Efficacy of Intramyocardial Injection of Angiogenic Cell Precursors for Ischemic Cardiomyopathy
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Introduction The objective of this study is to determine the efficacy of intramyocardial angiogenic cell precursors (ACPs) injection in ischemic cardiomyopathy (ICM). Methods Twenty-five ICM patients (cell group) underwent intramyocardial ACPs injection. Seventeen ICM patients (control group) treated by medical means were matched with cell group. There was no statistically significant difference between cell and control groups in relation to left ventricular ejection fraction (LVEF) and comorbidities. In the cell group, mean age was 58.4 ± 13.7 years. Mean LVEF was 26.1% ± 7.4%. New York Heart Association (NYHA) class was 2.9 ± 0.6. The ACPs were derived and expanded from autologous blood. The number of cells before injection was 27.4 ± 18.8 million cells. The cells were injected into the nonviable myocardium and hypokinetic segments in the cell group. Results There was no new ventricular arrhythmia. NYHA was improved by 0.9 ± 1.0 (P < 0.001) at 229.9 ± 98.8 days. Six-minute walk test and quality of life assessed by short form-36 improved in the cell group. LVEF was improved in 72% of patients (18 of 25). LVEF improved by 6.4 ± 9.9 points % (P = 0.003) at 290.4 ± 210.3 days. The percentage of infarction area decreased 21.9 ± 17.4 points % at 159 ± 54 days postoperatively. There was no significant improvement of NYHA and LVEF in the control group. Conclusions For this efficacy study, the NYHA class, quality of life, and six-minute walk test were improved after cell transplantation. The LVEF was also significantly improved in the cell treated group.Keywords:
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Background: It is not known whether the number of revascularizations modifies clinical outcomes in patients with ischemic cardiomyopathy (ICM) implanted with cardiac resynchronization therapy defibrillator (CRT-D) vs. an implantable cardioverter-defibrillator (ICD)-only. Methods: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), we evaluated the effect of CRT-D vs. ICD-only on heart failure (HF) or death, on ventricular tachycardia (VT), ventricular fibrillation (VF) or death, and on reverse remodeling in 592 ICM patients with left bundle branch block, by the number of pre-enrollment revascularizations (0, 1 or ≥ 2 revascularizations). Results: There was a risk reduction of HF/death with CRT-D vs. ICD-only in all three sub-groups: ICM with no need for revascularization (HR 0.51 [0.26–1.02]; p = 0.055), ICM with 1 revascularization (HR 0.45 [0.30–0.70]; p < 0.001), and ICM with 2 or more revascularizations (HR 0.37 [0.20–0.66]; p < 0.001). Similarly, there was a risk reduction of VT/ /VF/death with CRT-D vs. ICD-only in patients with no need for revascularization (HR 0.55 [0.31–0.99]; p = 0.044); with 1 revascularization (HR 0.77 [0.51–1.18]; p = 0.23); or with ≥ 2 revascularizations (HR 0.63 [0.34–1.17]; p = 0.14). There was a similar degree of left ventricular reverse remodeling in all three subgroups (p > 0.05 for LVESV, LVEDV, and LAV percent change at 1-year follow-up). Conclusions: In ICM patients, CRT-D is associated with a reduction in HF or death and VT/VF or death — irrespective of the frequency of pre-enrollment revascularization procedures — and is accompanied by a similar degree of beneficial left ventricular reverse remodeling.
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Stem cell therapy for heart failure is a rapidly progressing field. The objective of this study was to assess the safety, and short-term results of thoracoscopic direct injection of angiogenic cell precursors into patients with endstage cardiomyopathy. Cells were obtained from the patient's own blood, avoiding immunological concerns. The number of cells prior to injection was 29.1 ± 18.9 ×10 6 . Forty-one patients with cardiomyopathy (mean age, 58.5 ± 14.3 years) underwent stem cell injection; 21 had dilated cardiomyopathy and 20 had ischemic cardiomyopathy. Overall ejection fraction improved significantly by 4.8% ± 7.5% at 149 ± 98 days postoperatively. It increased from 25.9% ± 8.6% to 28.7% ± 9.8% in dilated cardiomyopathy, and from 26.6% ± 5.8% to 33.6% ± 7.8% in ischemic cardiomyopathy. New York Heart Association functional class was significantly better at 2 months in both groups. It was concluded that thoracoscopic intramyocardial angiogenic cell precursor injection is feasible and safe in patients with cardiomyopathy. The early results are good, and phase II trials are in progress.
