scholarly journals EFFICIENCY OF ENDOVASCULAR MYOCARDIAL REVASCULARIZATION AS A «BRIDGE» TO HEART TRANSPLANTATION IN PATIENTS WITH ISCHEMIC HEART FAILURE

2017 ◽  
Vol 18 (4) ◽  
pp. 66-70
Author(s):  
A. B. Mironkov ◽  
S. A. Sakhovsky ◽  
I. G. Ryadovoy ◽  
B. L. Mironkov
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Life Expectancy ◽  
Heart Transplantation ◽  
Nyha Class ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Ischemic Heart Failure ◽  
Observation Period

Aim: to estimate effi ciency of endovascular myocardial revascularization in patients with ischemic chronic heart failure, potential candidates for heart transplantation.Materials and methods.Survival of 108 patients with ischemic heart disease complicated by chronic heart failure (CHF) after performance of endovascular myocardial revascularization by percutaneous coronary intervention (PCI) is presented. The observation period composed 32.79 ± 6.2 (from 3 to 126) months, age from 33 to 72 (58.9 ± 0.64) years, 102 men, 6 women. Left ventricular (LV) ejection fraction was 34.9 ± 0.6%, EDV 249.75 ± 4.9 ml, ESV 163.27 ± 3.7 ml, mitral regurgitation 1.51 ± 0.07 points. 73% of patients had NYHA Class III CHF, 27% had NYHA Class IV CHF. Duration and quality of life after revascularization were determined. In 2–3 days after PCI dynamics of LV ultrasound parameters were estimated.Results.At the time of the end of our research 88 from 108 patients (81%) were alive, including 18 patients who underwent heart transplantation (HT). Repeated revascularization was carried out to 19 (17%) patients. 20 patients died: 16 patients with cardiovascular disorders (15%, including 4% of stroke), 3 with pulmonary embolism and 1 with oncological disease. Survival of 90% of the patients composed 4.5 years, 50% survival composed 9 years. At the time of the end of our research the maximum observation period was equal to 126 months. The duration from the fi rst PCI to HT composed from 7.5 to 105 months, mean value – 37 ± 7.5 months. Average life expectancy after HT composed 54.9 ± 24.4 months. Life expectancy from the fi rst PCI composed 87.5 ± 36.9 months. All patients of this group were alive by the time of the end of this research.Conclusion. Endovascular revascularization in patients with ischemic heart failure in 20% of cases can serve as «bridge» to HT, in 50% of cases it can be considered as an alternative to heart transplantation.

scholarly journals EFFICACY OF MYOCARDIAL REVASCULARIZATION IN POTENTIAL RECIPIENTS OF HEART WITH THE CHRONIC ISCHEMIC HEART FAILURE

2018 ◽  
Vol 20 (1) ◽  
pp. 39-44
Author(s):  
S. V. Gautier ◽  
A. B. Mironkov ◽  
S. A. Sakhovsky ◽  
N. N. Koloskova ◽  
I. I. Muminov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Life Expectancy ◽  
Heart Transplantation ◽  
Myocardial Revascularization ◽  
Ischemic Heart ◽  
Orthotopic Heart Transplantation ◽  
Ischemic Heart Failure ◽  
Results Of Treatment ◽  
Study Results ◽  
Chronic Ischemic Heart Failure

Aim: to evaluate clinical effi ciency of percutaneous coronary interventions (PCI) at potential recipients of heart with the chronic ischemic heart failure (CHF).Materials and methods. In this retrospective study results of treatment at 76 patients with CHF NYHA III and 36 patients with CHF NYHA IV by scheduled PCI are presented. Duration of observation was from 6 to 160 months. The age of patients at the time of intervention was 61,7 ± 0,62 years (from 33 to 76). 108 male and 4 female. Defi ned life expectancy and echocardiography parameters of the left ventricle (LV) of heart.  Results.20 patients were died, 16 of them from cardiovascular events. 18 patients during this period undergo orthotopic heart transplantation (HT). The endovascular revascularization leads to LV volumes reduction, increase of ejection fraction and decrease of pulmonary artery pressure. Progress CHF is followed by negative dynamics of these characteristics and need of HT performance. In 74% of cases the effect of myocardial revascularization allows to provide increase in life expectancy of potential recipients of heart with the chronic ischemic heart failure.  Conclusion.Performance of PCI at patients with the chronic ischemic heart failure can delay heart transplantation or become its alternative.

