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Long-term results of isolated transmyocardial laser revascularization in combination with the intramyocardial autologous bone marrow stem cells injection
摘要： To evaluate the long-term results of TMLR using a CO2 laser in combination with intramyocardial injection of ABMSC as an isolated procedure in patients with the end-stage coronary artery disease, the study included 20 patients (90% male), with a mean age of 58.4 ± 8.7 years. To assess the long-term results, patients were examined in a hospital. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Seattle Angina Questionnaire (SAQ) were used. The evolution of laboratory and instrumental indices, as well as medical therapy, was assessed. The end points of the study were death, acute myocardial infarction (AMI), repeated myocardial revascularization, recurrent hospitalizations due to coronary artery disease, and stroke. The changes in angina functional class were also evaluated. The median of follow-up period was 54 (36; 83) months, that is, 4.5 years. The analysis of the evolution of echocardiographic data showed the absence of statistically significant changes in the following parameters: left ventricular end-diastolic diameter (EDD) (p = 0.967), end-systolic diameter (ESD) (p = 0.204), end-diastolic volume (EDV) (p = 0.852), end-systolic volume (ESV) (p = 0.125), and left ventricular ejection fraction (LVEF) (p = 0.120). The patients continued to regularly take the main groups of medications. Nitrate consumption was significantly reduced (p < 0.001). Significant positive dynamics were observed in the changes in angina functional class. At the baseline, all patients had angina III FC, in the long term, 3 patients had II FC, 11 patients had I FC, and 6 patients had no angina. Clinical outcomes (mortality, recurrent myocardial infarction, stroke) were absent during the follow-up period. There were two cases of repeated myocardial revascularization. Regression analysis revealed that SYNTAX score was associated with the clinical outcome “repeated revascularization.” TMLR in combination with intramyocardial injection of ABMSC is a safe method to achieve a statistically significant antianginal effect and reduce the need for “nitrates,” which in turn improves the quality of life and reduces the frequency of hospitalizations due to coronary artery disease. These results can be achieved with strict adherence to the certain indications for the intervention.
关键词： Coronary artery disease,Transmyocardial laser myocardial revascularization,Autologous bone marrow stem cells,Chronic heart failure,CO2 laser
更新于2025-09-12 10:27:22
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Coronary computed tomography: current role and future perspectives for cardiovascular risk stratification
摘要： Coronary computed tomography: current role and future perspectives for cardiovascular risk stratification. F. Musella, R. Formisano, G. Mattiello, E. Iardino, L. Petraglia, A. Vitagliano, I. Fabiani, A.P. Cirillo, M. Petito, P. Perrone-Filardi. Atherosclerotic coronary artery disease (CAD) is a major cause of morbidity and mortality. The majority of cardiovascular events, more than 50% of CAD deaths, occur in previously asymptomatic individuals at intermediate cardiovascular risk, highlighting the relevance of accurate individual risk assessment to decrease cardiovascular events through more appropriate targeting of preventive measures. In the last decades, the development of non-invasive imaging techniques have prompted interest in imaging of atherosclerosis. Coronary computed tomography provides the opportunity to assess the deposition of calcium in the coronary tree and to non-invasively image coronary vessels. Both information are useful for risk stratification of asymptomatic subjects or of subjects with suspected CAD.
关键词： cardiovascular imaging,coronary artery disease,coronary calcium score,atherosclerosis,coronary CT angiography.
