Anna Kędziora

The use of stem cells in ischemic heart disease treatment

Ischemic heart disease is a major cause of death and disabilities worldwide. Unfortunately, not all patients are suitable for direct revascularization. Cell-based therapies may be alternative options because of their potential to promote neovascularisation and endothelial repair, improving myocardial perfusion. The success of cell-based therapies depends on the type of implanted stem cells, delivery method and underlying disease. Several different cell populations including bone marrow-derived mononuclear cells (MNCs), mesenchymal stromal cells (MSCs), CD34+, CD133+, endothelial progenitor cells, adipose-derived mesenchymal stromal cells (ASCs) and stem cells from placenta and umbilical cord have been investigated. Presently, no consensus exists about the best cell type for clinical regenerative therapy. Because the system of coronary arteries in the ischemic area is poor and most of the coronary artery is significantly narrowed or closed, direct implantation of stem cells in the ischemic area of the heart muscle appears an attractive method.

Use of adipose-derived stromal cells in the treatment of chronic ischaemic heart disease: safety and feasibility study

1Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland 2Jagiellonian University Collegium Medicum, Krakow, Poland 3Department of Plastic and Reconstructive Surgery, Rydygier Hospital, Krakow, Poland 4Students’ Scientific Group, Jagiellonian University Collegium Medicum, Krakow, Poland 5Centre for Diagnosis, Prevention, and Telemedicine, John Paul II Hospital, Krakow, Poland 6Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland 7Department of Transplantation, Jagiellonian University Collegium Medicum, Krakow, Poland

The effect of clinical variables on distress and depressive symptoms among heart transplant recipients

Background: Heart transplantation (HTx) is the standard treatment for end‐stage cardiomyopathy and coronary artery disease. Although major improvements have been made in the prevention and treatment of acute graft rejection, comorbidities still limit the long‐term survival of heart transplant recipients. The risk of poor outcome, such us major health status aggravation and death, can stimulate the occurrence of depression and stress in this population. The aim of this study was to determine the impact of comorbidities on depressive symptoms and distress among heart transplant recipients. Material/methods: The sample included 131 HTx recipients from one site. Data were collected during a follow‐up in‐hospital appointment, using the questionnaires assessing depression (Beck Depression Inventory Short Form) and stress (Perceived Stress Scale‐10). Statistical analyses included descriptive statistics, Pearson correlations, t‐tests, and generalized linear models. Results: Study patients were 75.6% (n = 97) male, 100% (n = 131) Caucasian, 74% (n = 89) married, with the mean age of 54 years at time of heart transplantation. Nearly half of the participants (40.5%) presented depression symptoms at the time of evaluation. Severe stress was observed in 30% of individuals. Depression symptoms and severe distress were more commonly observed in patients with many comorbidities, requiring multiple drug therapy, and high NYHA score. Moreover, in a multivariate logistic regression, depression and high distress level occurrence were predicted by the following independent factors: cardiac allograft vasculopathy, cancer, diabetes, higher NYHA score, and comorbidities. Conclusions: The prevalence of depression and severe distress is common among heart transplant recipients. Patients with many comorbidities are at higher risk of psychological indisposition.

Midterm outcomes of transmyocardial laser revascularization with intramyocardial injection of adipose derived stromal cells for severe refractory angina

Introduction Refractory angina has limited effective therapeutic options and often contributes to frequent hospitalizations, morbidity and impaired quality of life. Aim We sought to examine midterm results of a bio-interventional therapy combining transmyocardial laser revascularization (TMLR) and intramyocardial injection of adipose derived stem cells (ADSC) in patients with refractory angina not amenable to percutaneous or surgical revascularization. Material and methods We included 15 patients with severe refractory angina and anterior wall ischemia who were ineligible for revascularization strategies. Adipose tissue was harvested and purified, giving the stem cell concentrate. All patients underwent left anterior thoracotomy and TMLR using a low-powered holmium : yttrium–aluminum–garnet laser and intramyocardial injection of ADSC using a combined delivery system. Results No deaths or major adverse cardiovascular or cerebrovascular events were observed in the 6-month follow-up. Mean ejection fraction increased from 35% to 38%, and mean Canadian Cardiovascular Society Angina Score decreased from 3.2 to 1.4, with decreased necessity of nitrate usage. Seventy-three percent of patients reported health improvement particularly regarding general health and bodily pain. Improvement in endocardial movement, myocardial thickening and stroke volume index (35.26 to 46.23 ml/m2) on cardiac magnetic resonance imaging (MRI) was observed in 3 patients who had repeat CMR imaging after 6 months. Conclusions Our study suggested that interventional therapy combining TMLR with intramyocardial implantation of ADSC may reduce symptoms and improve quality of life in patients with refractory angina. These early findings need further validation in large scale randomized controlled trials.

