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Iwanski J, Knapp SM, Avery R, Oliva I, Wong RK, Runyan RB, Khalpey Z. Clinical outcomes meta-analysis: measuring subendocardial perfusion and efficacy of transmyocardial laser revascularization with nuclear imaging. J Cardiothorac Surg 2017; 12:37. [PMID: 28526044 PMCID: PMC5438520 DOI: 10.1186/s13019-017-0602-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Randomized and nonrandomized clinical trials have tried to assess whether or not TMR patients experience an increase in myocardial perfusion. However there have been inconsistencies reported in the literature due to the use of different nuclear imaging modalities to test this metric. The primary purpose of this meta-analysis was to determine whether SPECT, MUGA and PET scans demonstrate changes in myocardial perfusion between lased and non-lased subjects and whether laser type affects myocardial perfusion. The secondary purpose was to examine the overall effect of laser therapy on clinical outcomes including survival, hospital re-admission and angina reduction. METHODS Sixteen studies were included in the primary endpoint analysis after excluding all other non-imaging TMR papers. Standardized mean difference was used as the effect size for all quantitative outcomes and log odds ratio was used as the effect size for all binary outcomes. RESULTS Statistically significant improvements in myocardial perfusion were observed between control and treatment groups in myocardial perfusion at 6-month follow up using PET imaging with a porcine model. However non-significant differences were observed in patients at 3 and 12 months using SPECT, PET or MUGA scans. Both CO2 and Ho:YAG laser systems demonstrated an increase in myocardial perfusion however this effect was not statistically significant. In addition both laser types displayed statistically significant decreases in patient angina at 3, 6 and 12 months but non-significant increases in survival rates and decreases in hospital re-admissions. CONCLUSION In order to properly assess myocardial perfusion in TMR subjects, subendocardial perfusion needs to be analyzed via nuclear imaging. PET scans can provide this level of sensitivity and should be utilized in future studies to monitor and detect perfusion changes in lased and non-lased subjects.
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Affiliation(s)
- Jessika Iwanski
- Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Shannon M Knapp
- BIO5 Institute, Statistics Consulting Lab, University of Arizona, Tucson, AZ, USA
| | - Ryan Avery
- Department of Nuclear Medicine, Banner University Medical Center, Medical Imaging, Tucson, AZ, USA
| | - Isabel Oliva
- Department of Nuclear Medicine, Banner University Medical Center, Medical Imaging, Tucson, AZ, USA
| | - Raymond K Wong
- Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Raymond B Runyan
- Department of Cellular and Molecular Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Zain Khalpey
- Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, AZ, USA. .,Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA. .,Division of Cardiothoracic Surgery, Regenerative Medicine, Cellular & Molecular Medicine, University of Arizona College of Medicine, 1656 E. Mabel St, Rm 120, Medical Research Building, Tucson, AZ 85724, USA.
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Pattanakuhar S, Pongchaidecha A, Chattipakorn N, Chattipakorn SC. The effect of exercise on skeletal muscle fibre type distribution in obesity: From cellular levels to clinical application. Obes Res Clin Pract 2016; 11:112-132. [PMID: 27756527 DOI: 10.1016/j.orcp.2016.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/18/2016] [Accepted: 09/28/2016] [Indexed: 12/25/2022]
Abstract
Skeletal muscles play important roles in metabolism, energy expenditure, physical strength, and locomotive activity. Skeletal muscle fibre types in the body are heterogeneous. They can be classified as oxidative types and glycolytic types with oxidative-type are fatigue-resistant and use oxidative metabolism, while fibres with glycolytic-type are fatigue-sensitive and prefer glycolytic metabolism. Several studies demonstrated that an obese condition with abnormal metabolic parameters has been negatively correlated with the distribution of oxidative-type skeletal muscle fibres, but positively associated with that of glycolytic-type muscle fibres. However, some studies demonstrated otherwise. In addition, several studies demonstrated that an exercise training programme caused the redistribution of oxidative-type skeletal muscle fibres in obesity. In contrast, some studies showed inconsistent findings. Therefore, the present review comprehensively summarizes and discusses those consistent and inconsistent findings from clinical studies, regarding the association among the distribution of skeletal muscle fibre types, obese condition, and exercise training programmes. Furthermore, the possible underlying mechanisms and clinical application of the alterations in muscle fibre type following obesity are presented and discussed.