更新于2025-09-10 09:29:36
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Computed Tomography Imaging of the Coronary Arteries: State of the Art Applications and Recent Patents
摘要： Computed tomography (CT) is important for the management of many medical illnesses, including coronary artery disease (CAD). However this technique is not free from disadvantages like the exposure to ionizing radiations and to iodinated contrast agents. To overcome these problems, imaging technologies are changing rapidly. New-generation computed tomography scanners (NGCCT) may bring substantial advantages over traditional CT and other currently used imaging methods. These novel tools employ dedicated protocols to shorten imaging times and reduce radiation doses without affecting accuracy. Current CT scanners can very accurately identify severe CAD requiring intervention in most patients, but NGCCT may further benefit imaging for some “difficult” patients like obese patients, patients with high or irregular heart rates, and patients who have high coronary calcium burden or previous stents or bypass grafts. In fact in these patients traditional CT studies often produce suboptimal quality images. Our review presents the current status in the technical background of coronary nuclear tomographic imaging in the areas of clinical practice, and focuses on future developments of related patent forms.
关键词： Computed tomography,coronary artery disease,contrast nephrotoxicity,radiation dose,computed tomography coronary angiography,iodinated contrast medium
更新于2025-09-09 09:28:46
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Hybrid anatomo-functional imaging of coronary artery disease: Beneficial irrespective of its core components
摘要： Coronary artery disease (CAD) is the most common and important cause of ischemic heart disease, with major implications on global morbidity and mortality. Non-invasive testing is crucial in the diagnostic and prognostic work-up of patients with or at risk of CAD, and also to guide decision making in terms of pharmacologic and revascularization therapy. The traditional paradigm is to view anatomic (i.e., coronary computed tomography) and functional imaging (e.g., myocardial perfusion scintigraphy) tests as opposing alternatives. Such approach is too reductionist and does not capitalize on the strengths of each type of test while risking to overlook the inherent limitations. The combination of anatomic and functional tests in a logic of hybrid imaging holds the promise of overcoming the limitations inherent to anatomic and functional testing, enabling more accurate diagnosis, prognosis, and guidance for revascularization in patients with CAD.
关键词： hybrid imaging,single-photon emission computed tomography,computed tomography,Coronary artery disease
更新于2025-09-04 15:30:14
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Early Follow-Up Optical Coherence Tomographic Findings of Significant Drug-Eluting Stent Malapposition
摘要： BACKGROUND: Using optical coherence tomography, we evaluated early follow-up findings of significant stent malapposition (SSM) in patients treated with second-generation drug-eluting stent. METHODS AND RESULTS: From the DETECT-OCT randomized trial (Determination of the Duration of the Dual Antiplatelet Therapy by the Degree of the Coverage of the Struts on Optical Coherence Tomography From the Randomized Comparison Between Everolimus- Versus Biolimus-Eluting Stent), a total of 386 patients (390 lesions) who underwent both postintervention and 3-month follow-up optical coherence tomography examinations were included for the present analysis. SSM was defined as a stent that had a strut with a maximal wall-to-strut distance of ≥200 μm. Postintervention, SSM was detected in 175 lesions (44.9%), including 117 lesions with a maximal wall-to-strut distance of ≥200 to <400 μm and 58 lesions with a maximal wall-to-strut distance of ≥400 μm. As the implanted stent diameter-to-reference vessel diameter ratio grew, the risk of postintervention SSM dropped (odds ratio, 0.587; 95% CI, 0.367–0.941; P=0.0398). The optimal value that best separated SSM from non-SSM postintervention was a stent diameter-to-reference vessel diameter ratio of 1.0. At 3 months follow-up, the frequency of SSM decreased from 44.9% to 33.6% (131 lesions; P=0.0001), mainly driven by the decrease in lesions with a maximal wall-to-strut distance of ≥200 to <400 μm. As the maximal wall-to-strut distance on postintervention optical coherence tomography was larger, the risk of 3-month SSM increased (odds ratio, 1.607; 95% CI, 1.131–2.286; P=0.0284). The optimal value that best separated SSM from non-SSM at 3 months follow-up was a maximal wall-to-strut distance postintervention of 230 μm. CONCLUSIONS: A spontaneous decrease in SSM was observed early in this qualified study with a large number of study patients treated with second-generation drug-eluting stent.
关键词： optical coherence tomography,drug-eluting stents,coronary artery disease
更新于2025-09-04 15:30:14