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O114 Dose—effect relationship of magnetically-labelled mesenchymal stem cells in swines with acute myocardial infarction: MRI assessment
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Oral Sessions / International Journal of Cardiology 125 Suppl. 1 (2008) S39–S50
to identify those which significantly predicted the effect of DMP on hospital readmission and mortality. Results: 28 RCTs (N = 5667) were identified. During a pooled mean observation period of 8.5 (range, 3−18) months, DMPs significantly reduced all-cause (RR = 0.82; 95% CI 0.72−0.94; I222 = 75.07, p < 0.001) and cardiac-cause (RR = 0.56; 95% CI 0.44−0.73; I210 = 26.84, p = 0.003) hospital readmissions when compared with usual care. There was also a trend towards lower all-cause mortality (RR = 0.89; 95% CI 0.78−1.01; I223 = 34.24, p = 0.062). Subgroup analysis indicated that the DMP team structure (multi-disciplinary team, cardiac nurseled, or with active participation of a cardiologist), care components (in-hospital care to optimize patients’ condition, drug titration, or psychosocial care), and follow-up method (home visit and telephonic approach, or multiple approach) were associated with a lower relative risk for readmission and/or mortality. Univariate metaregression indicated that multi-disciplinary and cardiac nurse-led were significantly associated with the relative risk of hospital readmission and mortality. Drug titration was also significantly associated with mortality. Multivariable meta-regression confirmed the findings and indicated that DMPs run by a multi-disciplinary team (b = −0.47, SE = 0.14, p = 0.001) or led by a cardiac nurse specialist (b = −0.38, SE = 0.13, p = 0.003) was associated with a 32−37% reduction in risk of hospital readmission whereas DMPs run by a multi-disciplinary team (b = −0.42, SE = 0.20, p = 0.001) or a cardiac nurse (b = −0.47, SE = 0.16, p = 0.005), and incorporating drug titration (b = −0.44, SE = 0.15, p = 0.003) was associated with a 55−57% reduction in mortality risk. Conclusion: Comprehensive DMPs reduce heart failure hospital readmission and mortality. The most effective DMPs for heart failure are those that involve a multi-disciplinary team or cardiac nurse and incorporate drug titration. O113 The primary study on the effect of carvedilol on children with endocardial fibroelastosis Q.J. Yi, R. Li, Y.R. Qian. Department of Cardiovascular Medicine, Children’s Hospital, Chongqing Medical University, Chongqing 400014, China Objective: Endocardial fibroelastosis (EFE), a common pediatric cardiovascular disease, often results in chronic heart failure (CHF) and death. Traditional therapy (digoxin, prednisone, diuretics, and so on) seems to be effective in relieving symptoms of CHF of patients with EFE, but it cannot inhibit adrenergic activation, one of primary contributors to progressive left ventricular systolic dysfunction. Clinical trials have shown that the regimen of combining b-adrenoreceptor blocker with traditional medicines against CHF can improve left ventricular function and prevent ventricle from remodeling in patients with CHF. The authors aimed to observe the effect of carvedilol on concentration of plasma brain natriuretic peptide (BNP), and security on children with EFE in this study. Methods: 21 children with EFE were randomly divided into two groups: (1) treated with traditional medicine (digoxin, prednisone and/or diuretics) (n = 10); (2) treated with carvedilol plus traditional medicines (n = 11). Measurement of plasma concentration of BNP by ELISA, cardiac function by ultrasound were performed before and after 6 months of treatment. Observing the improvement of clinical symptom, heart rate, heart function, side effect and maximal tolerance dose after treatment with carvedilol. Results: Plasma concentration of BNP is much higher in group of patients with EFE (865±702 pg/ml) than that of control group (154±78 pg/ml) (P < 0.01), and there is positive correlation between plasma concentration of BNP and cardiac function classification, and cardiac function II, III, IV corresponding to plasma concentration of BNP (286±125 pg/ml, 437±386 pg/ml, 1673±859 pg/ml respectively) in children with EFE. Compared with the group treated with traditional medicines, plasma concentration of BNP (403±216 pg/ml vs 219±87 pg/ml) significantly decreased, the clinical symptom was obviously improved, cardio-thoracic ratio (CTR) (0.60±0.05 vs 0.54±0.06) (P < 0.05) and heart rate