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Affiliation(s)
- Sintip Pattanakuhar
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Thailand; Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Thailand
| | - Anchalee Pongchaidecha
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Thailand; Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand.
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Lin JW, Sheu WHH, Lee WJ, Chen YT, Liu TJ, Ting CT, Lee WL. Circulating Hepatocyte Growth Factor Level but Not Basic Fibroblast Growth Factor Level Is Elevated in Angiography-Proven Symptomatic Peripheral Artery Disease. Angiology 2016; 58:420-8. [PMID: 17875955 DOI: 10.1177/0003319706294556] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Circulating vasogenic factors may be up-regulated in response to ischemia to promote angiogenesis in patients with peripheral artery disease (PAD). Studies on this are limited in number and size, and results are inconsistent, especially regarding basic fibroblast growth factor (bFGF) level. From March 1999 to April 2004, all consecutive patients with lower limb PAD having serum samples at the time of intervention were recruited. The diameter of the primary PAD lesion had to be at least 70% stenotic at the lower limb artery. Control subjects, who underwent angiography, were free of PAD, coronary disease, and other major medical diseases. Serum samples were analyzed for circulating hepatocyte growth factor (HGF) and bFGF levels. Patients with PAD (n = 60) had higher circulating HGF levels (mean ± SEM, 1544 ± 238 vs 970 ± 129 pg/mL; P = .04) but similar bFGF distribution tertiles (P = .55) compared with control subjects (n = 30). Thirty-six patients with summed PAD lesion lengths exceeding 5 cm demonstrated a significantly higher circulating HGF level compared with control subjects (mean ± SEM, 1701 ± 335 vs 970 ± 129 pg/mL; P = .048). Patients with concurrent coronary artery disease tend to have a higher circulating HGF level (mean ± SEM, 1606 ± 365 vs 970 ± 129 pg/mL; P = .06) but not a higher bFGF level compared with control subjects. Circulating HGF level, but not bFGF level, is significantly elevated in patients with symptomatic angiographically documented PAD, especially in those with more extensive involvement.
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Affiliation(s)
- Jiunn-Wen Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 407, Taiwan
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Yi GH, George I, He KL, Lee MJ, Cahalan P, Zhang G, Gu A, Klotz S, Burkhoff D, Wang J. Direct left ventricle-to-coronary artery stent restores perfusion to chronic ischemic swine myocardium. Heart Surg Forum 2006; 9:E744-9. [PMID: 16809127 DOI: 10.1532/hsf98.20061021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Direct left ventricle (LV)-to-coronary artery shunts (VSTENT) have been proposed as an alternative means of myocardial revascularization. The goal of this study was to examine quantitative changes in myocardial perfusion and possible mechanisms of revascularization with an LV-to-coronary shunt. METHODS Ameroid occluders were implanted on the proximal left anterior descending coronary artery (LAD) of 6 pigs to create chronic ischemia. Four weeks later, a VSTENT was placed to directly connect the distal LAD with the LV chamber. Animals survived for an additional 3 weeks and received periodic bromodeoxyuridine (BrdU) injections to identify dividing cells to identify and quantify angiogenesis. Regional myocardial perfusion (RMP) was measured with color microspheres under adenosine vasodilatory stress before and 3 weeks after VSTENT implantation. Vascularity was assessed histologically by an overall vascularity index and a growth index reflecting the density of BrdU-positive vascular cells. RESULTS Three weeks after VSTENT placement, RMP improved from 38.4% +/- 19.6% of non-ischemic flow to 86.8% +/- 13.7% in treated animals (P < .05). This benefit was accompanied by histological evidence of increased vascularity and vascular proliferation. Four of 5 animals had patent and functional devices at the end of the study. CONCLUSION Chronic VSTENT placement improves RMP and may promote arterial remodeling in chronically ischemic porcine myocardium.
