scholarly journals Importance of evaluation for severity of myocardial ischemia: interpreted from clinical trials

2018 ◽  
Vol 24 (2) ◽  
pp. 79-83
Author(s):  
Keisuke Kiso ◽  
Emi Tateishi
Keyword(s):  
Clinical Trials ◽  
Myocardial Ischemia

Therapeutic angiogenesis for myocardial ischemia revisited: basic biological concepts and focus on latest clinical trials

Angiogenesis ◽  
2011 ◽  
Vol 15 (1) ◽  
pp. 1-22 ◽  
Author(s):  
Sofoclis Mitsos ◽  
Konstantinos Katsanos ◽  
Efstratios Koletsis ◽  
George C. Kagadis ◽  
Nikolaos Anastasiou ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Myocardial Ischemia ◽  
Therapeutic Angiogenesis ◽  
Biological Concepts

scholarly journals Effects on cardiac function, remodeling and inflammation following myocardial ischemia–reperfusion injury or unreperfused myocardial infarction in hypercholesterolemic APOE*3-Leiden mice

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Niek J. Pluijmert ◽  
Cindy I. Bart ◽  
Wilhelmina H. Bax ◽  
Paul H. A. Quax ◽  
Douwe E. Atsma
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Myocardial Ischemia ◽  
Cardiac Function ◽  
Infarct Size ◽  
Ischemia Reperfusion ◽  
Left Ventricular ◽  
Apo E ◽  
Lv Remodeling ◽  
Myocardial Ischemia Reperfusion

Abstract Many novel therapies to treat myocardial infarction (MI), yielding promising results in animal models, nowadays failed in clinical trials for several reasons. The most used animal MI model is based on permanent ligation of the left anterior descending (LAD) coronary artery in healthy mice resulting in transmural MI, while in clinical practice reperfusion is usually accomplished by primary percutaneous coronary interventions (PCI) limiting myocardial damage and inducing myocardial ischemia–reperfusion (MI-R) injury. To evaluate a more similar murine MI model we compared MI-R injury to unreperfused MI in hypercholesterolemic apolipoprotein (APO)E*3-Leiden mice regarding effects on cardiac function, left ventricular (LV) remodeling and inflammation. Both MI-R and MI resulted in significant LV dilation and impaired cardiac function after 3 weeks. Although LV dilation, displayed by end-diastolic (EDV) and end-systolic volumes (ESV), and infarct size (IS) were restricted following MI-R compared to MI (respectively by 27.6% for EDV, 39.5% ESV, 36.0% IS), cardiac function was not preserved. LV-wall thinning was limited with non-transmural LV fibrosis in the MI-R group (66.7%). Two days after inducing myocardial ischemia, local leucocyte infiltration in the infarct area was decreased following MI-R compared to MI (36.6%), whereas systemic circulating monocytes were increased in both groups compared to sham (130.0% following MI-R and 120.0% after MI). Both MI-R and MI models against the background of a hypercholesterolemic phenotype appear validated experimental models, however reduced infarct size, restricted LV remodeling as well as a different distributed inflammatory response following MI-R resemble the contemporary clinical outcome regarding primary PCI more accurately which potentially provides better predictive value of experimental therapies in successive clinical trials.

Reappraisal of Recent Clinical Trials of Angiogenic Therapy in Myocardial Ischemia

2005 ◽  
Vol 13 (1) ◽  
pp. 90-97 ◽  
Author(s):  
Carolyn J Teng ◽  
Kevin Lachapelle ◽  
Ray CJ Chiu
Keyword(s):  
Clinical Trials ◽  
Growth Factor ◽  
Myocardial Ischemia ◽  
Therapeutic Response ◽  
Molecular Level ◽  
Angiogenic Therapy ◽  
Or Gene

We review the clinical trials of angiogenic therapy for myocardial ischemia, focusing on why the results are unsatisfactory in more recent larger and better designed trials. Critical reappraisal of such trials, in view of the pathophysiologic complexity of the angiogenic process at a molecular level, suggests that the strategy of therapies based on a single growth factor protein or gene may not be adequate for optimal therapeutic response.

scholarly journals Myocardial Ischemia in the Management of Chronic Coronary Artery Disease

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Raymond J. Gibbons
Keyword(s):  
Coronary Artery Disease ◽  
Clinical Trials ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Medical Therapy ◽  
Randomized Clinical Trials ◽  
Population Decline ◽  
Chronic Coronary Artery Disease ◽  
Exercise Ecg ◽  
Artery Disease