(115±20 bpm vs 90±14 bpm, P < 0.01) decreased, ejection fraction (EF) (46.6±13.4% vs 54.5±12.9%), fractional shortening (FS) (21.6±8.1% vs 24.1±7.5%), mean velocity of circumferential fiber shortening (mVCFS) (0.8±0.5 cir/s vs 0.9±0.4 cir/s) were significantly increased (P < 0.01), left ventricular end-systolic dimension (LVESD) (34.0±8.6 mm vs 32.2±9.1 mm, P < 0.05), left ventricular mass (Lvmass) (65.9±34.1 g vs 65.9±34.1 g), interventricular septal thickness at end-systole (IVSTs) (6.0±1.0 mm vs 5.5±1.1 mm) were notably decreased (P < 0.01) after treatment with carvedilol. Conclusion: The data indicated that plasma concentration of BNP significantly increased in children with EFE, carvedilol can decrease plasma concentration of BNP, inhibit the remodeling of ventricle, significantly improve the cardiac function in children with EFE. So carvedilol is benefit and security on children with EFE. O114 Dose–effect relationship of magnetically-labelled mesenchymal stem cells in swines with acute myocardial infarction: MRI assessment Z.Y. Huang *, J.B. Ge, Y.Z. Zou, A.J. Sun, S.H. Zhang, J.Y. Qian. Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China Objectives of the study: There is a paucity of information correlating the number of transplanted stem cells after myocardial infarction (MI) with the beneficial effect on infracted heart. Therefore, we assessed the dose–effect relationship of transplanted magnetically-labelled mesenchymal stem cells (MSC) in swines with acute MI using magnetic resonance imaging (MRI). Methods: After 24-hour incubation with nanometer small superparamagnetic iron oxides (SPIO) and poly-l-lysine (PLL), autologous MSC were transextracardially implanted into the freshly infarcted myocardium approximately 1 hour following the ligation of left anterior descending coronary artery in 15 swines. Swines were randomized into 3 groups according to the number of MSC: low dose group (n = 5), 5×106 ; medium dose group (n = 5), 1×106 ; high dose group (n = 5), 2×107 . Another 5 swines received PBS only as control group. The dynamic monitoring of transplanted cells and ventricular function were performed by 1.5-T clinical MRI at 24 hours, 1, 3 and 6 months post infarction. Results: The improvement of left ventricular ejection fraction (LVEF) was obviously related to the number of transplanted MSC 3 months after transplantation [0.12% in control group, 1.78% in low dose group, 3.72% in medium dose group (P < 0.05, compared with control), 6.68% in high dose group (P < 0.01, compared with control), respectively], as well as 6 months after transplantation [−1.08% in control group, 1.82% in low dose group (P < 0.05, compared with control), 4.72% in medium dose group (P < 0.01, compared with control), 9.16% in high dose group (P < 0.01, compared with control), respectively]. SPIO-labelled MSC presenting low signal intensity spots with the scanning T∗2 WI-Flash2d sequence. The duration of discernible spots and the migration extent of the spots were related to the dose of injected cells. Conclusions: Locally injected MSC in infracted myocardium can improve ventricular function in a dose-dependent manner. O115 Left ventricular systolic dyssynchrony is common in heart failure patients with narrow QRS complexes: a real-time three-dimensional echocardiography study C.Y. Ma, Q. Zhang *, Y.S. Chan, J.W.H. Fung, G.W.K. Yip, F. Fang, C.M. Li, J.M. Xie, Y.J. Liang, C.M. Yu. Division of Cardiology, Department of Medicine and Therapeutics, Institute of Vascular Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Background: Real-time 3-dimensional echocardiography (RT3DE) has been suggested feasible to assess left ventricular (LV) systolic dyssynchrony in one cardiac cycle. This study investigated the
