Lacis A, Erglis A. Intramyocardial administration of autologous bone marrow mononuclear cells in a critically ill child with dilated cardiomyopathy. Cardiol Young. 2010 Oct 27:1-3.
http://www.ncbi.nlm.nih.gov/pubmed/20977823
Kopsavilkums
Almost half of the children with symptomatic dilated cardiomyopathy receive a transplant or die within 2 years; however, cardiac stem cell transplantation has become a promising therapeutic option. The present case demonstrates for the first time, to our knowledge, the intramyocardial administration of autologous bone marrow mononuclear cells in a critically ill 4-month-old child with severe dilated cardiomyopathy. Left ventricular ejection fraction increased from 20% before stem cell transplantation to 41% at 4 months of follow-up.
Scheffers IJ, Kroon AA, Schmidli J, Jordan J, Tordoir JJ, Mohaupt MG, Luft FC, Haller H, Menne J, Engeli S, Ceral J, Eckert S, Erglis A, Narkiewicz K, Philipp T, de Leeuw PW. Novel baroreflex activation therapy in resistant hypertension: results of a European multi-center feasibility study. J Am Coll Cardiol. 2010 Oct 5;56(15):1254-8.
http://www.ncbi.nlm.nih.gov/pubmed/20883933
Kopsavilkums
This study assessed the safety and efficacy of a novel implantable device therapy in resistant hypertension patients.
Despite the availability of potent antihypertensive drugs, a substantial proportion of patients remain hypertensive. A new implantable device (Rheos system, CVRx, Inc., Minneapolis, Minnesota) that activates the carotid baroreflex may help these patients.
Forty-five subjects with systolic blood pressure ≥160 mm Hg or diastolic ≥90 mm Hg despite at least 3 antihypertensive drugs were enrolled in a prospective, nonrandomized feasibility study to assess whether Rheos therapy could safely lower blood pressure. Subjects were followed up for as long as 2 years. An external programmer was used to optimize and individualize efficacy.
Baseline mean blood pressure was 179/105 mm Hg and heart rate was 80 beats/min, with a median of 5 antihypertensive drugs. After 3 months of device therapy, mean blood pressure was reduced by 21/12 mm Hg. This result was sustained in 17 subjects who completed 2 years of follow-up, with a mean reduction of 33/22 mm Hg. The device exhibited a favorable safety profile.
The Rheos device sustainably reduces blood pressure in resistant hypertensive subjects with multiple comorbidities receiving numerous medications. This unique therapy offers a safe individualized treatment option for these high-risk subjects. This novel approach holds promise for patients with resistant hypertension and is currently under evaluation in a prospective, placebo-controlled clinical trial.
Meredith I, Rothman M, Erglis A, Parikh K, Lotan C; for the E‐Five Investigators Extended follow-up safety and effectiveness of the endeavor zotarolimus-eluting stent in real-world clinical practice: Two-year follow-up from the E-Five Registry. Catheter Cardiovasc Interv. 2010 Sep 17.
http://www.ncbi.nlm.nih.gov/pubmed/20853351
Kopsavilkums
To present data from the cohort of patients in the all-comers Endeavor zotarolimus-eluting stent (ZES) registry (E-Five) who underwent 2-year follow-up.
The Endeavor ZES has been shown to be safe and efficacious for treatment of single, de novo lesions in patients with stable coronary artery disease. E-Five evaluated the ZES in over 8,000 real-world patients, at 188 sites followed to 1 year. A subset of sites continued follow-up through 2 years to evaluate late-term safety and effectiveness of the ZES in this population with diverse clinical and lesion characteristics.
E-Five, a prospective, multicenter, nonrandomized global registry, collected 2-year outcomes for 2,116 patients from 26 centers. Sites were selected for participation based on patient accrual rates and the ability to continue follow-up activities for an additional year. Complete data was available for 2,054 patients. To observe whether or not a sustained benefit was achieved, data for all patients from the selected sites were included in the analysis.
The outcomes in the 2-year cohort tracked with the results of randomized controlled trials using the Endeavor ZES. One year results were MACE 7.5%, TLR 4.5%, and ARC definite/probable stent thrombosis 0.6%. Outcomes at 2 years for MACE, TLR, and ARC definite/probable stent thrombosis were 8.5, 5.1, and 0.7%, respectively.
Long-term efficacy and safety outcomes were maintained between 1 and 2 years for the 2-year patient cohort, with only a small number of additional MACE, TLR, and very late stent thrombosis events.