Hybrid one-day coronary artery bypass grafting and carotid artery stenting – cardiac surgeons’ perspective on the procedure’s safety

1Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland 2Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland 3Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland 4Cardiosurgical Students’ Scientific Group, Jagiellonian University Medical College, Krakow, Poland 5Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland

Early onset and persistent progression of coronary artery disease of unknown etiology in a 30‑year‑old man

698 a non ‐ST ‐segment elevation myocardial infarc‐ tion in March 2011. He also suffered from par‐ oxysmal atrial fibrillation and preexcitation syn‐ drome. A family history of cardiovascular diseas‐ es and diabetes was negative. The predicted 4 ‐year mortality assessed with the SYNTAX II score was 6.4% for percutaneous coronary intervention and 0.7% for coronary artery bypass grafting (coronary angiography is presented in FIGURE 1A and 1B). The patient thus underwent emergent coronary artery bypass surgery with 3 arterial grafts, using the left and right internal mamma‐ ry arteries (LIMA and RIMA) and the radial ar‐ tery (RA): RIMA to the LAD, LIMA to the first The prevalence of coronary artery disease (CAD) in young patients is difficult to establish as most cases remain subclinical.1 The etiology and patho‐ genesis of atherosclerosis is complex. Its progres‐ sion is particularly rapid when environmental fac‐ tors coexist with genetic ones. An early and accu‐ rate identification of individuals at increased risk of CAD is critical for effective prevention and in‐ tervention, such as statin treatment.2 Neverthe‐ less, young smokers with hypertension and high fasting glucose levels have a higher probability of unsatisfactory results of lipid ‐lowering therapy.3 A 29 ‐year ‐old man with risk factors of hy‐ pertension and smoking was diagnosed with CLINICAL IMAGE

Minimally invasive coronary artery bypass as a safe method of surgical revascularization. The step towards hybrid procedures

Introduction Coronary artery disease is nowadays responsible for approximately 15% of hospitalizations in Poland. Minimally invasive coronary artery bypass (MIDCAB) represents an attractive alternative to a sternotomy, and at the same time provides better life quality and facilitates quick rehabilitation. Aim To evaluate whether MIDCAB can be performed with similar early and mid-term results as off-pump coronary artery bypass (OPCAB) and therefore can be considered as a safe stage in hybrid revascularization. Material and methods In a retrospective cohort study, we analyzed 73 consecutive patients who underwent coronary artery bypass grafting (left internal mammary artery to left anterior descending artery) between 2013 and 2016 in the Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow. Thirty-eight (52.1%) MIDCAB and 35 (47.9%) OPCAB patients were enrolled. Results Short-term results did not significantly differ between groups and similar 30-day mortality was observed (MIDCAB 2.6% vs. OPCAB 2.9%, p = 1). The median follow-up period was 21 months. There were no statistical differences in terms of overall survival or cardiac mortality between groups (94.7% vs. 88.6%, p = 0.42; 2.6% vs. 2.9%, p = 1, respectively). The rate of hospitalization due to cardiac causes was similar in both groups (7.9% vs. 5.1%, p = 1) and there were no differences in current exacerbation of angina or heart failure, with median NYHA class I and CCS class I in both groups. Conclusions Despite higher technical difficulty, MIDCAB procedures can be performed with similar safety results as OPCAB procedures. No differences in terms of mortality, repeat revascularization or recurrent angina are observed.

Does the postoperative troponin I blood concentration measured in the perioperative period influence hemodynamic function of a transplanted heart

Introduction Plasma troponin I (TnI) concentration is a well-established and widely-used marker of myocardial damage. Aim To determine the correlation between TnI concentration measured within the first 4 days following heart transplantation (HTX) and clinical course, with consideration of hemodynamic performance. Material and methods The retrospective study included 54 patients (12-62 years) who underwent HTX. TnI levels were assessed over the first 4 post-operative days. Hemodynamic parameters were assessed daily at Swan-Ganz catheterization and echocardiography. The number of required inotropic drugs was also analyzed. Results There is a strong and positive correlation between the mean TnI levels and the mean number of required inotropic drugs (r = 0.51, p = 0.00), and also mean central venous pressure (CVP) (r = 0.33, p = 0.015). A weak trend towards a positive correlation between the mean values of pulmonary capillary wedge pressure (PCWP) and the mean plasma TnI levels was observed. There was no correlation between mean TnI levels and mean values of ejection fraction (EF) and cardiac output (CO). Detailed analysis showed a statistically significant correlation between TnI levels on days 3 and 4 after HTX and PCWP on the preceding days (r = 0.32, p = 0.04; r = 0.46, p = 0.006 respectively). Furthermore, a strong, inverse correlation between TnI levels on day 3 and CO on day 4 following HTX was observed (r = –0.44, p = 0.03). Conclusions Plasma TnI could be a useful marker for assessing the hemodynamic function after HTX.