scholarly journals Miokardo gyvybingumas – svarbus požymis numatant chirurginį išeminio širdies nepakankamumo gydymą

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Elvyra Voluckienė ◽  
Loreta Ivaškevičienė ◽  
Virginija Grabauskienė ◽  
Jurgita Židanavičiūtė ◽  
Giedrius Uždavinys
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Ischemic Heart Failure ◽  
Surgical Ventricular Reconstruction ◽  
Ventricular Reconstruction ◽  
The Mean ◽  
Vilnius University ◽  
One Year

Elvyra Voluckienė1, Loreta Ivaškevičienė2, Virginija Grabauskienė3, Jurgita Židanavičiūtė4, Giedrius Uždavinys21 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius3 Vilniaus universiteto Kardiologijos ir angiologijos centras4 Vilniaus Gedimino technikos universitetasEl paštas: [email protected] Tikslas Nustatyti priešoperacinės kairiojo skilvelio (KS) funkcijos prognostinę reikšmę pacientams, sergantiems sunkiu išeminiu širdies nepakankamumu (IŠN), po chirurginės kairiojo skilvelio rekonstrukcijos (KSR) ir aortos bei vainikinių jungčių (AVJ) suformavimo operacijos. Ligoniai ir metodai Retrospektyvinei analizei tikslingai atrinkti 37 pacientai (32 vyrai, vidutinis amžius 59 ± 10,5 m.), sergantys IŠN ir KS išvarymo frakcija (IF) < 30%, kuriems buvo atlikta KSR ir AVJ suformavimo operacija. Po persirgto Q bangos priekinio miokardo infarkto buvo praėję vidutiniškai 5,8 ± 3,3 mėnesio. Vidutinė NYHA klasė buvo 3,4 ± 1,3. KS funkcijos rodikliai buvo apskaičiuoti dobutamino echokardiografijos tyrimo ramybės (r) ir mažos dobutamino dozės (mdd) metu: diastolinio skersmens indeksas – DDI cm/m² (r), IF (%) (r), sienos judėjimo indeksas – SJIr ir SJImdd, asinergijos plotas (Aproc.) (mdd). Hospitalinis mirštamumas buvo 13,5%; mirštamumas per vienus metus buvo 6,25%. Vidutinė NYHA klasė po vienų metų buvo 2,2 ± 1,1. Rezultatai Logistinės regresijos analizė ir „Proportional Odds“ modelis parodė, kad priešoperacinis KS Aproc. (mdd) buvo statistiškai reikšmingas prognostinis pooperacinės vienų metų NYHA klasės požymis (OR 0,86, p = 0,0086). Išvada Priešoperacinis kairiojo skilvelio asinergijos dydis, nustatytas dobutamino echokardiografijos tyrimo metu, yra svarbus požymis, numatant pooperacinę vienų metų NYHA klasę pacientams, sergantiems sunkiu išeminiu širdies nepakankamumu po chirurginės kairiojo skilvelio rekonstrukcijos ir aortos bei vainikinių jungčių suformavimo operacijos. Pagrindiniai žodžiai: išeminis širdies nepakankamumas, kairiojo skilvelio rekonstrukcija Myocardial viability predicts improvement in patients after surgical treatment of ischemic heart failure Elvyra Voluckienė1, Loreta Ivaškevičienė2, Virginija Grabauskienė3, Jurgita Židanavičiūtė4, Giedrius Uždavinys21 Vilnius University Hospital Santariškių Clinics, Cardial Surgery Centre,Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University, Cardiac Surgery Centre, Santariškių str. 2, LT-08661 Vilnius, Lithuania3 Vilnius University, Centre of Cardiology and Angiology4 Vilnius Gediminas Technical UniversityE-mail: [email protected] Objective This study sought to define the prognostic value of myocardial viability in patients with severe ischemic heart failure, who underwent surgical ventricular reconstruction with associated coronary grafting. Patients and methods This retrospective study selected 37 consecutive patients (32 men, mean age 59 ± 10.5 years) who underwent surgical ventricular reconstruction with associated coronary grafting, and preoperative left ventricular (LV) ejection fraction < 30% (mean, 25 ± 4.6%). The mean New York Heart Association (NYHA) class before operation was 3.4 ± 1.3. The time-frame of the large anterior myocardial infarction was 5.8 ± 3.3 months. LV systolic function was assessed by echo-dobutamine: the wall motion score index at rest (WMSIr), WMSI and the extent of LV asynergy (A%) during low-dose dobutamine (ldd). In-hospital mortality was 13.5%. After one-year, the mean functional NYHA class was 2.2 ± 1.1, and at one-year the mortality was 6.25%. Results Logistic regression analysis and the Proportional Odds model showed that LV A% during ldd (OR 0.86, p = 0.0086) was an independent predictor for the one-year postoperative functional NYHA class. Conclusions The preoperative extent of left ventricular asynergy during echo-dobutamine can predict the expectation of functional NYHA class improvement in patients with a severe ischemic heart failure one-year following surgical ventricular reconstruction with associated coronary grafting. Key words: ischemic heart failure, surgical ventricular reconstruction