For many years, stress-induced myocardial ischemia has been considered important in the management of chronic coronary artery disease. Early evidence focused on the exercise ECG and the Duke treadmill score. In the 1970s, randomized clinical trials, which compared coronary artery bypass surgery to medical therapy, enrolled patients who were very different from contemporary practice and had inconsistent results. Surgery appeared to be of greatest benefit in high-risk patients defined by anatomy (such as left main disease) or stress-induced ischemia. However, randomized clinical trials of revascularization versus contemporary medical therapy over the past 20 years have been surprisingly negative. Nuclear cardiology substudies from these trials reported inconsistent results. Two observational studies from a single-center provided the best evidence for the use of stress-induced ischemia to identify patients who were most likely to benefit from revascularization. The recently completed ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) was designed to test the hypothesis that revascularization would improve outcomes in patients with moderate-severe ischemia on stress testing. Unfortunately, 14.2% of the randomized patients had either mild or no ischemia on core lab review. Nearly one-quarter of the patients were randomized on the basis of an exercise ECG without imaging. The negative results of the trial reflect the long-term population decline in coronary artery disease and abnormal stress tests, as well as improvements in patient outcome due to optimal medical therapy. Topics requiring further research are presented. The implications of the trial for the use of both stress imaging and coronary computed tomography angiography in clinical practice are examined.

The results of fundamental and translational research carried out In the Department of Biomedical Research and Technology of the SBRAS INC in 2012-2016

2017 ◽  
Author(s):  
Константин Апарцин ◽  
Konstantin Apartsin
Keyword(s):  
Clinical Trials ◽  
Myocardial Ischemia ◽  
Translational Research ◽  
Progenitor Cells ◽  
Biomedical Research ◽  
Target Cells ◽  
Logit Analysis ◽  
Scientific Center ◽  
Surgical Methods

The results of basic and translational research of the Department of Biomedical Research and Technology of Irkutsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences in 2012–2016 The paper presents the results of interdisciplinary research carried out in 2012–2016. The review includes the study of molecular mechanisms of pathogenesis of reparative regeneration, experimental substantiation of methods of diagnosis and prognosis of systemic disturbances of regeneration process, carrying out clinical trials of medicinal products and the formation of observational studies in the field of personalized medicine, the preparation of practical recommendations on the testing of previously developed surgical methods of prevention or correction of postoperative recovery disorders. New data are obtained on the role of the MAP-kinase cascade in the process of regeneration of muscle tissue. It has been established, that with a significant increase of VEGF concentration at the site of the repair of ischemic myocardium, progenitor cells with the CD34+CD45+ phenotype appear, which opens up prospects for the development of biotechnology to restore the damaged myocardium with its own pool of progenitor cells. The new data on the role of growth factors in the post-infarction remodeling are found. It has been revealed, that in local increase of selenium concentration low intensity of mineralization of forming callus in the area of the damage is observed and the formation of bone regeneration slows down. Prospects for the use of nanocomposites of elemental selenium for modulation of reparative response are marked. The dynamics of the level of free circulating mitochondrial DNA (mtDNA) of blood in the early stages of experimental dyslipidemia has been studied. Atherogenic blood factors do not have a significant effect on the release of the mtDNA from dyslipidemia target cells. On the model of acute small-focal myocardial ischemia, we revealed the increase in the mtDNA levels. Prospects of broadcast of diagnostic mtDNA monitoring technology in myocardial ischemia have been marked. The mtDNA monitoring was first tested as a molecular risk pattern in acute coronary syndrome. In survived patients, the concentration of freely circulating mtDNA in blood plasma was 164 times lower. The probability of death of the patient with a high level of mtDNA (over 4000 copies/mL) was 50 % (logit analysis). Methodological level of translational research in the ISC SB RAS has increased due to effective participation in international multi-center clinical trials of drugs, mainly direct anticoagulants: fondaparinux, edoksabana, betriksabana. “Feedback broadcast” of the results of clinical trials of p38-kinase inhibitor, was carried out in the process of changing the model (initially – neuropathic pain) for coronary atherosclerosis. Technologies of pharmacogenetic testing and personalized treatment of diseases in the employees of the Irkutsk Scientific Center were applied. Step T2. Previously developed at the Irkutsk State Medical University and the Irkutsk Scientific Center of Surgery and Traumatologies approaches to surgical prevention and medicinal correction of postoperative hyposplenism were translated into practical health care. Thus, these results obtained in different areas of translational medicine will determine scientific topics of the department in future research cycle.