Symplicity HTN-2 Investigators, Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RERenal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010 Dec 4;376(9756):1903-9. Epub 2010 Nov 17.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2962039-9/abstract
Kopsavilkums
Activation of renal sympathetic nerves is key to pathogenesis of essential hypertension. We aimed to assess effectiveness and safety of catheter-based renal denervation for reduction of blood pressure in patients with treatment-resistant hypertension.
In this multicentre, prospective, randomised trial, patients who had a baseline systolic blood pressure of 160 mm Hg or more (≥150 mm Hg for patients with type 2 diabetes), despite taking three or more antihypertensive drugs, were randomly allocated in a one-to-one ratio to undergo renal denervation with previous treatment or to maintain previous treatment alone (control group) at 24 participating centres. Randomisation was done with sealed envelopes. Data analysers were not masked to treatment assignment. The primary effectiveness endpoint was change in seated office-based measurement of systolic blood pressure at 6 months. Primary analysis included all patients remaining in follow-up at 6 months. This trial is registered with ClinicalTrials.gov, number NCT00888433.
106 (56%) of 190 patients screened for eligibility were randomly allocated to renal denervation (n=52) or control (n=54) groups between June 9, 2009, and Jan 15, 2010. 49 (94%) of 52 patients who underwent renal denervation and 51 (94%) of 54 controls were assessed for the primary endpoint at 6 months. Office-based blood pressure measurements in the renal denervation group reduced by 32/12 mm Hg (SD 23/11, baseline of 178/96 mm Hg, p<0·0001), whereas they did not differ from baseline in the control group (change of 1/0 mm Hg [21/10], baseline of 178/97 mm Hg, p=0·77 systolic and p=0·83 diastolic). Between-group differences in blood pressure at 6 months were 33/11 mm Hg (p<0·0001). At 6 months, 41 (84%) of 49 patients who underwent renal denervation had a reduction in systolic blood pressure of 10 mm Hg or more, compared with 18 (35%) of 51 controls (p<0·0001). We noted no serious procedure-related or device-related complications and occurrence of adverse events did not differ between groups; one patient who had renal denervation had possible progression of an underlying atherosclerotic lesion, but required no treatment.
Catheter-based renal denervation can safely be used to substantially reduce blood pressure in treatment-resistant hypertensive patients.
Gerstein HC, Ratner RE, Cannon CP, Serruys PW, García-García HM, van Es GA, Kolatkar NS, Kravitz BG, Miller DM, Huang C, Fitzgerald PJ, Nesto RW; APPROACH Study Group. Effect of rosiglitazone on progression of coronary atherosclerosis in patients with type 2 diabetes mellitus and coronary artery disease: the assessment on the prevention of progression by rosiglitazone on atherosclerosis in diabetes patients with cardiovascular history trial. Circulation. 2010 Mar 16;121(10):1176-87. Epub 2010 Mar 1.
http://www.ncbi.nlm.nih.gov/pubmed/20194881
Kopsavilkums
Rosiglitazone has several properties that may affect progression of atherosclerosis. The Assessment on the Prevention of Progression by Rosiglitazone on Atherosclerosis in Diabetes Patients With Cardiovascular History (APPROACH) study was undertaken to determine the effect of the thiazolidinedione rosiglitazone on coronary atherosclerosis as assessed by intravascular ultrasound compared with the sulfonylurea glipizide.
This was a randomized, double-blind, controlled 18-month study in 672 patients aged 30 to 80 years with established type 2 diabetes mellitus treated by lifestyle, 1 oral agent, or submaximal doses of 2 oral agents who had at least 1 atherosclerotic plaque with 10% to 50% luminal narrowing in a coronary artery that had not undergone intervention during a clinically indicated coronary angiography or percutaneous coronary intervention. The primary outcome was change in percent atheroma volume in the longest and least angulated epicardial coronary artery that had not undergone intervention. Secondary outcomes included change in normalized total atheroma volume and change in total atheroma volume in the most diseased baseline 10-mm segment. Rosiglitazone did not significantly reduce the primary outcome of percent atheroma volume compared with glipizide (-0.64%; 95% confidence interval, -1.46 to 0.17; P=0.12). The secondary outcome of normalized total atheroma volume was significantly reduced by rosiglitazone compared with glipizide (-5.1 mm(3); 95% confidence interval, -10.0 to -0.3; P=0.04); however, no significant difference between groups was observed for the change in total atheroma volume within the most diseased baseline 10-mm segment (-1.7 mm(3); 95% confidence interval, -3.9 to 0.5; P=0.13).
