Coronary Artery Disease

Photomed Laser Surg. 2014 Oct;32(10):582-587.

Effects of Intravascular Low-Level Laser Therapy During Coronary Intervention on Selected Growth Factors Levels.

Derkacz A1, Protasiewicz M, Rola P, Podgorska K, Szymczyszyn A, Gutherc R, Por?ba R, Doroszko A.

Author information

  • 11 Department of Internal Medicine and Hypertension, Wroclaw Medical University , Wroclaw, Poland .

Abstract

Abstract Objective: The objective of this study was to evaluate the effect of intravascular low-level laser therapy (LLLT) on selected growth factor levels in subjects undergoing percutaneous coronary interventions (PCI).

Background data: Restenosis remains the main problem with the long-term efficacy of PCI, and growth factors are postulated to play a crucial role in the restenosis cascade.

Materials and methods: In a randomized prospective study, an 808 nm LLLT (100 mW/cm2, continuous wave laser, 9 J/cm2, illuminated area 1.6-2.5 cm2) was delivered intracoronarily to patients during PCI. Fifty-two patients underwent irradiation with laser light, and 49 constituted the control group. In all individuals, serum levels of insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF), transforming growth factor-β1 (TGF-β1), and fibroblast growth factor-2 (FGF-2) were measured before angioplasty, then 6 and 12 h and 1 month after the procedure. In all patients, a control angiography was performed 6 months later.

Results: There were no significant differences in IGF-1 and VEGF levels between the groups. While evaluating FGF-2, we observed its significantly lower levels in the irradiated patients during each examination. There was a significant increase in TGF-β1 level in control group after 12 h of observation. In the irradiated individuals, control angiography revealed smaller late lumen loss and smaller late lumen loss index as compared with the control group. The restenosis rate was 15.0% in the treated group, and 32.4% in the control group, respectively.

Conclusions: LLLT decreases levels of TGF-β1 and FGF-2 in patients undergoing coronary intervention, which may explain smaller neointima formation.

 
Lasers Med Sci.  2012 Jun 26. [Epub ahead of print]

Effect of the intravascular low energy laser illumination during percutaneous coronary intervention on the inflammatory process in vascular wall.

Derkacz A, Protasiewicz M, Porba R, Doroszko A, Andrzejak R.

Source

Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland, arkadiusz.derkacz@am.wroc.pl

Abstract

The angioplasty procedure is associated with a release of numerous factors triggering the local inflammatory reaction in vascular wall and leading thus to the restenosis. In this study, we hypothesize that the low-energy laser irradiation may exert beneficial effect by limiting this process. A group of 101 subjects (75 men and 26 women, mean age: 59.1±10.3) treated with percutaneous coronary intervention (PCI), were recruited to this study. While 52 patients (40 men and 12 women) were subjected to the intravascular low-energy laser irradiation (808 nm) of dilated lesion during the PCI, the remaining patients (35 men and 14 women) constituted the control group. The levels of interleukin 1, 6 and 10 (IL 1, IL 6 and IL 10) were measured immediately before the procedure, and then at the 6th, 12th hour as well as after 1 month following the PCI. Significantly lower levels of IL 1 and IL 6 in the irradiated group during each analysis after the procedure were observed. Moreover, significantly lower IL 10 level in irradiated group within 6 and 12 hours after PCI was observed. Irradiation of the lesion with low-energy laser radiation during the PCI procedure results in a decrease in the levels of pro-inflammatory IL 1 and IL 6 as well as in an increase in the levels of anti-inflammatory IL 10, which may result in decreased risk for restenosis.

Klin Med (Mosk). 2008;86(6):44-7.

Laser Doppler fluometry in assessment of endothelium state in patients with coronary heart disease and its correction by intravenous laser irradiation of blood.

[Article in Russian]

Burduli NM, Gazdanova AA.

Influence of laser therapy on vascular endothelium function in patients with stable angina pectoris, detected by the method of laser Doppler fluorimetry, was studied. 77patients with stable angina pectoris were divided into 2 groups. In control group only medicamentous therapy was used, in main group a course of intravenous blood laser irradiation was carried out additionally. The increase of initially decreased mean index of microcirculation and index of microcirculation after acetylcholine iontophoresis was noticed. Tendency to increase of endothelial oscillations and capillary blood flow under influence of intravenous blood laser irradiation was noticed too. Laser therapy can be considered an effective method of increase of endothelial functional activity in patients with stable angina pectoris.