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A A A A AA A A A A A A A A AA A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A
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At present not much data is available on changes in myocardial function after combined coronary artery bypass grafting (CABG) and downsizing of the mitral valve (MV) by restrictive prosthetic ring annuloplasty in patients with chronic ischemic mitral regurgitation (IMR) and advanced cardiomyopathy.63 patients with coronary artery disease, chronic IMR grade 3 - 4+, ischemic cardiomyopathy and reduced left ventricular (LV) function (LV ejection fraction [LVEF] of 30 +/- 9 %; range 12 - 45 %) underwent combined CABG and MV downsizing. Clinical follow-up and serial echocardiographic studies were performed to assess survival, New York Heart Association (NYHA) class, mitral regurgitation (MR), leaflet coaptation height (LCH), left atrial (LA) and LV end-systolic/end-diastolic dimensions/volumes and volume indices (LVESD, -EDD; LVESV, -EDV; LVESVI, -EDVI), fractional shortening (FS) and LVEF to evaluate the changes in myocardial function after surgery.Early mortality (< 30 days) was 1.6 %, survival at follow-up was 95 % (3 +/- 1 months) and 83 % (2 +/- 1 years), respectively. Functional class improved significantly after surgery; recurrence of relevant MR was absent in all patients. In general, LA/LV dimensions/volumes and volume indices, FS and LVEF improved significantly, even in patients with already severely reduced preoperative LV function (LVEF
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Cardiac resynchronization therapy (CRT) is an established therapy for heart failure patients who remain symptomatic despite optimal medical therapy, have reduced left ventricular ejection fraction (<35%) and wide QRS duration (>120 ms), preferably with left bundle branch block morphology. The response to CRT depends on the cardiac substrate: presence of correctable left ventricular mechanical dyssynchrony, presence of myocardial fibrosis (scar) and position of the left ventricular pacing lead. Patients with non-ischemic cardiomyopathy have shown higher response rates to CRT compared with patients with ischemic cardiomyopathy. Differences in myocardial substrate may partly explain this disparity. Multimodality imaging plays an important role to assess the cardiac substrate and the pathophysiological determinants of response to CRT.
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Қaй уaқыттa болмaсын мәдениетaрaлық қaрым-қaтынaстaрдың жaқсы деңгейде жүзеге aсуы не құлдырaуы бaстaпқы мәтіннің бaсқa тілдегі aудaрмaсымен aдеквaтты не бaлaмaлы болуынa тікелей бaйлaнысты. Осығaн орaй, көптеген ғaлымдaр aдеквaттылық пен бaлaмaлылық терминдерін зерттеуге жітінaзaр aудaрудa. Сондықтaн осы тaқырыпты зерттейтін теориялaрдың сaны күн-нен күнге aртып келеді. Кей ғaлымдaрдың есептеуінше, aдеквaттық және бaлaмaлық ұғымдaры бір мaғынaны білдіреді, aл бaсқaлaры олaрдың ұқсaстықтaры көп болғaнымен оны екі бөлек ұғым ретінде қaрaстыру керек деп пaйымдaйды. Сол себептібұл жұмыстың мaқсaты – aдеквaттылық және бaлaмaлылық ұғымдaрыныңмәнің aдевaтты және бaлaмa aудaрмaлaры турaлы теориялaрды жүйелеу және топтaстырып, сaрaлaу aрқылы aжырaту. Бір жaғынaн, бұл оқырмaнғa удaрмaтaнымындaғы aдеквaттылық және бaлaмaлық ұғымдaрын оңaй түсінуге,екінші жaғынaн бұл бізге екі ұғымның aйырмa шылықтaры мен ұқсaстықтaрынaнықтaуғa мүмкіндік береді. Зерттеу мaқсaтын жүзеге aсыру үшін жұмысбaрысындa сaлыстырмaлытaлдaу әдісі қолдaнылды. Шетелдік ғaлымдaрдың зерттеулерінің негізінде бұл жұмыстa aдеквaтты және бaлaмaлы aудaрм aның ұқсaс тұстaры мен aйырмaшылықтaры тaлдaнды. Тaлдaуғa сәйкес біз aдеквaтты aудaрмa ретінде күтілетін коммуникaтивтік әсерді қaмтaмaсыз етеді, сондaй-aқ оның бaсты тaлaптaрының бірі түпнұсқaның мaғынaсын толықтaй жеткізу үшін бaлaмaлaрды қолдaну деп қaрaстырaмыз. Бірaқ бaлaмaлы aудaрмa өз тaрaпындa прaгмaтикaлық мaқсaтты әрдaйым қaмтaмaсыз ете aлмaйды, әрі әрқaшaн aудaрмaның конвенционaлды нормaтивті тaлaптaрынa сәкес болa бермейді.
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