Rosiglitazone did not significantly decrease the primary end point of progression of coronary atherosclerosis more than glipizide in patients with type 2 diabetes mellitus and coronary atherosclerosis
В.Я.Дзерве Динамика толерантности к физической нагрузке у пациентов с ишемической болезнью сердца и периферической болезнью артерий на фоне длительной терапии милдронатом. цитопротективные свойства милдроната.Российский кардиологический журнал (iesniegts redkolēģijai).
http://www.fesmu.ru/elib/Article.aspx?id=233682
Kopsavilkums
Приведены данные 3 проспективных, рандомизированных, двойных слепых, плацебо-контролируемых клинических исследований с участием больных ишемической болезнью сердца (ИБС) и болезнью периферических артерий (БПА) с целью сравнения динамики показателей велоэргометрии, силы различных скелетных мышц у больных ИБС, динамики толерантности к физической нагрузке у больных БПА на фоне продолжительной стандартной терапии с добавлением или без добавления Милдроната.
Inga Stukena, Guntis Bahs, Aivars Lejnieks, Andrejs Kalvelis, Vilnis Dzerve, Baiba Ansmite, Oskars Kalejs Blood pressure control in treated hypertensive patients in daily practice of Latvian family physicians. Medicina.
http://medicina.kmu.lt/1110/1110-10e.htm
Kopsavilkums
Background and Objective. The aim of this study was to evaluate blood pressure (BP) control level in treated hypertensive patients in Latvia and to compare their characteristics according to the adequacy of BP control.
Materials and Methods. Family physicians collected information on demographic and clinical characteristics, and current antihypertensive treatment of 455 18-80-year-old patients with essential arterial hypertension treated for 1 or more years. Target BP was defined as values of <140/90 mm Hg for patients with low or moderate cardiovascular risk and <135/85-125/75 mm Hg for patients with high or very high risk. BP was measured in the office setting after a 5-minute rest in a sitting position using a calibrated aneroid sphygmomanometer.
Results. Nearly half of patients (46.2%) attained their target BP. The proportion of patients with effective BP control was higher in the group of low and moderate added cardiovascular risk than in the high and very high added cardiovascular risk group (61.7% vs. 34.4%, P<0.0001). The majority of patients were given two-drug (26.2%) or three-drug (31.6%) combined antihypertensive therapy. Current pharmacological treatment was similar in the patients who attained target BP and in those who did not. Overall, physicians did not modify antihypertensive treatment in 37.9% of patients; such a recommendation was more common among patients with controlled BP. Very few patients (7.4%) who did not attain target BP did not receive recommendations to modify antihypertensive treatment.
Conclusions. The rate of effective BP control was less than 50% and was even worse (34.4%) in patients with high or very high added cardiovascular risk in the present sample of treated hypertensive patients.
Kalejs M, Stradins P, Lacis R, Kasyanov V, Ozolanta I, Sayed PA, von Segesser LK. Valve Stent Deformability Of Historical And Contemporary Bioprostheses Compared To Native Aortic Root. Journal of Heart Valve Disease (iesniegts redkolēģijai).
Kasyanov V, Moreno-Rodriguez R, Trusk T, Mehesz AN, Wu Y, Zhang Y, Kalejs M, Ozolanta I, Stradins P, Bradshaw A, Wen X, Yao H, Markwald RR, Mironov V. Structural determinants of material properties of fetal and adult porcine mitral heart valve leaflets. Journal of Biomechanics (iesniegts redkolēģijai).
Mironov V., Kasyanov V., Beachley V., Nagy-Mehesz A., Norris R., Kalejs M., Stradins P., Markwald R., Wen X. Tissue spheroids fusion on pre-stretched electrospun polyurethane scaffolds. Journal of Tissue Engineering and Regenerative Medicine (iesniegts redkolēģijai).
Voita D, Valevica E, Bukulite A, Silina M. Psychosocial aspects of pain and nonmedication treatment of migraine patients in headache free period. Sveikatos Mokslai (Lietuvas ZA izdevums), 2010;3:3259-3263
Kalējs M, Stradiņš P, Lācis R, Kasjanovs V, Ozolanta I, Sayed PA, von Segesser LK. Tradicionālo sirds vārstuļu bioprotēžu un stentprotēžu karkasu deformējamības salīdzinājums. RSU Zinātnisko rakstu krājums 2010 (pieņemts publicēšanai).