scholarly journals The effect of milrinone on mortality in adult patients underwent CABG surgery: A systematic review of randomized clinical trials with meta-analysis and trial sequential analysis

2020 ◽  
Author(s):  
Yu-shan Ren ◽  
Lan-fang Li ◽  
Tao Peng ◽  
Yu-jun Tan ◽  
Ying Sun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Myocardial Ischemia ◽  
Standard Care ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Care Group ◽  
Cochrane Central Register ◽  
Standard Care Group ◽  
Cabg Surgery

Abstract Background: As an inodilator, milrinone is commonly used for patients underwent coronary artery bypass graft surgery (CABG) because of its effectiveness in decreasing cardiac index and mitral regurgitation. This study was to perform a systematic meta-analysis of existing studies in the past 20 years to evaluate the impact of milrinone on mortality in patients underwent CABG surgery. Methods: We performed a systematic literature search on the application of milrinone in patients underwent CABG surgery, which published between 1997 and 2017 in BioMed Central, PubMed, EMBASE, and the Cochrane Central Register. The included literatures should be set as milrinone compared to a group receiving either placebo or standard treatment, and further compare to systemic administration. Results: The network meta-analysis included 723 patients from 16 randomized clinical trials. Overall, there was no significant difference in mortality between the milrinone group and the placebo/standard care group when patients underwent CABG surgery. Besides that, 9 trials (with 440 randomized patients), 4 trials (with 212 randomized patients), and 10 trials (with 470 randomized patients) reported that the occurrence of myocardial infarction (MI), myocardial ischemia, and arrhythmias in the milrinone group were decreased comparing with the placebo/standard care group, respectively. Between the milrinone treatment and placebo/standard care groups, the occurrence of myocardial infarction, myocardial ischemia, arrhythmias was all significantly different. However, the occurrence of stroke and renal failure, duration of inotropic support (h), need for intra-aortic balloon pump (IABP), and mechanical ventilation (h) between these two groups showed no differences. Conclusions: Based on the current results, milrinone might be unable to decrease the mortality in adult CABG surgical patients, but can significantly ameliorate the occurrence of MI, myocardial ischemia, and arrhythmias compared with placebo-treated patients. These results provide evidence for further clinical application of milrinone and therapy strategies for CABG surgery. However, along with milrinone application in clinical use, sufficient randomized clinical trials need to be collected, and the potential benefit and adverse effects should be analyzed and reevaluated.

scholarly journals The effect of milrinone on mortality in adult patients: A systematic review of randomized clinical trials with meta-analysis and trial sequential analysis

2019 ◽  
Author(s):  
Yu-shan Ren ◽  
Lan-fang Li ◽  
Tao Peng ◽  
Yu-jun Tan ◽  
Ying Sun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Myocardial Ischemia ◽  
Standard Care ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Care Group ◽  
P Value ◽  
Standard Care Group ◽  
Cabg Surgery

Abstract OBJECTIVE: Milrinone is commonly used for patients performed coronary artery bypass graft surgery (CABG) because of its effectiveness in decreasing cardiac index and mitral regurgitation. This study was to perform a systematic meta-analysis of existing studies in the past 20 years to evaluate the impact of milrinone on mortality in patients undergoing CABG surgery. EASUREMENTS AND MAIN RESULTS: The network meta-analysis included 723 patients from 16 randomized clinical trials. Overall, there was no significantly difference in mortality between the milrinone group and the placebo/standard care group [11/352 (3.13%) vs. 9/346 (2.60%), risk ratio = 1.18 (0.53–2.62), p for effect = 0.69, I 2 = 0 %] when patients underwent CABG surgery. Besides that, 9 trials (with 440 randomized patients), 4 trials (with 212 randomized patients), and 10 trials (with 470 randomized patients) reported that the occurrence of myocardial infarction (MI), myocardial ischemia, and arrhythmias in the milrinone group were decreased in comparsion with the placebo/standard care group, respectively. Between the milrinone treatment and placebo/standard care groups, the occurrence of myocardial infarction was [5/219 (2.28 %) vs. 25/212 (17.79 %), odds ratio(OR) = 0.19 (0.08–0.49), p value = 0.0005, I 2 = 5%], the occurrence of myocardial ischemia was [12/106 (11.32 %) vs. 41/106 (36.68 %), OR = 0.20 (0.10–0.42), p value <0.0001, I 2 = 0 %], and the occurrence of arrhythmias was [16/234 (6.84 %) vs. 31/236 (13.14 %), OR= 0.46 (0.24–0.88), p value = 0.02, I 2 =0 %]. However, the occurrence of stroke and renal failure, duration of inotropic support (h), need for intra-aortic balloon pump (IABP), and mechanical ventilation (h) between these two groups showed no differences. CONCLUSION: Based on the current results, milrinone might be unable to decrease the mortality in adult CABG surgical patients, but can significantly ameliorate the occurrence of MI, myocardial ischemia, and arrhythmias compared with placebo-treated patients. These results provide evidence for further clinical application of milrinone and therapy strategies for CABG surgery. However, along with milrinone application in clinical use, sufficient randomized clinical trials need to be collected, and the potential benefit and adverse effects should be analyzed and reevaluated.

