scholarly journals Revascularization in Ischemic Heart Failure: A Review

2020 ◽  
Vol 1 (1) ◽  
pp. 31-36
Author(s):  
H V V S S Lakshman ◽  
Dayasagar Rao V.
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Obstructive Coronary Artery Disease ◽  
Bypass Graft ◽  
Viable Myocardium ◽  
Ischemic Heart ◽  
Stunned Myocardium ◽  
Reverse Remodeling ◽  
Lv Function

Ischemic heart disease as a cause of heart failure is common in India, ranging from 48% to 71%. The pathoanatomic basis of LV dysfunction is not only due to infarcted myocardium, but also due to viable but dysfunctional myocardium (hibernating/stunned myocardium) and structural abnormalities (mitral regurgitation/ventricular septal defect aneurysm) consequent to obstructive coronary artery disease. Evaluation of dysfunctional but viable myocardium is a key determinant of recovery of LV function, and magnitude of recovery is proportional to the amount of dysfunctional viable myocardium which if more than 25% LV (4 segments out of 17 segments model) results in improvement in function and size (reverse remodeling). Most of the data regarding therapy come from observational, registry data showing better outcomes with coronary artery bypass graft than percutaneous coronary intervention and medical therapy. The need for more multicentric, randomized controlled trials regarding recovery of LV function by various therapies is more than ever now.

scholarly journals Progenitor Cells for Arterial Repair: Incremental Advancements towards Therapeutic Reality

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Trevor Simard ◽  
Richard G. Jung ◽  
Pouya Motazedian ◽  
Pietro Di Santo ◽  
F. Daniel Ramirez ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Progenitor Cells ◽  
Clinical Outcomes ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Obstructive Coronary Artery Disease ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Therapeutic Modality ◽  
Vascular Repair

Coronary revascularization remains the standard treatment for obstructive coronary artery disease and can be accomplished by either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery. Considerable advances have rendered PCI the most common form of revascularization and improved clinical outcomes. However, numerous challenges to modern PCI remain, namely, in-stent restenosis and stent thrombosis, underscoring the importance of understanding the vessel wall response to injury to identify targets for intervention. Among recent promising discoveries, endothelial progenitor cells (EPCs) have garnered considerable interest given an increasing appreciation of their role in vascular homeostasis and their ability to promote vascular repair after stent placement. Circulating EPC numbers have been inversely correlated with cardiovascular risk, while administration of EPCs in humans has demonstrated improved clinical outcomes. Despite these encouraging results, however, advancing EPCs as a therapeutic modality has been hampered by a fundamental roadblock: what constitutes an EPC? We review current definitions and sources of EPCs as well as the proposed mechanisms of EPC-mediated vascular repair. Additionally, we discuss the current state of EPCs as therapeutic agents, focusing on endogenous augmentation and transplantation.

scholarly journals Recurrent Chylous Ascites Leading to Transudative Chylothorax Due to Bi-Ventricular Heart Failure

2021 ◽  
Vol 9 ◽  
pp. 232470962110261
Author(s):  
Tuong Vi Cassandra Do ◽  
Justin Cozza ◽  
Shyam Ganti ◽  
Jayaramakrishna Depa
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Chronic Kidney Disease Stage ◽  
Bypass Graft ◽  
Chylous Ascites ◽  
Lower Extremities ◽  
Disease Status ◽  
Disease Stage ◽  
Chronic Obstructive

Chylothorax is a pleural effusion of >110 mg/dL of triglycerides with a milky appearance with transudative being rare. In this article, we present a case of transudative chylothorax with concurrent chylous ascites that is secondary to congestive heart failure (CHF). A 70-year-old male with CHF with ejection fraction of 10%, coronary artery disease status post coronary artery bypass graft, sleep apnea, chronic kidney disease stage 3, and chronic obstructive pulmonary disease presented with worsening abdominal distention, shortness of breath, and increased lower extremities edema. He denied any cough or fever but had orthopnea and paroxysmal nocturnal dyspnea. He requires monthly paracentesis with drainage of 5 to 9 L each time. On physical examination, he had crackles bilaterally with no wheezes or jugular venous distension. His cardiac examination was unremarkable. He did have abdominal distension with dullness to percussion and a positive fluid wave. There was +2 bilateral pitting edema of lower extremities. He had a diagnostic paracentesis where 9.2 L of cloudy milky fluid was drained and therapeutic thoracentesis where 1.1 L of milky fluid was drained. Pleural fluid for triglycerides was 280. His peritoneal fluid had triglycerides of 671 confirming chylous ascites. CHF can lead to chylous ascites due to the increased lymph production in the abdomen, which flows to the thoracic duct. Due to the stiffness at the lymphatic junction, there is high pressure for less flow. The diaphragm plays a role allowing the chylous ascites to be absorb into the thorax.

scholarly journals Increased Perioperative B-type Natriuretic Peptide Associates with Heart Failure Hospitalization or Heart Failure Death after Coronary Artery Bypass Graft Surgery

