First experience with the use of bone marrow stem cells for regeneration therapy of ischemic heart disease.

AIM: To elucidate feasibility of the use of autologous bone marrow stem cells in candidates to myocardial revascularization- patients with ischemic heart disease and cardiosclerosis after myocardial infarction. METHODS: Between January 2003 and January 2004 25 men aged 56.3+/-5.4 years with ischemic heart disease were subjected to cell therapy including 4 patients with heart failure and 5 - with acute coronary syndrome. Subgroup of patients with postinfarction cardiosclerosis consisted of 16 men satisfying the following criteria: (1) history of myocardial infarction with scar formation; (2) class III-IV angina; (3) presence of indications for endovascular or surgical intervention on coronary arteries. Study protocol included clinical examination, coronary angiography; dobutamine stress-, contrast- and tissue echocardiography with assessment of segmental myocardial perfusion, systolic and diastolic left ventricular function. RESULTS: There were no complications during bone marrow sampling and administration of cells. All patients were restudied 1 month after transplantation. Improvement of clinical state without complications and adverse effects of the procedure noted in all patients was associated with lowering of mean angina class (from 3.4 to 1.4, p<0.05); decrease of NYHA heart failure class (from 3.1 to 1.5); rise of left ventricular ejection fraction (from 42.9 to 56.3%); decrease of average number of asynergic segments (from 5.3+/-0.7 to 2.1+/-0.3, p<0.01). Systolic velocity before intervention was 2.3 cm/s, after procedure in segments subjected to isolated revascularization it increased up to 4.8 cm/s, while in those subjected to revascularization combined with administration of stem cells - up to 6.2 cm/s. Contrast echocardiography in 9 patients demonstrated augmented myocardial perfusion in regions exposed to cell therapy. CONCLUSION: Transplantation of autologous bone marrow stem cells to ischemic heart disease patients - candidates for myocardial reperfusion - turned out to be safe and well tolerated procedure. Combination of myocardial revascularization with administration of stem cells into regions of postinfarction scars was associated with improvement of total and local myocardial contractility and normalization of left ventricular diastolic filling. Cell therapy facilitated augmentation of myocardial perfusion.     

Therapeutic value of muscular counterpulsation after coronary bypass grafting operation

Abstract Objective: Coronary artery bypass grafting continues to be the operation of choice in patients with severe multiple coronary artery disease. However, there are several unresolved issues such as treatment of postoperative heart failure following bypass surgery. There is worldwide interest in evaluating new treatment methods for this condition. The objective is to determine the effect of a new external, bioassisted circulation—muscular counterpulsation (MCP) method in patients with ischemic heart disease (IHD) undergoing coronary artery bypass grafting (CABG). Methods: Fifty patients (age 54 ± 8) undergoing CABG were included in the present analysis. Patients were randomized into two groups: A control group (n = 20) receiving standard postoperative treatment without counterpulsation and a treatment group (n = 30) undergoing MCP with a cardio‐synchronized pulse generator using stimulation electrodes on the lower extremities. Treatment was 30 minutes daily for the eight initial postoperative days in addition to standard therapy. In all patients, a resting electrocardiogram (ECG), two‐dimensional echocardiography, and impedance plethysmography of the forearm were carried out pre‐CABG and on the eighth postoperative day. Results: Follow‐up was completed in 94% of the patients. Two patients of the control and one of the treatment group refused follow‐up examination. MCP treatment resulted in a 36% decrease of systemic vascular resistance (p < 0.001) compared to a 16% decrease (p = 0.011) in the control group. Postoperative complications occurred in one (3%) patient of the treatment group and in seven (39%) patients of the control group. Compared to the control group, patients in the treatment group had a 28% shorter postoperative hospital stay (12.0 ± 4.6 days) than in the control group (16.8 ± 4.4 days) (p < 0.001). Conclusions: MCP represents a new, noninvasive, ECG‐triggered circulation support system, which is effective for achieving hemodynamic improvement via afterload reduction. The use of MCP decreases postoperative complications and significantly shortens the hospital stay.     

Acute coronary syndrome and cell technologies

The authors researched into the possibility of autologous bone marrow stem cell (MSC) application in patients with acute myocardial infarction (AMI). 10 patients with AMI received cell therapy after giving an informed consent. ECG and EchoCG revealed myocardial infarction (MI) in the basin of the anterior interventricular branch (AIB) of the left coronary artery (LCA) in 4 patients, in the basin of the circumflex branch (CB) of the LCA--in 3 patients, and in the basin of the right coronary artery (RCA)--in 3 patients. Patients older than 70, patients with acute heart failure and those who developed AMI more than 48 hours ago, were excluded from the study. All the patients were male, aged 56.3 +/- 5.2 years, mean time from pain onset to the performance of myocardial revascularization was 11.4 +/- 7.2 hours. Marrow mononuclear fraction was introduced into the infarction-related artery on the 5th-7th day after primary angioplasty and stenting. Marrow sampling and cell material introduction did not cause any complications. All the patients were re-studied 1 month after the MSC transplantation. All the patients' condition improved; no complications or side effects of the interventions were observed. Left ventricle ejection fraction increased from 42.9% to 51.4%; the average number of asynergic segments was 5.3 +/- 0.7 before the intervention and decreased to 2.6 +/- 0.7 (p < 0.01) afterwards. Systolic velocity before the intervention was 2.5 cm/sec, and after the procedure it increased to 4.6 cm/sec in the segments submitted to isolated revascularization and to 6.1 cm/sec--in segments where the intervention was accompanied by the introduction of MSC (p < 0.01). Contrast EchoCG demonstrated an increase of myocardial perfusion in the area of cell therapy. The chief results of the study are as follows: 1) autologous MSC transplantation in patients with acute coronary syndrome is a safe and well-tolerated procedure; 2) myocardial revascularization in combination with MSC introduction in AMI area improves total and local contractile myocardial function and normalizes diastolic filling process in the LV; 3) cell therapy improves the myocardial perfusion.     

Effect of dipyridamole on blood levels of fibroblast growth factor and vascular endothelial growth factor in patients with ischemic heart disease

Addition if dipyridamole to standard therapy in patients with ischemic heart disease was associated with improvement of functional class of angina and elevation of blood levels of fibroblast growth factor and Vascular Endothelial Growth Factor.     

The etiological structure of acute viral hepatitis in Tadzhikistan in a period of decreased morbidity

In the period of reduced incidence of viral hepatitis in Tajikistan, January-December, 1990, 1562 patients with acute viral hepatitis (AVH) were examined in the first days of the jaundice phase (928 children under 14 years and 634 adults) in Dushanbe. Markers of hepatitis A, B, and D (HBsAg, anti-HA IgM, anti-HBc IgM, anti-delta IgM) were determined by enzyme immunoassay. Hepatitis A occurred in 25.8% of the patients with AVH, mostly children of 1-6 years, HB in 22.8%, HD co- and superinfection) in 9.2%. In 42.1% of the patients who had no HA, HB, or HD markers in the blood, non-A, non-B hepatitis (mostly hepatitis E) was diagnosed, mainly in the age groups of 30-39 years (70.7%) and 15-29 years (59.2%). Thus, in Tajikistan hepatitis E occurs not only during outbreaks of this infection but also sporadically.