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Cleveland Clinic Journal of Medicine Feb 2007SCS is an efficacious, reversible, and safe therapy that improves quality of life, increases exercise tolerance, and relieves angina pectoris, but clinical trials in... (Review)
Review
SCS is an efficacious, reversible, and safe therapy that improves quality of life, increases exercise tolerance, and relieves angina pectoris, but clinical trials in North America are needed to confirm the data coming from Europe. Neuronal convergence onto STT cells underlies the referred pain associated with angina pectoris. With pain referred to the chest and upper arm, cardiac nociceptive information is transmitted via sympathetic afferent fibers to thoracic cells. With pain referred to the jaw and neck, cardiac nociceptive information is transmitted via vagal afferent fibers onto cervical cells. SCS can modulate the responses of thoracic STT cells to nociceptive input originating from the heart. SCS modulates cardiac function. It stabilizes neurons in the intrinsic cardiac nervous system, and can reduce infarct size via adrenoreceptors.
Topics: Angina Pectoris; Electric Stimulation Therapy; Heart Diseases; Humans; Spinal Cord
PubMed: 17455540
DOI: 10.3949/ccjm.74.suppl_1.s30 -
Clinical Cardiology Nov 1989
Topics: Angina Pectoris; Angina, Unstable; Humans
PubMed: 2582653
DOI: 10.1002/clc.4960121102 -
Acta Medica Portuguesa Apr 1997One of the most difficult problems related to coronary artery disease is the detection and eventual treatment of silent myocardial ischemia (SMI). After defining the... (Review)
Review
One of the most difficult problems related to coronary artery disease is the detection and eventual treatment of silent myocardial ischemia (SMI). After defining the concept of SMI and total ischemia burden, the author approaches the pathophysiology of myocardial ischemia and focuses on the ischemic cascade. Concerning the detection of SMI the importance of exercise testing and Holter ECG is stressed. Following the classification of SMI proposed by P. F. Cohn, the author analyzes SMI type III with particular interest. He refers the prevalence of SMI in patients suffering from chronic stable angina, and focuses on the prognostic importance of SMI. Afterwards, the problem of treatment and prognostic implications is approached. The paper ends with mention of the results of the most important clinical trials in this field: CASIS, CAPE, TIBBS, ASIST, ACIP, TIBET.
Topics: Angina Pectoris; Cardiovascular Agents; Clinical Trials as Topic; Humans; Myocardial Ischemia; Prevalence; Prognosis
PubMed: 9341023
DOI: No ID Found -
Clinical Cardiology Jun 2023The use of spinal cord stimulation (SCS) in patients with refractory angina pectoris (RAP) is still under debate. Studies up to date have shown a positive effect with an... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The use of spinal cord stimulation (SCS) in patients with refractory angina pectoris (RAP) is still under debate. Studies up to date have shown a positive effect with an improvement in quality of life. However, no double blinded randomized controlled trials have been performed.
HYPOTHESIS & METHODS
The objective of this trial is to investigate if high density SCS leads to a significant reduction in the amount of myocardial ischemia in patients with RAP. Eligible patients must meet the criteria for RAP, have proven ischemia and a positive transcutaneous electrical nerve stimulator treadmill test. Patients who meet the inclusion criteria will receive an implanted spinal cord stimulator. Patients receive 6 months of high density SCS and 6 months of no stimulation using a cross-over design. The order of the treatment options is determined using randomization. The primary endpoint is the effect of SCS measured by the change in percentage of myocardial ischemia using myocardial perfusion positron emission tomography scan. Key secondary endpoints are patient related outcome measures, major cardiac adverse events and safety endpoints. The follow-up period is 1 year for the primary and key secondary endpoints.
RESULTS
The SCRAP trial began enrollment on December 21, 2021 and is set to complete the primary assessments in June 2025. To date, January 2, 2023, 18 patients have been enrolled in the study and 3 patients have completed the 1-year follow-up.