2013 ◽  
Vol 119 (2) ◽  
pp. 284-294 ◽  
Author(s):  
Amanda A. Fox ◽  
Luigino Nascimben ◽  
Simon C. Body ◽  
Charles D. Collard ◽  
Aya A. Mitani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Natriuretic Peptide ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Hazard Ratio ◽  
Artery Bypass Graft ◽  
Clinical Model

Abstract Background: Heart failure (HF) is a leading cause of hospitalization and mortality. Plasma B-type natriuretic peptide (BNP) is an established diagnostic and prognostic ambulatory HF biomarker. We hypothesized that increased perioperative BNP independently associates with HF hospitalization or HF death up to 5 yr after coronary artery bypass graft surgery. Methods: The authors conducted a two-institution, prospective, observational study of 1,025 subjects (mean age = 64 ± 10 yr SD) undergoing isolated primary coronary artery bypass graft surgery with cardiopulmonary bypass. Plasma BNP was measured preoperatively and on postoperative days 1–5. The study outcome was hospitalization or death from HF, with HF events confirmed by reviewing hospital and death records. Cox proportional hazards analyses were performed with multivariable adjustments for clinical risk factors. Preoperative and peak postoperative BNP were added to the multivariable clinical model in order to assess additional predictive benefit. Results: One hundred five subjects experienced an HF event (median time to first event = 1.1 yr). Median follow-up for subjects who did not have an HF event = 4.2 yr. When individually added to the multivariable clinical model, higher preoperative and peak postoperative BNP concentrations each, independently associated with the HF outcome (log10 preoperative BNP hazard ratio = 1.93; 95% CI, 1.30–2.88; P = 0.001; log10 peak postoperative BNP hazard ratio = 3.38; 95% CI, 1.45–7.65; P = 0.003). Conclusions: Increased perioperative BNP concentrations independently associate with HF hospitalization or HF death during the 5 yr after primary coronary artery bypass graft surgery. Clinical trials may be warranted to assess whether medical management focused on reducing preoperative and longitudinal postoperative BNP concentrations associates with decreased HF after coronary artery bypass graft surgery.

scholarly journals Surgical treatment of coronary artery aneurysm with calcification and stenosis：a Case Report and Review of the Literature

2020 ◽  
Author(s):  
He Sun ◽  
Mingkui Zhang ◽  
Qingyu Wu ◽  
Hui Xue ◽  
Yongqiang Jin
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Artery ◽  
Coronary Artery Aneurysm ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Aneurysm ◽  
Causative Factor ◽  
Artery Bypass Graft ◽  
Review Of The Literature

Coronary artery aneurysm (CAA) has been increasingly reported in recent years. The symptoms are related to myocardial ischemia, such as angina pectoris, myocardial infarction, sudden death and congestive heart failure. This report describes a case of a giant CAA with calcification and stenosis involving two coronary arteries, and the patient underwent a complete arterialized coronary artery bypass graft successfully. In this report, all cases related to CAA with calcification and stenosis are summarized. According to the data, the following conclusions can be drawn: CAA seem to be more common in men; Kawasaki disease is likely to be a causative factor in some patients with asymptomatic CAA involving calcification and stenosis; CABG is a feasible treatment option for CAA with calcification and stenosis.

Myocardial Viability Assessment

2015 ◽  
Author(s):  
Vasken Dilsizian ◽  
Ines Valenta ◽  
Thomas H. Schindler
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Medical Therapy ◽  
Ischemic Cardiomyopathy ◽  
Interstitial Fibrosis ◽  
Artery Bypass ◽  
Hibernating Myocardium ◽  
Lv Function ◽  
Term Survival ◽  
Myocardial Viability Assessment

Heart failure may be a consequence of ischemic or non-ischemic cardiomyopathy. Etiologies for LV systolic dysfunction in ischemic cardiomyopathy include; 1) transmural scar, 2) nontransmural scar, 3) repetitive myocardial stunning, 4) hibernating myocardium, and 5) remodeled myocardium. The LV remodeling process, which is activated by the renin-angiotensin system (RAS), stimulates toxic catecholamine actions and matrix metalloproteinases, resulting in maladaptive cellular and molecular alterations5, with a final pathway to interstitial fibrosis. These responses to LV dysfunction and interstitial fibrosis lead to progressive worsening of LV function. Established treatment options for ischemic cardiomyopathy include medical therapy, revascularization, and cardiac transplantation. While there has been continuous progress in the medical treatment of heart failure with beta-blockers, angiotensin-converting enzyme (ACE) inhibition, angiotensin II type 1 receptor (AT1R) blockers, and aldosterone to beneficially influence morbidity and mortality, the 5-years mortality rate for heart failure patients remains as high as 50%. Revascularization procedures include percutaneous transluminal coronary artery interventions (PCI) including angioplasty and endovascular stent placement and coronary artery bypass grafting (CABG). Whereas patents with heart failure due to non-coronary etiologies may best benefit from medical therapy or heart transplantation, coronary revascularization has the potential to improve ventricular function, symptoms, and long term survival, in patients with heart failure symptoms due to CAD and ischemic cardiomyopathy.

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