Miokardo revaskuliarizacijos, taikant smūginės bangos terapiją, efektyvumo vertinimas daugialypės (multimodalios) vaizdinės diagnostikos metodais

Ischemic heart disease (IHD) is one of leading morbidity and mortality caused worldwide. Along with medical treatment currently there are two main methods of coronary revascularisation – percutaneous coronary intervention (PCI) and aortocoronary bypass surgery (ACBS). New heart revascularisation methods are under development, which are to be applied for routine practice in the future. One of methods stimulating angiogenesis is cardiac shock wave therapy (CSWT). CSWT is new reconstructive / regeneration treatment method offering alternative for revascularisation, as use of steam cells for such purposes is still in the stage of trials. Low frequency mechanical waves are used for CSWT. Their effect results in improved heart perfusion and development of blood vessels' network. Such waves for the first time in medicine were applied about 20 years ago for renal stones fragmentation. This treatment method has been recently applied in clinics worldwide and only few of them obtained some experience in this area. CSWT, along with medical and invasive treatment methods for patients with severely advanced ischemic heart disease, in Santariškių Clinics of Vilnius University Hospital was introduced in 2008

Cardiac shock-wave therapy in the treatment of coronary artery disease: systematic review and meta-analysis

Abstract Aim To systematically review currently available cardiac shock-wave therapy (CSWT) studies in humans and perform meta-analysis regarding anti-anginal efficacy of CSWT. Methods The Cochrane Controlled Trials Register, Medline, Medscape, Research Gate, Science Direct, and Web of Science databases were explored. In total 39 studies evaluating the efficacy of CSWT in patients with stable angina were identified including single arm, non- and randomized trials. Information on study design, subject’s characteristics, clinical data and endpoints were obtained. Assessment of publication risk of bias was performed and heterogeneity across the studies was calculated by using random effects model. Results Totally, 1189 patients were included in 39 reviewed studies, with 1006 patients treated with CSWT. The largest patient sample of single arm study consisted of 111 patients. All selected studies demonstrated significant improvement in subjective measures of angina symptoms and/or quality of life, in the majority of studies left ventricular function and myocardial perfusion improved. In 12 controlled studies with 483 patients included (183 controls) angina class, Seattle Angina Questionnaire (SAQ) score, nitrates consumption were significantly improved after the treatment. In 593 participants across 22 studies the exercise capacity was significantly improved after CSWT, as compared with the baseline values (in meta-analysis standardized mean difference SMD = −0.74; 95% CI, −0.97 to −0.5; p < 0.001). Conclusions Systematic review of CSWT studies in stable coronary artery disease (CAD) demonstrated consistent improvement of clinical variables. Meta-analysis showed a moderate improvement of exercise capacity. Overall, CSWT is a promising non-invasive option for patients with end-stage CAD, but evidence is limited to small sample single-center studies. Multi-center adequately powered randomised double blind studies are warranted

Long-term results of minimally invasive stand-alone bi-atrial surgical ablation with a bipolar ablation device for persistent and longstanding persistent AF: a single-center case series of 91 patients.

BACKGROUND: Minimally invasive surgical treatment of lone atrial fibrillation (AF) is an alternative for AF that is refractory to medical treatment. We present long-term results of standalone surgical ablation of AF using a bipolar ablation device in 91 consecutive patients. METHODS: This was an observational, retrospective study of 91 patients (77 % males; mean age, 53 ± 10 years [range, 23–75 years]) who underwent minimally invasive standalone surgical ablation of persistent and longstanding persistent AF using a bipolar ablation device from 2008 to 2014. Mean follow-up was 60 ± 21 months. The absence of arrhythmia was confirmed at 3, 6, and 12 months, and annually thereafter, with 24-hour Holter monitoring. RESULTS: The mean duration of preoperative AF was 6.5 ± 5.4 years. Persistent AF was present in 86 % of patients and longstanding persistent AF in 14 %. Mean left atrial diameter was 4.3 ± 0.8 cm. There were two postoperative strokes (2 %) and three conversions to median sternotomy (3 %). Permanent pacemakers were implanted in six (7 %) patients. There were no intra- or postoperative deaths. At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 59, 45, 41, 38, and 38 % of patients, respectively. The failure to achieve pulmonary vein isolation was the only independent predictor of long-term recurrence of AF (HR −3 [95 % CI 1,858 to 8,586], p = 0,001). There was a tendency towards higher rates of SR at long term follow up in patients with pulmonary vein isolation if division of ligament of Marshall was performed (HR - 2 [95 % CI 0.987 to 4,202], p = 0,067). CONCLUSIONS: In the present series, the efficacy of epicardial surgical ablation was similar to that reported previously. The rate of arrhythmia recurrence increased over time. Achieving pulmonary vein isolation is essential to AF elimination. The division of ligament of Marshall could contribute to improved rates of SR restoration in patients with persistent or long-standing persistent AF if PVI is achieved

Technical Recommendations for Real-Time Echocardiography and Fluoroscopy Imaging Fusion in Catheter-Based Mitral Valve Paravalvular Leak and Other Procedures