CONCLUSIONS
The SCRAP trial is an investigator-initiated, single-center, double-blind, placebo-controlled, and cross-over randomized controlled trial investigating the efficacy of SCS in patients with RAP. (ClinicalTrials. gov Identifier: NCT04915157).
Topics: Humans; Angina Pectoris; Coronary Artery Disease; Heart; Quality of Life; Randomized Controlled Trials as Topic; Spinal Cord Stimulation; Treatment Outcome
PubMed: 37013654
DOI: 10.1002/clc.24016 -
Heart (British Cardiac Society) Feb 2004
Review
Topics: Angina Pectoris; Chronic Disease; Coronary Artery Disease; Coronary Stenosis; Exercise; Humans; Quality of Life; Vagus Nerve Diseases
PubMed: 14729809
DOI: 10.1136/hrt.2003.025031 -
Heart (British Cardiac Society) Oct 2019Around 40% of all patients undergoing angiography are found to have normal coronary arteries or non-obstructive coronary artery disease (NOCAD). Despite the high... (Review)
Review
Around 40% of all patients undergoing angiography are found to have normal coronary arteries or non-obstructive coronary artery disease (NOCAD). Despite the high prevalence, this is a group who rarely receive a definitive diagnosis, are frequently labelled and managed inappropriately and by and large, continue to remain symptomatic. Half of this group will have coronary microvascular dysfunction (CMD), associated with a higher rate of major adverse cardiovascular events; identifying CMD represents a therapeutic target of unmet need. As the pressure wire has revolutionised our ability to interrogate epicardial coronary disease during the time of angiography, measuring flow can similarly classify NOCAD during a single procedure. Assessment of flow is a function that is already integral to some pressure wires and furthermore, the familiarity and usage of the combined Doppler and pressure wire is rapidly increasing-these are techniques that readily lend themselves to the skillset of a practising interventional cardiologist. We present a structured algorithm designed for cardiologists who frequently encounter NOCAD in the catheter laboratory, identifying specific disease phenotypes within this heterogeneous population with linked therapy. This review paper clearly explains the rationale for this algorithm and outlines its applicability to routine clinical practice and also, the importance of phenotyping for future research. Ultimately, personalised therapy could improve outcomes for both patients and healthcare providers; while these approaches in turn will need robust evaluation to ensure that they improve both clinical outcomes and health economic benefits, this proposal will provide a framework for future trials and evaluations.
Topics: Algorithms; Angina Pectoris; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Humans; Microvessels
PubMed: 31366574
DOI: 10.1136/heartjnl-2019-315042 -
Circulation Research Mar 2016The effect of stem/progenitor cells on myocardial perfusion and clinical outcomes in patients with refractory angina remains unclear because studies published to date... (Meta-Analysis)
Meta-Analysis Review
RATIONALE
The effect of stem/progenitor cells on myocardial perfusion and clinical outcomes in patients with refractory angina remains unclear because studies published to date have been small phase I-II trials.
OBJECTIVE
We performed a meta-analysis of randomized controlled trials to evaluate the effect of cell-based therapy in patients with refractory angina who were ineligible for coronary revascularization.
METHODS AND RESULTS
Several data sources were searched from inception to September 2015, which yielded 6 studies. The outcomes pooled were indices of angina (anginal episodes, Canadian Cardiovascular Society angina class, exercise tolerance, and antianginal medications), myocardial perfusion, and clinical end points. We combined the reported clinical outcomes (myocardial infarction, cardiac-related hospitalization, and mortality) into a composite end point (major adverse cardiac events). Mean difference (MD), standardized mean differences, or odds ratio were calculated to assess relevant outcomes. Our analysis shows an improvement in anginal episodes (MD, -7.81; 95% confidence interval [CI], -15.22 to -0.41), use of antianginal medications (standardized MD, -0.59; 95% CI, -1.03 to -0.14), Canadian Cardiovascular Society class (MD, -0.58; 95% CI, -1.00 to -0.16), exercise tolerance (standardized MD, 0.331; 95% CI, 0.08 to 0.55), and myocardial perfusion (standardized MD, -0.49; 95% CI, -0.76 to -0.21) and a decreased risk of major adverse cardiac events (odds ratio, 0.49; 95% CI, 0.25 to 0.98) and arrhythmias (odds ratio, 0.25; 95% CI, 0.06 to 0.98) in cell-treated patients when compared with patients on maximal medical therapy.