scholarly journals ACE Inhibition Modulates Myeloid Hematopoiesis after Acute Myocardial Infarction and Reduces Cardiac and Vascular Inflammation in Ischemic Heart Failure

Antioxidants ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 396
Author(s):  
Wolf-Stephan Rudi ◽  
Michael Molitor ◽  
Venkata Garlapati ◽  
Stefanie Finger ◽  
Johannes Wild ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Bone Marrow ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Vascular Inflammation ◽  
Ace Inhibition ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Ischemic Heart Failure

Aims: Angiotensin-converting-enzyme inhibitors (ACE inhibitors) are a cornerstone of drug therapy after myocardial infarction (MI) and improve left ventricular function and survival. We aimed to elucidate the impact of early treatment with the ACE inhibitor ramipril on the hematopoietic response after MI, as well as on the chronic systemic and vascular inflammation. Methods and Results: In a mouse model of MI, induced by permanent ligation of the left anterior descending artery, immediate initiation of treatment with ramipril (10 mg/k/d via drinking water) reduced cardiac inflammation and the number of circulating inflammatory monocytes, whereas left ventricular function was not altered significantly, respectively. This effect was accompanied by enhanced retention of hematopoietic stem cells, Lin−Sca1−c-Kit+CD34+CD16/32+ granulocyte–macrophage progenitors (GMP) and Lin−Sca1−c-Kit+CD150−CD48− multipotent progenitors (MPP) in the bone marrow, with an upregulation of the niche factors Angiopoetin 1 and Kitl at 7 d post MI. Long-term ACE inhibition for 28 d limited vascular inflammation, particularly the infiltration of Ly6Chigh monocytes/macrophages, and reduced superoxide formation, resulting in improved endothelial function in mice with ischemic heart failure. Conclusion: ACE inhibition modulates the myeloid inflammatory response after MI due to the retention of myeloid precursor cells in their bone marrow reservoir. This results in a reduction in cardiac and vascular inflammation with improvement in survival after MI.

