Interventional Treatment of Advanced Ischemic Heart Disease (eBook)

Interventional Treatment of Advanced Ischemic Heart Disease 2
In Memoriam 5
Preface 7
Contents 10
Contributors 12
The Problems of Advanced Ischemic Heart Disease: Epidemiology, Growth Rate, Burden, and Costs of AIHD 14
Introduction 14
Epidemiology 15
Growth Rate 17
The Burden 20
References 24
Imaging for Viable and Ischemic Myocardium: Value of Assessment of Viable and Ischemic Myocardium and Techniques Such as MRI, Radionuclide Imaging 26
Introduction 26
Historical Perspective and Definitions 26
Physiologic Principles of Myocardial Perfusion Imaging 27
Radionuclide Imaging of Chronic Ischemic Heart Disease 33
Myocardial Viability, Size of Myocardial Scar, LV Function, and Outcomes 35
Essential Conditions for FDG PET Imaging 40
Limitations of FDG Imaging 41
Molecular Imaging 42
References 44
Sudden Cardiac Death in Advanced Ischemic Heart Disease: Epidemiology, Etiology, and Defibrillator Therapy 50
Definition 50
Etiology and Epidemiology 50
Identification of Risk of Sudden Cardiac Death in Ischemic Cardiomyopathy 52
Strategies for Prevention of Sudden Cardiac Death in Ischemic Cardiomyopathy 52
Implantable Cardioverter Defibrillators for Secondary Prevention of Sudden Cardiac Death 53
Evidence for Implantable Cardioverter Defibrillators for Primary Prevention of Sudden Cardiac Death 53
Summary of Evidence and Current Guidelines 56
Prevention of Harm in Patients with Implantable Cardioverter Defibrillators 57
Implementation and Cost of Implantable Cardioverter Defibrillators 58
References 58
Pacemaker Therapy for Advanced Ischemic Heart Disease: Explanation of Cardiac Resynchronization Therapy and Its Role in Treating AIHD 61
Conduction System Disease in Ischemic Heart Disease 61
Anatomy and Physiology of the Normal Conduction System 61
Conduction Disturbances During Acute Myocardial Infarction 62
Sinus Node Dysfunction in Heart Failure 62
Treatment 63
AV Synchrony 64
Treatment 65
Atrial Fibrillation and Heart Failure 65
Treatment 65
Intraventricular Conduction System Disease 66
Clinical Studies of Multisite Pacing 67
Treatment 71
CRT in Other Patient Populations 71
Chapter Summary 74
References 74
The Role of Percutaneous Coronary Revascularization in Advanced Ischemic Heart Disease: Modern Angioplasty and Stent Technology Technique, Application and Efficacy, Comparison to Surgical
Historical Perspective 80
PTCA Versus Medical Therapy with Stable Angina/Unstable Angina 82
Treatment of ST Elevation Myocardial Infarction 85
Drug Eluting Stent Era 87
PCI in Patients with Left Ventricular Dysfunction 91
Conclusion 92
References 92
Percutaneous Mechanical Assist Devices: Currently Available Devices, Their Indications and Usages, Patient Selection and Management 96
Introduction 96
Intra Aortic Balloon Counterpulsation 96
Rationale for Ventricular Support Therapy 97
TandemHeart 97
Current and Future Indications for Percutaneous Support Devices 99
Impella Recovery System 99
Cancion Cardiac Recovery System 100
Percutaneous Long-Term Left Ventricular Support 100
Conclusions 101
References 101
Cellular Implantation Therapy: Current Studies, Different Strategies and Potential Applications 103
Introduction 103
Stem Cell Basics 103
Definition 103
Stem Cell Identification 104
Postnatal Vasculogenesis: Stem Cells and Vascular Repair 105
Stem Cells and Cardiac Repair 105
Atherosclerosis and the Senescent Bone Marrow Hypothesis 106
Stem Cells as Biomarkers 106
Stem Cell Types and Characteristics 107
Adult Bone Marrow-Derived Stem Cells 107
Mesenchymal Stem Cells 108
Endothelial Progenitor Cells 109
Other Bone Marrow Stem Cells 111
Skeletal Myoblasts 112
Embryonic Stem Cells 113
Resident Cardiac Stem Cells 113
Alternative Sources of Stem Cells 115
Stem Cell Delivery Methods 115
Stem Cell Mobilization 116
Transvascular Delivery: Peripheral (Intravenous) Infusion 116
Retrograde Coronary Venous Delivery 116
Intracoronary Infusion 117
Intramyocardial Injection 117
Transepicardial Injection 117
Transendocardial Injection 118
Transcoronary Venous Injection 120
Comparisons of Delivery Methods 121
Clinical Trials of Cardiac Stem Cell Therapy 122
Stem Cell-Induced Functional Improvement in Myocardial Ischemia 127
Evidence from Preclinical Studies 127
Evidence from Clinical Trials 128
Safety of Stem Cell Therapy 131
Conclusions 131
References 131
The Future of Treatment of Advanced Ischemic Heart Disease: New Technologies and Strategies Being Studied and Their Potential Impact on the Disease 139
Prevention or Diagnosis of Ischemic Disease Before Irreversible Remodeling Occurs 140
How Do We Prevent Myocardial Infarction? 140
Revascularize Ischemic Myocardium in Ways that Cannot Currently Be Done 143
Restore Function to Infarcted Myocardium via Replacement of Non-functional Myocardium or the Entire Heart 143
Mechanically Supporting the Failing or Ischemic Heart Without Surgery 144
Better Utilize Existing Technologies to Slow or Prevent the Progression of the Disease 145
Detect and Monitor Established Heart Failure or Ischemia 148
Conclusion 148
References 150
Index 153