Oral Sessions / International Journal of Cardiology 125 Suppl. 1 (2008) S39–S50
to identify those which significantly predicted the effect of DMP on hospital readmission and mortality. Results: 28 RCTs (N = 5667) were identified. During a pooled mean observation period of 8.5 (range, 3−18) months, DMPs significantly reduced all-cause (RR = 0.82; 95% CI 0.72−0.94; I222 = 75.07, p < 0.001) and cardiac-cause (RR = 0.56; 95% CI 0.44−0.73; I210 = 26.84, p = 0.003) hospital readmissions when compared with usual care. There was also a trend towards lower all-cause mortality (RR = 0.89; 95% CI 0.78−1.01; I223 = 34.24, p = 0.062). Subgroup analysis indicated that the DMP team structure (multi-disciplinary team, cardiac nurseled, or with active participation of a cardiologist), care components (in-hospital care to optimize patients’ condition, drug titration, or psychosocial care), and follow-up method (home visit and telephonic approach, or multiple approach) were associated with a lower relative risk for readmission and/or mortality. Univariate metaregression indicated that multi-disciplinary and cardiac nurse-led were significantly associated with the relative risk of hospital readmission and mortality. Drug titration was also significantly associated with mortality. Multivariable meta-regression confirmed the findings and indicated that DMPs run by a multi-disciplinary team (b = −0.47, SE = 0.14, p = 0.001) or led by a cardiac nurse specialist (b = −0.38, SE = 0.13, p = 0.003) was associated with a 32−37% reduction in risk of hospital readmission whereas DMPs run by a multi-disciplinary team (b = −0.42, SE = 0.20, p = 0.001) or a cardiac nurse (b = −0.47, SE = 0.16, p = 0.005), and incorporating drug titration (b = −0.44, SE = 0.15, p = 0.003) was associated with a 55−57% reduction in mortality risk. Conclusion: Comprehensive DMPs reduce heart failure hospital readmission and mortality. The most effective DMPs for heart failure are those that involve a multi-disciplinary team or cardiac nurse and incorporate drug titration. O113 The primary study on the effect of carvedilol on children with endocardial fibroelastosis Q.J. Yi, R. Li, Y.R. Qian. Department of Cardiovascular Medicine, Children’s Hospital, Chongqing Medical University, Chongqing 400014, China Objective: Endocardial fibroelastosis (EFE), a common pediatric cardiovascular disease, often results in chronic heart failure (CHF) and death. Traditional therapy (digoxin, prednisone, diuretics, and so on) seems to be effective in relieving symptoms of CHF of patients with EFE, but it cannot inhibit adrenergic activation, one of primary contributors to progressive left ventricular systolic dysfunction. Clinical trials have shown that the regimen of combining b-adrenoreceptor blocker with traditional medicines against CHF can improve left ventricular function and prevent ventricle from remodeling in patients with CHF. The authors aimed to observe the effect of carvedilol on concentration of plasma brain natriuretic peptide (BNP), and security on children with EFE in this study. Methods: 21 children with EFE were randomly divided into two groups: (1) treated with traditional medicine (digoxin, prednisone and/or diuretics) (n = 10); (2) treated with carvedilol plus traditional medicines (n = 11). Measurement of plasma concentration of BNP by ELISA, cardiac function by ultrasound were performed before and after 6 months of treatment. Observing the improvement of clinical symptom, heart rate, heart function, side effect and maximal tolerance dose after treatment with carvedilol. Results: Plasma concentration of BNP is much higher in group of patients with EFE (865±702 pg/ml) than that of control group (154±78 pg/ml) (P < 0.01), and there is positive correlation between plasma concentration of BNP and cardiac function classification, and cardiac function II, III, IV corresponding to plasma concentration of BNP (286±125 pg/ml, 437±386 pg/ml, 1673±859 pg/ml respectively) in children with EFE. Compared with the group treated with traditional medicines, plasma concentration of BNP (403±216 pg/ml vs 219±87 pg/ml) significantly decreased, the clinical symptom was obviously improved, cardio-thoracic ratio (CTR) (0.60±0.05 vs 0.54±0.06) (P < 0.05) and heart rate