Kalējs M, Stradiņš P, Lācis R, von Segesser LK. Metode ātrai elastīgu cilvēka aortas saknes modeļu radīšanai. RSU Zinātnisko rakstu krājums 2010 (pieņemts publicēšanai).
Daina Voita, Evita Vaļēviča, Anastasija Zakke, Juris Porozovs, Anda Kauliņa. Autonomic nervous system properties in migraine patients and nonmedication treatment in headache free period. LZA Vēstis.
http://versita.metapress.com/content/57737g564580174n/?a=9
Kopsavilkums
Pētījuma mērķis bija noteikt autonomās nervu sistēmas (ANS) darbības īpatnības migrēnas pacientiem un izstrādāt optimālas biologiskās atgriezeniskās saites (BAS) treniņmetodes. Sirdsdarbības frekvence (SF), arteriālais asinsspiediens un barorefleksu jutība (BRJ) tika mērīta relatīvā fiziskā mierā, statiskā slodzē, pēcdarba arteriālajā oklūzijā un atjaunošanās periodā. Pētījumā piedalījās 22 migrēnas pacienti (sievietes, vecums 22,2 ± 2,4 gadi) un 14 pēc vecuma un dzimuma atbilstošas veselas kontroles grupas sievietes. Pēc SF un BRJ datiem mierā migrēnas pacienti tika iedalīti divās grupās (M1 un M2). Relatīva fiziska miera stāvoklī 60% migrēnas pacientu (M1 grupa) tika konstatēta samazināta SF, salīdzinot ar kontroles grupu (P < 0,01). BRJ miera stāvoklī M2 grupai salīdzinot ar kontroles grupa un M1 grupu bija samazināta (P < 0,01). 10 sekunžu pirmsslodzes periodā, kas tika saistīta ar orientācijas reakciju un mobilizāciju darbam, M1 grupā bija ievērojami mazāks SF pieaugums, salīdzinot ar citām analizētajām grupām (P < 0,01). Atjaunošanās periodā M1 grupai SF tika konstatēta ticami mazāka, nekā kontroles un M2 grupās (P < 0,05). Tika konstatēts, ka abas ANS daļas - parasimpatiskā nervu sistēma (PNS) un simpātiskā nervu sistēma (SNS) ir izmainītas migrēnas slimniekiem. M2 grupā vērojama samazināta PNS aktivitāte un izmainīta SNS aktivitāte. M1 grupai ir palielināta PNS aktivitāte. BAS treniņi samazināja zāļu lietošanu migrēnas lēkmēm un migrēnas lēkmju frekvenci M2 grupā, bet būtiski neietekmēja rezultātus M1 grupā. Tālāki pētījumi par nemedikamentozās modulācijas iespējām tiks veikti M1 grupā.
Dace Sondore, Kārlis Trušinskis, Dace Juhnēviča, Kārlis Štrenge, Inga Narbute, Sanda Jēgere, Aļona Grāve, Andrejs Ērglis Plaque composition by IVUS-virtual histology (VH) in the coronary and the carotid arteries. LZA Vēstis (sagatavots iesniegšanai)
Erglis A. Sondore D, Dombrovskis A, Jegere S, Narbute I, Skride A, Juhnevica D, Grave A, Cakstina I, Ramata-Stunda A, Jakobsons E. TCT-137: Autologous Bone Marrow Mononuclear Cells Transplantation In Patients With Type 2 Diabetes: Three-month Follow-up Results J Am Coll Cardiol 2010 56: B32 (Abstract from TCT 2010, September 21-25, 2010, Washington, USA)
http://content.onlinejacc.org/cgi/reprint/56/13_MeetingAbstracts/B32-b.pdf
Trusinskis K, Juhnevica D, Strenge K, Sondore D, Kumsars I, Jegere S, Narbute I, Grave A, Zakke I, Erglis A. P359: Possible causes of no-reflow or slow flow phenomen in primary PCI. Eur Heart J Supplements 2010:12(Suppl F):F87 (Abstract form Acute Cardiac Care 2010, October 16-19, Copenhagen, Denmark)
http://spo.escardio.org/AbstractDetails.aspx?id=88331&eevtid=41
Kopsavilkums
Objective: The current standard of care for acute ST-segment elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (PCI), however, successful restoration of antegrade coronary flow does not always result in myocardial salvage. Moreover, causes of angiographic no-reflow phenomenon remains unclear. Therefore we searched for possible causes of no-reflow or slow reflow phenomenon in primary PCI.
