Stanislav Janoušek

Cell Therapy in Patients with Left Ventricular Dysfunction Due to Myocardial Infarction

Objectives: The purpose of this study was to determine the impact of autologous transplantation of mononuclear bone marrow cells on myocardial function in patients with left ventricular (LV) dysfunction due to an acute myocardial infarction. Methods: The randomized study included 82 patients with a first acute myocardial infarction treated with a stent implantation. This presentation is a subanalysis of 47 patients with left ventricular dysfunction–EF (ejection fraction) ≤ 40%. Group H patients (n = 17) received higher number (100,000,000) of cells; Group L patients (n = 13) received lower number (10,000,000) of cells. The patients of control Group C (n = 17) were not treated with cells. The Doppler tissue imaging and single photon emission computed tomography were performed before cell transplantation and 3 months later. Results: At 3 months of follow‐up, the baseline EF of 35%, 36%, 35% in Groups H, L, and C increased by 6% (P < 0.01 vs. baseline), 5% (P < 0.01 vs. baseline), and 4% (P = NS vs. baseline), respectively, as assessed by single photon emission computed tomography (P = NS between groups). The baseline number of akinetic segments of 6.9, 7.0, and 6.2 in H, L, and C groups decreased by 1.7 (P < 0.01 vs. baseline), 1.5 (P < 0.01 vs. baseline), and 0.7 (P = NS vs. baseline, P = NS between groups), respectively, as demonstrated by echocardiography. Conclusion: In our study, the statistically important effect of transplantation of mononuclear bone marrow cells on myocardial function was not found. Only an insignificant trend toward the improvement of global LV EF fraction was found at 3‐month follow‐up.

Individual differences in the effectiveness of intracoronary bone marrow cell transplantation assessed by gated sestamibi SPECT/FDG PET imaging.

AbstractBackground. The impact of different levels of tracer uptake on improvements of left-ventricular (LV) function was analyzed in patients treated by intracoronary bone marrow cell (BMC) transplantation. Methods and Results. Thirty-one patients with irreversible damage after their first acute myocardial infarction (MI), as confirmed by sestamibi single-photon emission computed tomography (MIBI SPECT)/fluorodeoxyglucose positron emission tomography (FDG PET), underwent high-dose (1×108 cells) BMC transplantation, whereas 31 similar patients were randomly integrated into a control group. In 11 BMC-treated patients with very low sestamibi uptake at less than 30% of maximum in the infarcted area, the mean left-ventricular ejection fraction (LVEF) improved after 3 months of follow-up by 3% only, and mean end-diastolic/end-systolic volumes (EDV/ESV) enlarged by 10/1 mL (P=NS vs controls). In 20 BMC-treated patients with higher sestamibi uptake in the range of 31% to 50% of maximum, LVEF improved by 7%, and EDV/ESV decreased by 5/12 mL (P<.05 vs BMC-treated subgroup with low MIBI uptake and controls). No similar categorization was seen in the control group: in patients with higher sestamibi uptake or very low uptake, the LVEF increased by 2% and 3% only, and the EDV/ESV enlarged in both subgroups by 12/4 mL and 12/2 mL, respectively (P=NS). Conclusions. Our results suggest the capability of SPECT/PET imaging to select patients who will receive the maximum benefit from BMC therapy.

Hemodynamic effects of transdermal nitroglycerin patches in patients with acute myocardial infarction

Transdermal nitroglycerin patches are used mainly in the therapy of angina pectoris. However, the magnitude and duration of their effects are still controversial. In this study, transdermal discs with nitroglycerin were given to 14 patients with acute myocardial infarction (AMI) and mild hemodynamic impairment. Seven patients received Nitroderm TTS, and seven patients Deponit 5 (in this case 2 patches), the nitroglycerin dose being 10 mg. Hemodynamic measurements were made 19-24 h after application of the patch and 1 h after its removal. Comparing with the values obtained 1 h after removal of the patch, 19-24 h after the application of the patch heart rate was significantly higher (90.2 +/- 3.8 vs. 85.6 +/- 4.0 min-1; p less than 0.01), mean right atrial pressure was significantly lower (10.8 +/- 1.0 vs. 12.7 +/- 1.3 mm Hg; p less than 0.01), and so were the pulmonary artery pressure: systolic (36.9 +/- 3.0 vs. 43.0 +/- 3.1 mm Hg; p less than 0.001), mean (26.8 +/- 2.1 vs. 31.4 +/- 2.0 mm Hg; p less than 0.001) and the capillary wedge pressure (19.2 +/- 1.8 vs. 23.0 +/- 1.9 mm Hg; p less than 0.01). These findings revealed that in patients with AMI hemodynamic effects persist for at least 19 h after single application of a nitroglycerin patch of 10 mg. The therapy is safe and the risk of side effects is small.

Risk factors, clinical features and outcome of acute myocardial infarction in Sana´a, Yemen

Of all patients, 348 (90.2%) were men with a mean (+/- SD) age 54 +/- 11 years (range, 27-82 years) and 38 (9.8%) were women with a mean age of 59 +/- 11 years (range, 38-80 years). Almost all patients (97.9%) were Yemeni. The prevalence of risk factors was as follows: khat chewing (88%), smoking (81%), total serum cholesterol (29%), diabetes mellitus (25%) and hypertension (18%). When classified according to site, recurrence and severity of AMI, in 57.0% there was an anterior infarction, in 35.2% an inferior infarction,in 7.0% an inferoseptal infarction, in 1.8% a lateral infarction and location was undetermined in 2.5%. Only 34 (8.8%) patients had a previous history of AMI; in 352 (91.2%) patients, it was the first AMI. In 341 (88.3%) it was a Q-wave infarction while a non Q-wave infarction was found in 35 (9.1%) and in 10 (2.6%) it was undetermined. The complications of AMI were heart failure in 94 cases (24.6%), primary ventricular fibrillation or tachycardia in 18 cases (4.7%), and second or third degree atrioventricular block in 17 (4.4%). The ICU mortality rate was 11.4% (44 patients) and the total in-hospital mortality was 14.2% (55 patients). Causes of death during hospitalization were cardiogenic shock (62%), sudden death (18%), resistant arrhythmia (13%), brain embolization (5%), and hypoxic brain damage after CPR (2%).