(115±20 bpm vs 90±14 bpm, P < 0.01) decreased, ejection fraction (EF) (46.6±13.4% vs 54.5±12.9%), fractional shortening (FS) (21.6±8.1% vs 24.1±7.5%), mean velocity of circumferential fiber shortening (mVCFS) (0.8±0.5 cir/s vs 0.9±0.4 cir/s) were significantly increased (P < 0.01), left ventricular end-systolic dimension (LVESD) (34.0±8.6 mm vs 32.2±9.1 mm, P < 0.05), left ventricular mass (Lvmass) (65.9±34.1 g vs 65.9±34.1 g), interventricular septal thickness at end-systole (IVSTs) (6.0±1.0 mm vs 5.5±1.1 mm) were notably decreased (P < 0.01) after treatment with carvedilol. Conclusion: The data indicated that plasma concentration of BNP significantly increased in children with EFE, carvedilol can decrease plasma concentration of BNP, inhibit the remodeling of ventricle, significantly improve the cardiac function in children with EFE. So carvedilol is benefit and security on children with EFE. O114 Dose–effect relationship of magnetically-labelled mesenchymal stem cells in swines with acute myocardial infarction: MRI assessment Z.Y. Huang *, J.B. Ge, Y.Z. Zou, A.J. Sun, S.H. Zhang, J.Y. Qian. Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China Objectives of the study: There is a paucity of information correlating the number of transplanted stem cells after myocardial infarction (MI) with the beneficial effect on infracted heart. Therefore, we assessed the dose–effect relationship of transplanted magnetically-labelled mesenchymal stem cells (MSC) in swines with acute MI using magnetic resonance imaging (MRI). Methods: After 24-hour incubation with nanometer small superparamagnetic iron oxides (SPIO) and poly-l-lysine (PLL), autologous MSC were transextracardially implanted into the freshly infarcted myocardium approximately 1 hour following the ligation of left anterior descending coronary artery in 15 swines. Swines were randomized into 3 groups according to the number of MSC: low dose group (n = 5), 5×106 ; medium dose group (n = 5), 1×106 ; high dose group (n = 5), 2×107 . Another 5 swines received PBS only as control group. The dynamic monitoring of transplanted cells and ventricular function were performed by 1.5-T clinical MRI at 24 hours, 1, 3 and 6 months post infarction. Results: The improvement of left ventricular ejection fraction (LVEF) was obviously related to the number of transplanted MSC 3 months after transplantation [0.12% in control group, 1.78% in low dose group, 3.72% in medium dose group (P < 0.05, compared with control), 6.68% in high dose group (P < 0.01, compared with control), respectively], as well as 6 months after transplantation [−1.08% in control group, 1.82% in low dose group (P < 0.05, compared with control), 4.72% in medium dose group (P < 0.01, compared with control), 9.16% in high dose group (P < 0.01, compared with control), respectively]. SPIO-labelled MSC presenting low signal intensity spots with the scanning T∗2 WI-Flash2d sequence. The duration of discernible spots and the migration extent of the spots were related to the dose of injected cells. Conclusions: Locally injected MSC in infracted myocardium can improve ventricular function in a dose-dependent manner. O115 Left ventricular systolic dyssynchrony is common in heart failure patients with narrow QRS complexes: a real-time three-dimensional echocardiography study C.Y. Ma, Q. Zhang *, Y.S. Chan, J.W.H. Fung, G.W.K. Yip, F. Fang, C.M. Li, J.M. Xie, Y.J. Liang, C.M. Yu. Division of Cardiology, Department of Medicine and Therapeutics, Institute of Vascular Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Background: Real-time 3-dimensional echocardiography (RT3DE) has been suggested feasible to assess left ventricular (LV) systolic dyssynchrony in one cardiac cycle. This study investigated the