Abstract 19474: Clinical Characteristics and Outcomes of Patients With and Without Diabetes in the Surgical Treatment for Ischemic Heart Failure (STICH) trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael R MacDonald ◽  
Lilin She ◽  
Torsten Doenst ◽  
Philip Binkley ◽  
Jean Rouleau ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ischemic Heart Failure ◽  
Stich Trial

Introduction: Diabetes mellitus (DM), coronary artery disease (CAD) and heart failure commonly coexist. Hypothesis 1 of the Surgical Treatment for Ischemic Heart Failure (STICH) trial enrolled 1212 patients with a left ventricular ejection fraction (LVEF) of 35% or less and CAD amenable to CABG. Patients were randomised to CABG and optimal medical therapy (OMT) or OMT alone. Hypothesis: We assessed the hypothesis that patients with DM enrolled in the STICH trial would have greater benefit of CABG than patients without DM. Methods: We compared the characteristics and clinical outcomes of patients with and without DM randomized to CABG and OMT or OMT alone. Cox-proportional hazards analyses were used to assess treatment effect. Results: Diabetes was present in 40.3%. At baseline, patients with DM had more triple vessel CAD (66% v 57%, p<0.001), higher LVEF [median 29% (IQR:22,35) vs 27% (IQR:22,33), p=0.015] and smaller left ventricular end diastolic volume index [median 105 ml/m2 (IQR:85, 128) vs 117 ml/m2 (IQR:93, 146) (p<0.001)]. Among patients with DM, there was a higher proportion of females, higher BMI on average, worse renal function, and more hypertension. Patients with DM undergoing CABG spent longer on cardio-pulmonary bypass [median 97 (IQR:71,126) vs 87 (IQR:65, 115) minutes, p=0.029], and were more likely to develop perioperative AF (23% vs 11%, p<0.001) and worsening renal function (9% vs 4%, p=0.021). Patients with DM on OMT had similar outcomes as those on OMT without diabetes (Table 1). A statistically significant or near statistically significant improvement in clinical outcomes with CABG compared to OMT was documented in patients without DM, but not in patients with DM. However, there was no significant interaction between DM and treatment group on formal statistical testing. Conclusions: Patients with and without DM enrolled in the STICH trial had similar outcomes at 5 years, and CABG did not exert greater benefit in patients with DM.

Changing Strategies in the Management of Chronic Congestive Heart Failure

DICP ◽  
1991 ◽  
Vol 25 (12) ◽  
pp. 1349-1354 ◽  
Author(s):  
Daniel E. Hilleman ◽  
Syed M. Mohiuddin
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Mortality Rate ◽  
Heart Transplantation ◽  
Nyha Class ◽  
Class Ii ◽  
Left Ventricular ◽  
Fixed Dose ◽  
Chronic Congestive Heart Failure ◽  
Organ Systems

Recent studies have more clearly defined the role of drug therapy in patients with chronic congestive heart failure (CHF). Treatment of patients with asymptomatic left ventricular dysfunction (New York Heart Association [NYHA] class I) cannot be recommended at this time. The benefit of prophylactic treatment with angiotensin-converting enzyme inhibitors (ACEIs) or vasodilators in patients at high risk for developing symptomatic CHF is currently being evaluated. Treatment of patients with symptomatic CHF (NYHA class II-IV) should be initiated with a combination of a diuretic, digoxin, and an ACEI. This combination has been shown to reduce the mortality rate in patients with NYHA class II-IV CHF. Patients who remain symptomatic despite treatment with this combination may benefit from the addition of the direct-acting, nonspecific vasodilators—hydralazine and a nitrate. The addition of the nonspecific vasodilators to an ACEI has not been tested in controlled trials. In patients who remain symptomatic despite treatment with diuretics, digoxin, ACEIs, and nonspecific vasodilators, treatment options are not clear. The use of beta-agonists, phosphodiesterase inhibitors, and intermittent fixed-dose, fixed-interval dobutamine should be avoided as these agents are associated with a high mortality rate. Heart transplantation should be considered early in the course of CHF to allow for preservation of other vital organ systems. Unfortunately, heart transplantation is available to only a very small minority of potential transplant candidates.

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