culture. Magnetic resonance imaging (MRI) was used to determine the area of the visceral (VAT) and subcutaneous adipose tissue (SAT) of the abdominal region, the thickness of epicardial adipose tissue (EAT). The calculation of the free leptin index (FLI) was determined by the formula: leptin/SOB-R * 100. Leptin resistance was defined as an FLI >0.25. All study was carried out in compliance with the Helsinki Declaration, and its protocol was approved by the Ethical Committee of Research Institute. Statistical analysis was performed using Statistica 10.0. Results In adipocytes of EAT, leptin secretion was 1.2 times higher than in adipocytes of PVAT, which is consistent with the expression of the leptin gene. The content of leptin soluble receptor was opposite in the adipocytes of PVAT higher than in EAT and SAT 2.3 and 3.1 times, respectively. At the same time, the index of free leptin was higher in SAT adipocytes 1.3 and 3.2 times in comparison with EAT and PVAT. The correlation analysis confirmed the relationship between EAT thickness and the serum concentrations of leptin. Thus, in patients with VO, the leptin concentration had a negative dependence on the thickness of the left and right ventricle (r=−0.28, p=0.02; r=−0.33, p=0.02, respectively). A negative dependence on the EAT thickness was also established for the FLI (r=−0.28; p=0.03). PVAT of the abdominal aorta is similar to the properties of visceral AT. An analysis of the possible relationship between perivascular adipocytes and adipokine exchange rates showed a direct relationship between the volume PVAT of the abdominal aortic ventricle and leptin (r=0.44, p=0.01), as well as the FLI (r=0.56; p=0.03). Conclusion Adipocytes SAT, EAT and PVAT differed in the level of secretion of leptin. In epicardial and, to a greater extent, in perivascular adipocytes, a protective mechanism against a high concentration of leptin was observed due to increased secretion of the soluble receptor to leptin. The high content of leptin and the low soluble receptor for leptin led to the development of leptin resistance, which was more pronounced in the culture of adipocytes SAT. Meanwhile, the EAT thickness was inversely related to the concentration of leptin and the FLI index (one of the main leptin-resistance markers).
Abstract Aim Optimal revascularization strategy in multi-vessel (MV) coronary artery disease (CAD) eligible for percutaneous intervention (PCI) and surgery remains unresolved. We evaluated, in a randomized clinical trial, residual myocardial ischemia (RI) and clinical outcomes of MV-CAD revascularization using coronary artery bypass grafting (CABG), hybrid coronary revascularization (HCR) or MV-PCI. Materials and methods Consecutive MV-CAD patients (n=155) were randomized (1:1:1) to conventional CABG (LIMA-LAD plus venous grafts) or HCR (MIDCAB LIMA-LAD followed by PCI for remaining vessels) or MV-PCI (everolimus-eluting CoCr stents) under Heart Team agreement on equal technical and clinical feasibility of each strategy. The primary endpoint was SPECT at 12 months (primary endpoint of RI that the trial was powered for; a measure of revascularization mid-term efficacy and an independent predictor of long-term prognosis). The secondary endpoint was 3-year MACCE. Results Baseline characteristics were similar between the study arms. 5 (9.8%) patients in the HCR group required conversion to CABG. Data are given respectively for the CABG, HCR and MV-PCI arm. Incomplete revascularization rate was 8.0% vs. 7.7% vs. 5.7% (p=0.86). At 12 months, RI was 5 (2,9)% vs. 5 (3,7)% vs. 6 (3,10)% (median; Q1,Q3) with non-inferiority p values of 0.0006 (HCR vs. CABG) and 0.016 (MV-PCI vs. CABG). 3-year MACCE rate was similar (34.7% vs. 27.1% vs. 38%; p=0.18). Conclusion In patients with MV-CAD amenable to CABG, HCR, and MV-PCI, endpoints of residual myocardial ischemia at 12 months and 3-year MACCE were similar. ClinicalTrials: gov identifier: NCT01699048 Funding Acknowledgement Type of funding source: None
