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Title: Value of percutaneous myocardial laser revascularisation in treatment of angina pectoris

Abstract:

Due to limitations of current therapeutic options of coronary artery disease there is still a group of patients with so called refractory angina pectoris. Methods of direct myocardial revascularization are under investigation. One of them is percutaneous myocardial laser revascularization (PMLR). Aim of our study was to determine value of percutaneous myocardial laser revascularization in treatment of refractory angina pectoris and to evaluate its effect on left ventricular function and myocardial perfusion. Since November 1999 to July 2003 fifty-eight patients have been referred to Department of Hemodynamics and Angiocardiography with diagnosis of refractory angina. Ultimately, 25 of them have been treated with PMLR. Study group undergone pre- and post procedural assessment with exercise treadmill test, perfusion exercise scintigraphy, dobutamine echocardiography and psychological evaluation. Till December 2003 post procedural testing after 1, 3, 6, 12 and 24 months undergone 24, 23, 22, 20 and 18 patients, respectively. Significant decrease of mean CCS score after 1 month post procedure was observed. In long-term, mean CCS score hasn’t changed significantly with trend toward increase. Mean duration of treadmill test increased significantly after 1 month. In long-term follow-up significant decrease in mean duration of exercise test was observed, but this value was still significantly higher than before procedure. Mean wall motion score index (WMSI) at rest decreased significantly at both early and long-term follow-up. Mean WMSI during low-rate dobutamine infusion decreased significantly at early follow-up. Mean WMSI during high-rate dobutamine infusion decreased significantly at both early and late follow-up. Mean ejection fraction (EF) et rest and during high-rate dobutamine infusion increased significantly at early follow-up while in long-term it was not significantly different from baseline. Significant decrease of number of segments with transient ischemic defect in region of inferior wall after 3 and 6 months was demonstrated. Number of segments with transient ischemic deficit per patient decreased significantly. Improvement of basic mood and personal and professional life attitude was 52 observed. Anxiety level decreased significantly after 6 months. Level of emotional tension decreased significantly at 6 month follow-up and was lower than before PMLR in long-term. Intensity of dyspnea, chest pain, tiredness, somnolence, dizziness, edema and tremor decreased significantly. We concluded, that vast part of patients with initial diagnosis of refractory angina pectoris can be successfully treated by maximal medical therapy or incomplete direct revascularization. PMLR was assumed to be valuable method of refractory angina pectoris treatment, as it causes significant long-term decrease of angina, improves quality of life and exercise tolerance and leads to improvement of selected parameters of left ventricular function. Prospective, randomized, double-blind clinical study with sufficient patients population is needed to finally determine place of PMLR in treatment of refractory angina pectoris.

Level of degree:

2 - studia doktoranckie

Degree discipline:

choroby układu krążenia

Degree grantor:

Wydział Lekarski

Promoter:

Krzysztof Żmudka

Date issued:

2004

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:1300

Call number:

ZB-100459

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Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego - Collegium Medicum

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Last modified:

Feb 10, 2020

In our library since:

Nov 21, 2012

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All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/1300

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ZB-100459 Feb 10, 2020
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