scholarly journals The effect of milrinone on mortality in adult patients who underwent CABG surgery: A systematic review of randomized clinical trials with a meta-analysis and trial sequential analysis

2020 ◽  
Author(s):  
Yu-shan Ren ◽  
Lan-fang Li ◽  
Tao Peng ◽  
Yu-jun Tan ◽  
Ying Sun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Myocardial Ischemia ◽  
Standard Care ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Care Group ◽  
Cochrane Central Register ◽  
Standard Care Group ◽  
Cabg Surgery

Abstract Background: As an inodilator, milrinone is commonly used for patients who undergo coronary artery bypass graft (CABG) surgery because of its effectiveness in decreasing the cardiac index and mitral regurgitation. The aim of this study was to perform a systematic meta-analysis of existing studies from the past 20 years to evaluate the impact of milrinone on mortality in patients who undergo CABG surgery.Methods: We performed a systematic literature search on the application of milrinone in patients who underwent CABG surgery in studies published between 1997 and 2017 in BioMed Central, PubMed, EMBASE, and the Cochrane Central Register. The included studies evaluated milrinone groups compared to groups receiving either placebo or standard treatment and further compared the systemic administration.Results: The network meta-analysis included 723 patients from 16 randomized clinical trials. Overall, there was no significant difference in mortality between the milrinone group and the placebo/standard care group when patients underwent CABG surgery. In addition, 9 trials (with 440 randomized patients), 4 trials (with 212 randomized patients), and 10 trials (with 470 randomized patients) reported that the occurrence of myocardial infarction (MI), myocardial ischemia, and arrhythmia was lower in the milrinone group than in the placebo/standard care group. Between the milrinone treatment and placebo/standard care groups, the occurrence of myocardial infarction, myocardial ischemia, and arrhythmia was significantly different. However, the occurrence of stroke and renal failure, the duration of inotropic support (h), the need for an intra-aortic balloon pump (IABP), and mechanical ventilation (h) between these two groups showed no differences.Conclusions: Based on the current results, compared with placebo, milrinone might be unable to decrease mortality in adult CABG surgical patients but can significantly ameliorate the occurrence of MI, myocardial ischemia, and arrhythmia. These results provide evidence for the further clinical application of milrinone and of therapeutic strategies for CABG surgery. However, along with milrinone application in clinical use, sufficient data from randomized clinical trials need to be collected, and the potential benefits and adverse effects should be analyzed and reevaluated.

Computer-Assisted Continuous ST-Segment Analysis for Clinical Research: Methodological Issues

2001 ◽  
Vol 3 (2) ◽  
pp. 65-77 ◽  
Author(s):  
Shu-Fen Wung
Keyword(s):  
Clinical Trials ◽  
Myocardial Ischemia ◽  
Reperfusion Therapy ◽  
Acute Myocardial Ischemia ◽  
Computer Assisted ◽  
Clinical Settings ◽  
Methodological Issues ◽  
Measurement Issues ◽  
St Segment ◽  
Ecg Data

Continuous ST-segment monitoring has been used to detect acute myocardial ischemia, determine the success of the reperfusion therapy, and predict outcomes in both research and a variety of clinical settings. However, analyzing the abundant electrocardiography (ECG) data recorded using continuous multilead ST-segment monitoring techniques is time consuming and requires expertise. Experienced data interpreters in dedicated ECG core laboratories handle many continuous ECG data records fromlar ge clinical trials. Little information on measurement issues for computer-assisted ST-segment analysis is available for individual investigators. Unsupervised or inexperienced computer analysis of ST-segment deviations can, under certain circumstances, yield invalid or unreliable summary indices. The goal of this article is to discuss basic ST-segment measurement principles in evaluating acute myocardial ischemia and methodological issues surrounding the use of computerassisted ST-segment analysis for continuous ECG data. Variables affecting ST-segment measurements will be examined. Sources and examples of variability for these potential errors will be identified.

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