The aim . Evaluates longterm clinical outcomes of percutaneous coronary intervention (PCI) with bioresorbable vascular scaffold (BVS) versus minimally invasive direct coronary artery bypass (MIDCAB) surgery for the treatment of left anterior descending (LAD) lesions. Methods and Results. In this singlecenter study were included 130 patients with stable angina and significant (≥ 70 %) LAD disease. Patients were randomly assigned in a 1:1 ratio to PCI with everolimuseluting BVS (n=65) or MIDCAB (n=65). The primary endpoint was major adverse cerebrocardiovascular events (MACCE) and secondary was scaffold (graft) thrombosis at 1 year. The groups of patients were comparable for all baseline demographic, clinical and angiographic parameters. MACCE at 12 month occurred in 9.2 % of patients in the BVS group and in 4.6 % of patients in the MIDCAB group (p=0.3). There was no significant difference between the groups in rates of all cause death (1.5 % vs 1.5 %, p=1.0), myocardial infarction (3.1 % vs. 6.1 %, p=0.4), any revascularization (1.5 % vs. 6.1 %, p=0.1) and scaffold (graft) thrombosis (1.5 % vs. 1.5 %, p=1.00). Conclusion. At 12month follow up, there was no significant difference in the rate of MACCE between PCI by BVS and MIDCAB in patients with isolated LAD lesions.
Adipose tissue, an easily available and bioactive tissue, is currently considered as an attractive source of autologous cells for tissue engineering and regenerative medicine. Here we estimated endothelial cell yield of epicardial adipose tissue (EAT) and subcutaneous adipose tissue (SAT), the two major fat depots, in patients with coronary artery disease. Following enzymatic dissociation of adipose tissue, stromal vascular fraction was cultured in endothelial cell growth medium according to the established protocol. Endothelial phenotype was authenticated by a double immunostaining to VE-cadherin/CD144 and von Willebrand factor. We found that both EAT and SAT contain a comparable and significant amount of endothelial progenitor cells.
This study aimed to investigate the adipokine and cytokine profiles of adipocytes from epicardial and subcutaneous adipose tissues in interconnection with the visceral adipose tissue area and the biochemical and clinical characteristics of patients with coronary artery disease. We assessed 84 patients with coronary artery disease (65 men, 19 women) and divided them into two groups based on the presence of visceral obesity. We sampled epicardial and subcutaneous adipose tissues from the patients with visceral obesity. We then cultured the adipocytes and evaluated their adipokine profiles and pro-inflammatory activity. Results show that the mRNA expression of adiponectin in cultures of epicardial adipocytes from patients with and without visceral obesity was lower than that in subcutaneous adipocytes. Moreover, adiponectin mRNA expression in cultures of subcutaneous and epicardial adipocytes from patients with visceral obesity was lower than that in patients without obesity. For leptin, the reverse pattern was observed, with expression higher in cultures of epicardial adipocytes than in subcutaneous adipocytes and higher in epicardial adipocytes from patients with visceral obesity than in those from subjects without visceral obesity. In addition, in epicardial adipocytes, increased expression of proinflammatory cytokine genes (IL6, TNF) was observed compared with that in subcutaneous adipocytes. In contrast, expression of IL10 was higher in cultures of subcutaneous adipocytes than in epicardial adipocytes. The epicardial adipose tissue area was associated with the presence of higher levels of leptin and TNF-α within adipocytes and serum, increased lipid and carbohydrate metabolism. Coronary artery disease, in the context of the status of epicardial adipocytes, can be characterised as 'metabolic inflammation', suggesting the direct involvement of adipocytes in pathogenesis through the development of adipokine imbalances and activation of proinflammatory processes.