CONCLUSIONS
The present meta-analysis indicates that cell-based therapies are not only safe but also lead to an improvement in indices of angina, relevant clinical outcomes, and myocardial perfusion in patients with refractory angina. These encouraging results suggest that larger, phase III randomized controlled trials are in order to conclusively determine the effect of stem/progenitor cells in refractory angina.
Topics: Angina Pectoris; Cardiovascular Agents; Cell- and Tissue-Based Therapy; Exercise Tolerance; Humans; Percutaneous Coronary Intervention; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 26838794
DOI: 10.1161/CIRCRESAHA.115.308056 -
Current Cardiology Reports Oct 2022This review will outline the current evidence on the anatomical, functional, and physiological tools that may be applied in the evaluation of patients with late... (Review)
Review
PURPOSE OF REVIEW
This review will outline the current evidence on the anatomical, functional, and physiological tools that may be applied in the evaluation of patients with late recurrent angina after coronary artery bypass grafting (CABG). Furthermore, we discuss management strategies and propose an algorithm to guide decision-making for this complex patient population.
RECENT FINDINGS
Patients with prior CABG often present with late recurrent angina as a result of bypass graft failure and progression of native coronary artery disease (CAD). These patients are generally older, have a higher prevalence of comorbidities, and more complex atherosclerotic lesion morphology compared to CABG-naïve patients. In addition, guideline recommendations are based on studies in which post-CABG patients have been largely excluded. Several invasive and non-invasive diagnostic tools are currently available to assess graft patency, the hemodynamic significance of native CAD progression, left ventricular function, and myocardial viability. Such tools, in particular the latest generation coronary computed tomography angiography, are part of a systematic diagnostic work-up to guide optimal repeat revascularization strategy in patients presenting with late recurrent angina after CABG.
Topics: Angina Pectoris; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease; Humans; Reoperation; Treatment Outcome
PubMed: 35925511
DOI: 10.1007/s11886-022-01746-w -
Cardiovascular Therapeutics Dec 2011The optimal treatment of coronary artery disease (CAD) involves reducing the ischemic burden, lowering the risk of future adverse cardiac events, and relieving symptoms... (Review)
Review
The optimal treatment of coronary artery disease (CAD) involves reducing the ischemic burden, lowering the risk of future adverse cardiac events, and relieving symptoms of angina pectoris. Medical and mechanical therapies have played a major role in reducing the morbidity and mortality associated with ischemic heart disease. Despite the success of these conventional therapies, there are patients with CAD who continue to experience angina despite maximal medical and revascularization therapy. Therapeutic angiogenesis represents a novel treatment option for these "no-option" patients with refractory ischemic coronary disease. A growing body of evidence has demonstrated the therapeutic potential of therapeutic angiogenesis with gene, protein, or cell-based therapies. The goal of therapeutic angiogenesis is to induce the formation of new vessels that can enhance blood flow to areas that no longer have adequate blood supply. While the existing data are not definitive, there is reason to be optimistic, as several studies have suggested a clinical benefit. This review focuses on the current state of therapeutic angiogenesis in the management of the "no-option" patient with refractory angina.
Topics: Angina Pectoris; Angiogenesis Inducing Agents; Animals; Coronary Artery Disease; Genetic Therapy; Humans; Neovascularization, Physiologic; Stem Cell Transplantation; Treatment Outcome
PubMed: 20406245
DOI: 10.1111/j.1755-5922.2010.00153.x -
Journal of the American College of... Feb 1991
Topics: Adenosine; Angina Pectoris; Coronary Angiography; Coronary Circulation; Coronary Vessels; Humans; Syndrome; Vascular Resistance; Vasoconstriction
PubMed: 1991909
DOI: 10.1016/s0735-1097(10)80122-6