Widespread catheter-based interventions for structural heart disease have overtaken the treatment of paravalvular leaks (PVL). Multimodality imaging techniques play a crucial role in accurate diagnosis, procedure planning and performance. However, PVL closure is often technically challenging due to the complex anatomy of the defects and their relation to surrounding anatomical structures. The application of echocardiography and fluoroscopy imaging fusion (EFF) may simplify challenging imaginative three-dimensional reconstruction of the intracardiac anatomy and facilitate the procedure. To master new technology, personnel must make cognitive changes, overcome a learning curve, and obtain adequate theoretical knowledge. Main aim of this manuscript is to present basic recommendations for EFF application in practice, alongside, each scenario is supported by technically challenging clinical examples. We may conclude that our manuscript may provide useful information for physicians on EEF application in clinical practice

Возможности различных протоколов экстракорпоральной ударно-волновой терапии в лечении стабильной стенокардии

Aim. To evaluate effects of various protocols of cardiac shock wave therapy (CSWT) on quality of life and exercise tolerance in patients with stable angina against the background of optimal medication therapy (OMT). Material and methods. Overall 53 patients (37 men, 16 women) were included in the study. The mean age of examined patients was 67,3±8,1 years. Inclusion criteria: CCS class I-IV angina pectoris, stable therapy for at least 1 month before inclusion in the study and a stable course of coronary artery disease for more than 3 months (no cardiovascular events) before inclusion in the study. Patients were divided into 2 groups. The Group 1 (n=37) received OMT+CSWT standard-modified protocol, Group 2 (n=16) received OMT+CSWT rapid-modified protocol. Electrocardiography, echocardiography, treadmill test, and Seattle quality of life questionnaire (SAQ) were performed at inclusion and 6 months follow up. Results. Both CSWT with rapid-modified protocol and standard-modified protocol significantly reduced the number of short-acting nitrates from 2 (2; 7) to 1 (0; 2) (p=0,04) and from 2 (0; 6) to 0 (0; 2) (p≤0,001) at 6 months, respectively, as well as the number of angina attacks per week (from 4 (2; 7) to 1 (1; 1) (p=0,007) and 6 (2; 20) to 1 (0; 5) (p≤0,001). Treadmill test total exercise duration was significantly increased from 393 (326; 574) to 561 (411; 650) seconds (p=0,007) and 365±140,4 to 411,5±156,1 seconds (p=0,01), respectively. Time to 1 mm ST segment depression was also significantly increased from 399,8±169 to 460±182 seconds (p≤0,05) and from 303,1±179 to 389,9±203 seconds (p=0,001), respectively. Conclusion. In our study, CSWT with rapid-modified protocol improved quality of life and exercise tolerance in patients with stable angina similar to the standard-modified protocol. Rapid-modified protocol of CSWT reduced total duration of the treatment

The effect of cardiac shock wave therapy on myocardial function and perfusion in the randomized, triple-blind, sham-procedure controlled study.

Background: Recent triple-blind sham procedure-controlled study revealed neutral effects of the cardiac shock wave therapy (CSWT) on exercise tolerance and symptoms in patients with stable angina. Current data about the effects of CSWT on global and regional myocardial contractility and perfusion is limited. Hereby we report the results of an imaging sub-study that evaluated the capacity of CSWT to ameliorate myocardial ischemia induced during dobutamine stress echocardiography (DSE) and cardiac single photon emission computed tomography (SPECT). Methods: Prospective, randomized, triple-blind, sham procedure-controlled study enrolled 72 adult subjects who complied with defined inclusion criteria. The subjects were assigned to the OMT + CSWT and the OMT + sham procedure study groups with 1:1 ratio. Application of the CSWT covered all segments of the left ventricle. Imaging ischemia tests were performed in 59 study patients: DSE and SPECT before the CSWT treatment and after 6 months, with DSE carried out additionally at 3 months after randomization. Co-primary endpoints of the study were: change in wall motion score index (WMSI), representing the stress-induced impairment of regional myocardial function, and change in summed difference score (SDS), representing the amount of perfusion defect. Results: OMT + CSWT and OMT + sham procedure study groups included 30 and 29 patients, respectively. Regional myocardial contractility during DSE significantly improved at 3 months follow-up in OMT + CSWT group compared to baseline as shown by WMSI at stress (1.4 ± 0.4 vs 1.6 ± 0.4, p = 0.001), but not in OMT + sham procedure group (1.5 ± 0.3 vs 1.6 ± 0.4, p = 0.136). The difference in stress DSE results between both study groups disappeared after 6 months. SPECT results demonstrated a significant reduction of inducible ischemia in OMT + CSWT group compared to OMT + sham procedure group at 6 months follow-up (SDS dropped from 5.4 ± 3.7 to 3.6 ± 3.8 vs 6.4 ± 5.9 to 6.2 ± 5 respectively, p = 0.034). Conclusions: Cardiac shock wave treatment showed the ability to reduce stress-induced myocardial ischemia, as assessed by wall motion abnormalities and perfusion defects, compared to sham procedure