Aim. To compare the effectiveness and safety of endovascular occlusion and thoracoscopic amputation of the left atrial appendage (LAA) in patients with atrial fibrillation (AF). Methods. We present a retrospective single-center study with a prospective component including 25 patients with AF who underwent thoracoscopic amputation of the LAA and 31 patients on prospective part who underwent endovascular occlusion of the LAA. All patients signed voluntary informed consent for medical intervention and participation in the study. The criteria for selecting patients for thoracoscopic amputation of the LAA were the impossibility of performing an endovascular technique, features of its anatomy and increased trabecularity. Results. In the group of patients with thoracoscopic amputation of the LAA, 2 cases of embologenic stump of the LAA with a depth of 1.6 cm (8%) were identified; these patients were recommended to continue taking anticoagulant therapy. Among patients who underwent thoracoscopic amputation, no complications were identified in the first 30 days after surgery, including mortality, bleeding, phrenic nerve paresis, acute cerebrovascular accident, pleurisy, pneumothorax, hemothorax. In 3 patients who underwent endovascular occlusion of the LAA, hematomas were detected at the site of puncture of the great vessels (9.7%), in 2 patients thrombus were detected on the occlusion device according to the results of transesophageal echocardiography (6.5%), which required the prescription of warfarin in these patients. Also, in 2 patients (6.5%) during implantation of the occluder into the LAA, as a result of the incorrect diameter of the disk of the occluding device, a residual cavity with a depth of 0.7 cm was formed between the ridge and the occluder. No significant differences in the frequency of non-severe complications were found in the groups, p =0.139. During the year of postoperative observation, thromboembolic complications were absent in the operated patients of both groups. Conclusion. When comparing two methods of LAA isolation, no severe complications were identified, either in the perioperative or in the early or late postoperative period. There were no significant differences in the incidence of non-severe complications in the early postoperative period. Thus, the effectiveness and safety of thoracoscopic amputation and endovascular occlusion of the left atrial appendage are comparable.
Abstract Obesity is still a major health, social and economic problem throughout the world. Recently, it is important to study the role of adipokines of adipose tissue of various localization in the development of cardiovascular diseases, as well as methods for their pharmacological correction. Purpose The study was to evaluate the effect of rosuvastatin on the secretion of leptin and its receptor by adipocytes of different localization, as well as on the expression of their genes in patients with ischemic heart disease. Methods 29 patients with coronary heart disease which will be held coronary bypass surgery. Adipocytes were isolated from the samples of SAT, EAT and PVAT obtained during coronary artery bypass grafting, which were cultured for 24 hours with rosuvastatin 1 μmol/l and 5 μmol/l. A day later, the concentration of leptin and the leptin receptor in cell culture was determined. All study was carried out in compliance with the Helsinki Declaration, and its protocol was approved by the Ethical Committee of Research Institute. Statistical analysis was performed using Statistica 10.0. All patients gave written informed consent to participate in the study. Results 1 μmol/l of rosuvastatin increased the level of leptin 1.6 and 2.9 times higher in adipocytes SAT compared with EAT and PVAT, respectively, and 1.8 times higher in EAT than in PVAT, which is consistent with the results of expression leptin gene. The concentration of rosuvastatin 5 μmol/l had an effect only on adipocytes SAT, increasing the level of leptin 1.6 and 2.2 times in comparison with adipocytes EAT and PVAT. Rosuvastatin had no significant effect on leptin receptor soluble levels. The free leptin index was higher in adipocytes SAT in the presence of 1 μmol/l of rosuvastatin 1.6 and 2.8 times in comparison with adipocytes of EAT and PVAT. Conclusion The concentration of rosuvastatin 1 μmol/l had a more pronounced effect on adipocytes compared to a concentration of 5 μmol/l and increased the level of leptin and its expression in cell culture. At the same time, a high content of leptin under conditions of low expression of a soluble receptor to leptin in the presence of rosuvastatin 1 μmol/l can lead to leptin resistance, more pronounced in SAT adipocytes.
A clinical case of successful radiofrequency thoracoscopic ablation of persistent atrial fibrillation after implantation of an occluder in the left atrium appendage is presented.