Methods: A total of 59 patients with STEMI were enrolled in this study. After thrombectomy with an aspiration catheter, IVUS with i-Map tissue characterization of the infarct-related vessel followed by stenting was performed. The relationship between plaque composition, blood levels of MMP-9, ICAM-1, CRP and time period from onset of symptoms till flow restoration in infarct related coronary artery and angiographic no-reflow phenomenon was analyzed.
Results: The angiographic no-reflow phenomenon was observed in 4 individuals. Blood levels of inflammatory markers did not correlate with statistical significance with no-reflow phenomenon. However, MMP-9, ICAM-1 and CRP levels were slightly higher in patients with no reflow in absolute numbers, 290.28±122.93 ng/ml vs. 268.99±172.19 ng/ml, 211.33±122.07 ng/ml vs. 188.68±67.32 ng/ml and 15.54±12.36 mg/l vs. 9.58±13.17 mg/l, respectively. Plaque composition did not correlate statistically significant with no-reflow although patients with no-reflow phenomenon had tendency to higher percentage of necrotic tissue 29.88±11.12% vs 23.20±11.01%, p = 0.166 and calcific tissue 3.78±5.41% vs. 2.28±1.42%, p = 0.096 and lower percentage of fibrotic tissue 40.33±8.58% vs 49.18±13.28%, p = 0.117 in culprit lesion. Time period from onset of symptoms till flow restoration surprisingly was shorter in patients with no-reflow (210.00±72.45 vs. 266.69±153.35 minutes, p = 0.470), although not statistically significant.
Conclusions: Because of lack of statistical power we did not find statistically strong correlations among analyzed factors and no-reflow phenomenon. However, higher percentage of necrotic and calcific tissue as well as lower percentage of fibrotic tissue in culprit lesion had tendency to correlate with no-reflow phenomenon.
Sondore D, Juhnevica D, Trusinskis K, Strenge K, Jegere S, Narbute I, Grave A, Erglis A. Plaque vulnerability in coronary and carotid arteries in correlation with acute cerebral event in history. Eur Heart J Supplements 2010:12(Suppl F):F117 (Abstract form Acute Cardiac Care 2010, October 16-19, Copenhagen, Denmark)
http://spo.escardio.org/AbstractDetails.aspx?id=88420&eevtid=41
Kopsavilkums
Objective: Imaging of coronary as well as carotid plaques has traditionally focused on evaluating degree of stenosis, as the risk for adverse cardiac or cerebral events increases with stenosis severity. However, the relation between plaque composition and rates of acute events are not absolutely clear. In this study we analyzed relationship of plaque composition in both coronary and carotid arteries with acute cerebral events in history.
Methods: Thirty six patients (22 men and 14 women) with mean age 68.08±8.57 years were enrolled non-randomly into a single-center, prospective study. All patients underwent virtual histology intravascular ultrasound imaging examination of coronary artery segment with plaque burden stenosis at least 50% and carotid plaque with a cerebral protection device followed by carotid and/or coronary artery stenting. Comparison between plaque composition according to virtual histology in coronary and carotid arteries and acute cerebral event (stroke or transitory ischemic attack) in history was done. Statistical analyses were performed with SPSS 17.0 version. Categorical variables were analyzed with chi-square test and continuous variables with ANOVA test.
Results: Acute cerebral event in history was documented in 14 patients (38.9%). Percentage of fibrolipids in carotid artery plaque surprisingly was lower in patients with acute cerebral event in history 16.00±12.23 vs. others 24.24±10.17, p = 0.038. Necrotic core was larger in patients with acute cerebral event in history in both carotid and coronary arteries, however, without statistical significance in last. In carotid arteries necrotic core in patients with acute cerebral event in history was 22.86±12.01% vs. others 14.00±8.44% (p = 0.015) and in coronary arteries 21.83±6.32% vs. 16.53±8.59% (p = 0.080). Necrotic core above 20% in carotid arteries as well as in coronary arteries were documented in 13 cases. In carotid arteries in patient subgroup with necrotic core above 20% in 69.23% (n = 9) were documented acute cerebral event in history vs. 22.73% (n = 5) patients with necrotic core below 20% (p = 0.007). The same tendency was true in coronary arteries, although not statistically significant (p = 0.219). In 53.85% (n = 7) patients with necrotic core in coronary artery above 20% were documented acute cerebral event in history vs. 31.25% (n = 5) patients with necrotic core below 20%.
Conclusions: We found strong correlations between plaque vulnerability in carotid arteries and similar tendencies between percentage of necrotic core in coronary arteries and acute cerebral event in history.
