Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russia.
Lasers Med Sci. 2020 Jul;35(5):1111-1117. doi: 10.1007/s10103-019-02925-y. Epub 2019 Dec 4.
To evaluate the long-term results of TMLR using a CO laser in combination with intramyocardial injection of ABMSC as an isolated procedure in patients with the end-stage coronary artery disease, the study included 20 patients (90% male), with a mean age of 58.4 ± 8.7 years. To assess the long-term results, patients were examined in a hospital. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Seattle Angina Questionnaire (SAQ) were used. The evolution of laboratory and instrumental indices, as well as medical therapy, was assessed. The end points of the study were death, acute myocardial infarction (AMI), repeated myocardial revascularization, recurrent hospitalizations due to coronary artery disease, and stroke. The changes in angina functional class were also evaluated. The median of follow-up period was 54 (36; 83) months, that is, 4.5 years. The analysis of the evolution of echocardiographic data showed the absence of statistically significant changes in the following parameters: left ventricular end-diastolic diameter (EDD) (p = 0.967), end-systolic diameter (ESD) (p = 0.204), end-diastolic volume (EDV) (p = 0.852), end-systolic volume (ESV) (p = 0.125), and left ventricular ejection fraction (LVEF) (p = 0.120). The patients continued to regularly take the main groups of medications. Nitrate consumption was significantly reduced (p < 0.001). Significant positive dynamics were observed in the changes in angina functional class. At the baseline, all patients had angina III FC, in the long term, 3 patients had II FC, 11 patients had I FC, and 6 patients had no angina. Clinical outcomes (mortality, recurrent myocardial infarction, stroke) were absent during the follow-up period. There were two cases of repeated myocardial revascularization. Regression analysis revealed that SYNTAX score was associated with the clinical outcome "repeated revascularization." TMLR in combination with intramyocardial injection of ABMSC is a safe method to achieve a statistically significant antianginal effect and reduce the need for "nitrates," which in turn improves the quality of life and reduces the frequency of hospitalizations due to coronary artery disease. These results can be achieved with strict adherence to the certain indications for the intervention.
为了评估在终末期冠心病患者中使用 CO 激光联合心肌内注射 ABMSC 作为单一治疗方法的 TMLR 的长期疗效，该研究纳入了 20 名患者（90%为男性），平均年龄为 58.4±8.7 岁。为了评估长期疗效，患者在医院接受了检查。采用明尼苏达州心力衰竭生活质量问卷（MLHFQ）和西雅图心绞痛问卷（SAQ）进行评估。评估了实验室和仪器指标的演变以及药物治疗情况。研究的终点为死亡、急性心肌梗死（AMI）、再次血运重建、因冠心病再次住院和中风。还评估了心绞痛功能分级的变化。中位随访时间为 54（36；83）个月，即 4.5 年。超声心动图数据演变分析显示，以下参数无统计学显著变化：左心室舒张末期直径（EDD）（p=0.967）、收缩末期直径（ESD）（p=0.204）、舒张末期容积（EDV）（p=0.852）、收缩末期容积（ESV）（p=0.125）和左心室射血分数（LVEF）（p=0.120）。患者继续定期服用主要药物。硝酸酯类药物的消耗量显著减少（p＜0.001）。心绞痛功能分级的变化呈显著正性趋势。基线时，所有患者均有 III FC 级心绞痛，长期随访时，3 例患者为 II FC 级，11 例患者为 I FC 级，6 例患者无心绞痛。随访期间无临床结局（死亡、再次心肌梗死、中风）。有 2 例再次血运重建。回归分析显示，SYNTAX 评分与“再次血运重建”的临床结局相关。TMLR 联合心肌内注射 ABMSC 是一种安全的方法，可实现统计学上显著的抗心绞痛效果，并减少“硝酸酯类”的需求，从而提高生活质量，减少因冠心病再次住院的频率。这些结果可以通过严格遵守介入的某些适应证来实现。