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Affiliation(s)
- Geng-Hua Yi
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Krisciukaitis A, Tamosiunas M, Jakuska P, Veteikis R, Lekas R, Saferis V, Benetis R. Evaluation of ischemic injury of the cardiac tissue by using the principal component analysis of an epicardial electrogram. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2006; 82:121-9. [PMID: 16644061 DOI: 10.1016/j.cmpb.2006.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 03/07/2006] [Accepted: 03/10/2006] [Indexed: 05/08/2023]
Abstract
Monitoring and control of the heart tissue viability is of crucial importance during heart surgery operations. In most cases the heart tissue suffers from an ischemic injury that causes a decrease in the velocity of electrical excitation propagation in it and influences the shape of the excitation wave front that spreads over the injured area. It is reflected in a more complex shape of the registered epicardial electrogram as compared to normal. A method for quantitative evaluation of the complexity of the shape of the epicardial electrogram based on the principal component analysis is here proposed for evaluation of the ischemic injury of the cardiac tissue. A minimal, yet sufficient, number of the principal components (the optimal basis functions) for truncated expansion of the epicardial electrogram signals could be used as an estimate of signal complexity. The method for determination of such a minimal, yet sufficient, number of principal components were developed by using epicardial electrograms registered during in situ experiments on dogs in which local ischemia was evoked by ligation of a coronary vessel.
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Affiliation(s)
- Algimantas Krisciukaitis
- Institute for Biomedical Research of Kaunas University of Medicine, Eiveniu 4, LT-50009 Kaunas, Lithuania.
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Krisciukaitis A, Minet O, Tamosiunas M, Zabarylo U, Bytautas A, Baniene R, Mildaziene V, Lekas R, Jakuska P, Lukosevicius K, Benetis R, Beuthan J. Heart tissue viability monitoring in vivo by using combined fluorescence, thermography and electrical activity measurements. BIOMED ENG-BIOMED TE 2006; 50:419-25. [PMID: 16429947 DOI: 10.1515/bmt.2005.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A prototype system for in vivo monitoring of the heart tissue viability by using combined measurements of fluorescence, thermography and electrical activity has been elaborated for cardiac surgery. The fluorescence imaging of nicotinamide adenine dinucleotide NAD(P)H in the blue light range (lambda=467 nm) by using UV light (lambda=347 nm) excitation was used to detect metabolic disturbances. The method of the principal component analysis was used for the processing of the fluorescence image sequences. Far infrared (lambda=7.5-13 microm) imaging was used to evaluate temperature dynamics of the tissue surface during circulation disturbances. Evaluation of the epicardial electrogram shape by using continuous wavelet transform was used to detect and evaluate ischemia-caused disturbances of the electrical activity of the tissue. The combination of temperature, fluorescence and electrical activity estimates obtained from synchronically registered parameters during the experiments on model systems and experimental animals yielded qualitatively new results for the evaluation of cardiac tissue viability and enabled to achieve a versatile evaluation of the heart tissue viability.
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Affiliation(s)
- A Krisciukaitis
- Institute for Biomedical Research of Kaunas University of Medicine, Eiveniu str.4, LT-50009, Kaunas Lithuania.
