2.50
Hdl Handle:
http://hdl.handle.net/2436/29432
Title:
Angiogenesis in chronically ischaemic human heart following percutaneous myocardial revascularisation.
Authors:
Cotton, James M.; Thomas, M.R.; Dunmore, Simon J.; Salisbury, J.; Shah, Ajay M.; Brindle, N.P.J.
Abstract:
Patients with intractable angina and severe diffuse coronary artery disease not amenable to conventional revascularisation therapy have relatively few treatment options. A number of studies suggest myocardial laser revascularisation is of clinical benefit in such patients.1, 2 Percutaneous myocardial revascularisation (PMR) involves the use of an intravascular catheter, positioned within the left ventricular cavity under fluoroscopic guidance, to deliver controlled bursts of holmium:YAG laser energy. PMR results in the formation of small channels (~1.75 mm diameter) that extend from the endocardial surface partly into the myocardial wall. Many uncontrolled studies suggest that PMR provides symptomatic relief, although the first randomised controlled trial demonstrated no benefit over a sham procedure.3 It has been suggested that PMR induces angiogenesis, although many other mechanisms of action have been suggested. To determine whether PMR has any effects on angiogenesis in the human ischaemic myocardium we have undertaken a detailed histological and immunohistochemical examination of the hearts of two patients who died eight weeks and 52 weeks after apparently symptomatically successful PMR therapy. In this first detailed study of human myocardium subjected to percutaneous myocardial laser revascularisation, we report evidence of sustained myocardial neovascularisation in treated areas and of the presence of vascular endothelial growth factor (VEGF). Unexpectedly, most of the neovessels are abnormal and immature, lacking a smooth muscle coat. Furthermore, neovessels are largely confined to scar tissue. Both the above factors are likely to limit the extent to which angiogenesis following PMR could improve perfusion. In a broader context, our findings that, once formed, immature and abnormal neovessels are sustained long term in human myocardium, may be relevant to the general design of strategies for therapeutic angiogenesis in patients—for example, the direct application of angiogenic factors (or genes).
Citation:
Heart, 87(3): 281-283
Publisher:
BMJ Journals
Journal:
Heart
Issue Date:
2002
URI:
http://hdl.handle.net/2436/29432
PubMed ID:
11847177
Additional Links:
http://heart.bmj.com/cgi/content/full/87/3/281
Type:
Article
Language:
en
ISSN:
1468-201X
Appears in Collections:
Centre for Health and Social Care Improvement

Full metadata record

DC FieldValue Language
dc.contributor.authorCotton, James M.-
dc.contributor.authorThomas, M.R.-
dc.contributor.authorDunmore, Simon J.-
dc.contributor.authorSalisbury, J.-
dc.contributor.authorShah, Ajay M.-
dc.contributor.authorBrindle, N.P.J.-
dc.date.accessioned2008-06-04T08:46:53Z-
dc.date.available2008-06-04T08:46:53Z-
dc.date.issued2002-
dc.identifier.citationHeart, 87(3): 281-283en
dc.identifier.issn1468-201X-
dc.identifier.pmid11847177-
dc.identifier.urihttp://hdl.handle.net/2436/29432-
dc.description.abstractPatients with intractable angina and severe diffuse coronary artery disease not amenable to conventional revascularisation therapy have relatively few treatment options. A number of studies suggest myocardial laser revascularisation is of clinical benefit in such patients.1, 2 Percutaneous myocardial revascularisation (PMR) involves the use of an intravascular catheter, positioned within the left ventricular cavity under fluoroscopic guidance, to deliver controlled bursts of holmium:YAG laser energy. PMR results in the formation of small channels (~1.75 mm diameter) that extend from the endocardial surface partly into the myocardial wall. Many uncontrolled studies suggest that PMR provides symptomatic relief, although the first randomised controlled trial demonstrated no benefit over a sham procedure.3 It has been suggested that PMR induces angiogenesis, although many other mechanisms of action have been suggested. To determine whether PMR has any effects on angiogenesis in the human ischaemic myocardium we have undertaken a detailed histological and immunohistochemical examination of the hearts of two patients who died eight weeks and 52 weeks after apparently symptomatically successful PMR therapy. In this first detailed study of human myocardium subjected to percutaneous myocardial laser revascularisation, we report evidence of sustained myocardial neovascularisation in treated areas and of the presence of vascular endothelial growth factor (VEGF). Unexpectedly, most of the neovessels are abnormal and immature, lacking a smooth muscle coat. Furthermore, neovessels are largely confined to scar tissue. Both the above factors are likely to limit the extent to which angiogenesis following PMR could improve perfusion. In a broader context, our findings that, once formed, immature and abnormal neovessels are sustained long term in human myocardium, may be relevant to the general design of strategies for therapeutic angiogenesis in patients—for example, the direct application of angiogenic factors (or genes).en
dc.language.isoenen
dc.publisherBMJ Journalsen
dc.relation.urlhttp://heart.bmj.com/cgi/content/full/87/3/281en
dc.subjectAngiogenesisen
dc.subjectPercutaneous Myocardial Revascularisationen
dc.subjectVascular Endothelial Growth Factorsen
dc.subject.meshActinsen
dc.subject.meshChronic Diseaseen
dc.subject.meshCoronary Vesselsen
dc.subject.meshEndothelial Growth Factorsen
dc.subject.meshHeart Catheterizationen
dc.subject.meshHumansen
dc.subject.meshImmunohistochemistryen
dc.subject.meshLymphokinesen
dc.subject.meshMicrocirculationen
dc.subject.meshMuscle, Smooth, Vascularen
dc.subject.meshMyocardial Ischemiaen
dc.subject.meshMyocardial Revascularizationen
dc.subject.meshVascular Endothelial Growth Factor Aen
dc.subject.meshVascular Endothelial Growth Factorsen
dc.titleAngiogenesis in chronically ischaemic human heart following percutaneous myocardial revascularisation.en
dc.typeArticleen
dc.identifier.journalHearten

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