revascularization – ABC CARDIOL

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Predictors of viability in patients with negative low-dose dobutamine stress echocardiograph

BACKGROUND: Low-dose dobutamine stress echocardiography is specific for predicting reversible contractility dysfunction, but its sensitivity is lower than ideal. OBJECTIVE: We sought to explore the predictors of myocardial contractile recovery following revascularization, in patients with no viability by low-dose dobutamine stress echocardiography. METHODS: We prospectively enrolled 30 consecutive patients with significant coronary stenosis/occlusion amenable for revascularization, regional wall motion abnormality in the distribution of the affected artery and absence of viability by low-dose dobutamine stress echocardiography. They underwent resting 99mTc-sestamibi imaging study, and then underwent successful coronary revascularization. Follow-up echocardiography was performed 3 months later. Patients were classified into 2 groups: group 1: with evidence of myocardial contractile recovery after revascularization at follow-up echocardiography and group 2: with no such evidence of recovery. The two groups were compared with respect to patients’ clinical, echocardiographic and scintigraphic data. RESULTS: The mean age was 52.3 ± 5.9 years, with 97% being males. The percentage of total 99mTc-sestamibi uptake was significantly higher in group 1 as compared to group 2 (p < 0.01), and it was the strongest independent predictor of myocardial contractile recovery at 3-month follow-up by multivariate regression analysis. Receiver operating characteristics curve revealed that a cutoff value of the percentage of total 99mTc-sestamibi uptake of 72% best predicted myocardial contractile recovery, with a sensitivity of 100% and specificity of 95.7%. CONCLUSION: In patients with no viability by low-dose dobutamine stress echocardiography, the percentage of total 99mTc-sestamibi uptake independently predicted myocardial contractile recovery following coronary revascularization.

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Sustained improvement in symptoms and exercise capacity up to six months after autologous transendocardial transplantation of bone marrow mononuclear cells in patients with severe ischemic heart disease

Hans Fernando R. Dohmann et al. Emerson C. Perin Radovan Borojevic Suzana A. Silva … Andre L. S. Souza Guilherme V. Silva João A. R. Assad Maria I. D. Rossi Claudio T. Mesquita Hans J. Dohmann

OBJECTIVE: This study aimed at assessing the effects of autologous transendocardial transplantation of bone marrow mononuclear cells (ATTBMMC) on symptoms, exercise capacity, myocardial perfusion and contractility in patients with severe ischemic heart disease during a 6-month follow-up period. METHODS: This prospective study comprised 21 patients as follows: the first 14 patients forming the treated group, and the last 7 patients forming the control group. Initially, all patients underwent clinical and laboratory assessment, treadmill testing, echocardiography, myocardial scintigraphy, and 24-hour Holter. The bone marrow mononuclear cells (BMMC) were isolated, washed, and diluted in 0.9% saline solution for transendocardial injection in areas of viable myocardium in the treated group, (15 0.2-mL injections). All patients were reassessed in the end of 2 and 6 months of follow-up. RESULTS: The demographic data and other characteristics did not significantly differ between the groups in the initial evaluation. No major adverse events related to the ATTBMMC were observed. In the end of 6 months, a reduction in the ischemic area was observed on nuclear perfusion imaging (P=0.05), as was a significant improvement in symptoms, functional capacity, and left ventricular overall function. CONCLUSION: This study showed that transendocardial injections of BMMC are safe in human beings with ischemic heart disease associated with severe ventricular dysfunction. The effects observed in the short run were maintained up to the sixth month of follow-up.

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Predictors of viability in patients with negative low-dose dobutamine stress echocardiograph

Sustained improvement in symptoms and exercise capacity up to six months after autologous transendocardial transplantation of bone marrow mononuclear cells in patients with severe ischemic heart disease

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Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)