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Youssef EAS, Zhang P, Rogers PI, Tremble P, Rokovich J, Johnstone BH, March KL, Hou D. Enhancing myocardial plasmid expression by retrograde coronary venous delivery. Catheter Cardiovasc Interv 2005; 65:528-34. [PMID: 16003788 DOI: 10.1002/ccd.20450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Myocardial delivery of genes holds great promise for treating many heart diseases; however, the optimal delivery technique, which maximizes safety and efficacy, has not been established. Two delivery techniques were evaluated in swine; percutaneous retrograde coronary venous delivery (RCVD) and direct intramyocardial injection (IM). RCVD was performed in the anterior interventricular vein (AIV) with an end-hole occlusion balloon catheter. The plasmid gWiz, encoding beta-galactosidase (10 ml; 1 mg/ml), was injected using either manual high pressure (HP-RCVD; n = 5) or pressure wire-guided low pressure (LP-RCVD; n = 4). For the IM group (n = 4), beta-Gal plasmid (5 mg/ml) was injected at 10 sites (200 microl/site) in the anterior left ventricular wall. Animals were euthanized after 5 days. The percentage of beta-Gal expressing cells in the delivered region was higher in the HP-RCVD (0.26% +/- 0.05%) than the LP-RCVD (0.05% +/- 0.03%; P = 0.07) and IM groups (0.02% +/- 0.01%; P = 0.01). Myocardium from the HP-RCVD group contained 7- and 17-fold higher levels of beta-Gal activity than either LP-RCVD and IM groups, respectively (P = 0.05 for both). The results of this study confirm the safety and efficacy of RCVD for myocardial gene delivery.
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Affiliation(s)
- Eyas Al-Shaykh Youssef
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Laser literature watch. Photomed Laser Surg 2004; 22:261-76. [PMID: 15315736 DOI: 10.1089/1549541041438588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Almeda FQ, Glock D, Sandelski J, Ibrahim O, Macioch JE, Allen T, Dainauskas JR, Parrillo JE, Snell RJ, Schaer GL. The effect of percutaneous transmyocardial laser revascularization on left ventricular function in a porcine model of hibernating myocardium. ACTA ACUST UNITED AC 2004; 5:132-5. [PMID: 15721848 DOI: 10.1016/j.carrad.2004.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Revised: 11/07/2004] [Accepted: 11/07/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hibernating myocardium is defined as a state of persistently impaired myocardial function at rest due to reduced coronary blood flow that can partially or completely be restored to normal if the myocardial oxygen supply/demand relationship is favorably altered. Percutaneous laser revascularization (PMR) is an emerging catheter-based technique that involves creating channels in the myocardium, directly through a percutaneous approach with a laser delivery system, and has been shown to reduce symptoms in patients with severe refractory angina; however, its effect on improving regional wall motion abnormalities in hibernating myocardium has not been clearly established. We sought to determine the effect of PMR using the Eclipse System (Cardiogenesis) on left ventricular function in a porcine model of hibernating myocardium. METHODS A model of hibernating myocardium was created by placement of an ameroid constrictor in the proximal left anterior descending artery of a 35 kg male Yorkshire pig. The presence of hibernating myocardium was confirmed with dobutamine stress echocardiography (DSE) and defined as severe hypocontractility at rest, with an improvement in systolic wall thickening with low-dose dobutamine in myocardial regions with a subsequent deterioration in function at peak stress (biphasic response). After the demonstration of hibernating myocardium, PMR was performed in the area of hypocontractile function, and the serial echocardiography was performed. The echocardiograms were reviewed by an experienced echocardiologist blinded to the results, and regional wall motion was assessed using the American Society of Echocardiography Wall Motion Score. Six weeks after PMR, the animal was sacrificed and the heart sent for histopathologic studies. RESULTS A comparison of the regional wall motion function of the area distal to the ameroid constrictor and in the contralateral wall at baseline, post-ameroid placement, and post-PMR was performed. Hibernating myocardium was demonstrated 4 weeks after ameroid placement by DSE. Coronary angiography demonstrated a discrete 90%stenosis in the proximal LAD at the site of ameroid constrictor placement without evidence of collaterals. Using PMR, 17 bursts were successfully delivered to the anterior wall distal to the ameroid constrictor. Four weeks after PMR, there was improvement in wall motion function in the region distal to the ameroid placement by echocardiography. Histopathologic analysis demonstrated the absence of myocardial infarction in the anterior wall distal to the ameroid constrictor. CONCLUSIONS The performance of PMR in a porcine model of hibernating myocardium is feasible and is associated with an improvement regional wall motion function after 4 weeks.
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Affiliation(s)
- Francis Q Almeda
- Rush University Medical Center, Rush Heart Institute, and Rush Medical College, Chicago, IL, USA.
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