Jaroslav Tintera

One Day Kinetics of Myocardial Engraftment After Intracoronary Injection of Bone Marrow Mononuclear Cells in Patients with Acute and Chronic Myocardial Infarction.

Objective: To investigate the kinetics of myocardial engraftment of bone marrow-derived mononuclear cells (BMNCs) after intracoronary injection using 99mTc-d,l-hexamethylpropylene amine oxime (99mTc-HMPAO) nuclear imaging in patients with acute and chronic anterior myocardial infarction. Design: Nuclear imaging-derived tracking of BMNCs at 2 and 20 h after injection in the left anterior descending (LAD) coronary artery. Setting: Academical cardiocentre. Patients: Five patients with acute (mean (SD) age 58 (11) years; ejection fraction range 33–45%) and five patients with chronic (mean (SD) age 50 (6) years; ejection fraction range 28–34%) anterior myocardial infarction. Interventions: A total of 24.2×108–57.0×108 BMNCs (20% labelled with 700–1000 MBq 99mTc-HMPAO) were injected in the LAD coronary artery. Results: At 2 h after BMNC injection, myocardial activity was observed in all patients with acute (range 1.31–5.10%) and in all but one patient with chronic infarction (range 1.10–3.0%). At 20 h, myocardial engraftment was noted only in three patients with acute myocardial infarction, whereas no myocardial activity was noted in any patient with chronic infarction. Conclusions: Engraftment of BMNCs shows dynamic changes within the first 20 h after intracoronary injection. Persistent myocardial engraftment was noted only in a subset of patients with acute myocardial infarction.

Clinical value of assessment of left atrial late gadolinium enhancement in patients undergoing ablation of atrial fibrillation

BACKGROUND Left atrial (LA) fibrosis begets atrial fibrillation (AF). Cardiovascular magnetic resonance (CMR) using the late gadolinium enhancement (LGE) technique might visualize the LA fibrosis and thus help to choose an appropriate strategy for treatment of AF. In this regard, we investigated whether the extent of preablation LA LGE would predict AF recurrence after ablation in a non-selected patient population. METHODS CMR was performed in 95 patients before radiofrequency ablation of AF. An interpretable scan was available in 73 patients (age, 59 ± 8 years; men, 71%; persistent/paroxysmal AF, 55/45%). The extent of LA LGE was quantified by three established thresholding techniques. In addition, CMR was used to quantify LA volume and reservoir function. The patients were followed for AF recurrence for 1.3 ± 0.8 years. RESULTS The arrhythmia recurred in 29 (40%) of the patients. The extent of LA LGE did not differ between paroxysmal and persistent AF and it did not predict the AF recurrence. Moreover, the extent of LA LGE did not correlate with LA volume, reservoir function and bipolar voltage. CONCLUSIONS Our data indicate a limited value of a routine assessment of LA LGE before ablation of AF. Further experimental and clinical researches should be done before applying the method to a wide clinical practice.

Myocardial viability and cardiac dyssynchrony as strong predictors of perioperative mortality in high-risk patients with ischemic cardiomyopathy having coronary artery bypass surgery

OBJECTIVE Myocardial viability and left ventricular dyssynchrony are important predictors of long-term outcomes in patients with ischemic left ventricular dysfunction. The objective of this study was to test the hypothesis that assessment of myocardial viability and left ventricular dyssynchrony will predict perioperative mortality in high-risk patients with ischemic left ventricular dysfunction having coronary artery bypass surgery. METHODS The study consisted of 79 consecutive patients with ischemic cardiomyopathy (age 65 +/- 9 years; 81% men; ejection fraction 30% +/- 6%) and logistic European system for cardiac operative risk evaluation > 10% having coronary artery bypass surgery. Myocardial viability was assessed by delayed contrast-enhanced magnetic resonance imaging. Left ventricular dyssynchrony was calculated using tissue Doppler from measurements of regional electromechanical coupling times in left ventricular basal segments before coronary artery bypass surgery. RESULTS Twenty (25.3%) patients died within 30 days following coronary artery bypass surgery. Survivors (n = 59) showed a larger extent of viable myocardium (6.9 +/- 3.6 viable segments vs 3.4 +/- 3.3 viable segments, P < .001) and smaller left ventricular dyssynchrony (75 +/- 5 ms vs 179 +/- 83 ms, P < .001) than nonsurvivors. The presence of significant dyssynchrony (>or=105 ms) and absence of myocardial viability (<5 viable segments) independently predicted 30-day mortality with hazard ratio 3.26, 95% confidence interval 1.61 to 8.33 (P < .01) and hazard ratio 1.72, 95% confidence interval 1.59 to 1.89 (P < .01), respectively. All but 2 patients (94.1%) with viable myocardium and without left ventricular dyssynchrony survived coronary artery bypass surgery as compared with only 12 (52.2%) patients with nonviable myocardium and severe dyssynchrony (P < .001). CONCLUSIONS In high-risk patients with ischemic left ventricular dysfunction having coronary artery bypass surgery, both myocardial viability and left ventricular dyssynchrony are important predictors of perioperative outcome. Assessment of myocardial viability and left ventricular dyssynchrony should be a routine part of the preoperative evaluation of these patients.

A Novel Biomarker‐Based Approach for the Detection of Asymptomatic Brain Injury During Catheter Ablation of Atrial Fibrillation

Diffusion‐weighted magnetic resonance imaging (DW‐MRI) is a widely used method for studying of asymptomatic brain injury during catheter ablation of atrial fibrillation (AF). However, this technique lacks sensitivity for subtle or diffuse brain lesions. We investigated whether detection of the ablation‐related brain injury can improve by assessment of a biomarker of brain damage—protein S100B.

Endocarditis of left ventricular apical patch with cavity formation.

An 82-year-old man was admitted for septic fever and chills in May 2005. He had undergone coronary artery bypass grafting and aneurysmectomy of the left ventricular apical aneurysm in September 2004. Since January 2005, he had complained about episodes of night sweating, fever with chills and fatigue. Antibiotics prescribed …