Kardiol Pol. 2007 Jan;65(1):13-21; discussion 22-3.

Laser biostimulation in end-stage multivessel coronary artery disease – a preliminary observational study.

[Article in English, Polish]

Zyciski P, Krzemiska-Pakuna M, Peszynski-Drews C, Kierus A, Trzos E, Rechci?ski T, Figiel L, Kurpesa M, Plewka M, Chrzanowski L, Drozdz J.

II Katedra i Klinika Kardiologii Uniwersytetu Medycznego, ul. Kniaziewicza 1/5, Lódz.

BACKGROUND: Low-energy laser radiation through its direct influence on tissue repair processes without heating effect may have vital importance in the therapy of patients with advanced coronary artery disease (CAD). AIM: The introductory assessment of the effects of laser biostimulation applied to patients with advanced multivessel CAD.

METHODS: 39 patients with advanced CAD were assigned (mean age 64.8+/-9.6, male gender 64%, CCS class 2.5+/-0.5, EF=46+/-11%, 69% with a history of acute myocardial infarction), to undergo two sessions of irradiation of low-energy laser light on skin in the chest area from helium-neon B1 lasers. The time of irradiation was 15 minutes while operations were performed 6 days a week for one month. Before including the patients in the experimental group a full clinical evaluation, basic biochemical tests, ECG, 24h Holter recordings, 6-minute walk test, treadmill test using Bruce protocol and full echocardiographic examination were performed. After the first and second period of laser therapy with a one-month break between them analogical parameters with the initial examination were measured.

RESULTS: No side effects associated with the laser biostimulation or performed clinical tests were noted. Lower CCS class (2.5+/-0.5 –> 2.2+/-0.4 –> 2.0+/-0.4, p<0.001), higher exercise capacity (5.1+/-2.2 –> 5.8+/-2.2 –> 6.6+/-2.5 [METS], p=0.023), longer exercise time (257+/-126 –> 286+/-127 –> 325+/-156 [s], p=0.06), less frequent angina symptoms during the treadmill test (65% –> 44% –> 38%, p=0.02), longer distance of 6-minute walk test (341+/-93 –> 405+/-113 –> 450+/-109 [m], p <0.001), lower systolic blood pressure values (SP 130+/-14 –> 125+/-12 –> 124+/-14 [mmHg], p=0.05) and trend towards less frequent 1 mm ST depression lasting 1 min during Holter recordings were noted.

CONCLUSIONS: An improvement of functional capacity and less frequent angina symptoms during exercise tests without a significant change in the left ventricular function were observed. Laser biostimulation in short-term observation was a very safe method. These encouraging results should be confirmed in a larger, placebo-controlled study.

Coron Artery Dis. 2006 May;17(4):385-90.

Long-term results following percutaneous myocardial laser therapy.

Salem M, Rotevatn S, Nordrehaug JE.

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

OBJECTIVES: The usefulness and safety of percutaneous myocardial laser therapy in selected patients have been identified in previous 1-year randomized trial reports, including that from a double-blind, sham-controlled trial we independently conducted. We aimed to determine whether the 1-year effects are maintained through a long-term, longitudinal follow-up.

METHODS: Patients (n=77) with chronic, stable, medically refractory angina (class III or IV) not amenable to conventional revascularization and with evidence of reversible ischemia, ejection fraction > or =25%, and myocardial wall thickness > or =8 mm were treated with percutaneous myocardial laser. After the 1-year follow-up and disclosure of all randomized assignments as prespecified in the respective study protocol, patients were followed up longitudinally for a mean of 3 years for angina class, left ventricular ejection fraction, medication usage, and adverse events.

RESULTS: No procedural mortality, myocardial infarction, or cerebral embolism occurred. Pericardiocentesis was required in two patients (2.6%). Cardiac event-free survival was 88% at 1 year and 66% at late follow-up. Mean Canadian Cardiovascular Society angina class was significantly improved from baseline (3.2+/-0.4) at 1 year (2.2+/-1.1, P<0.001) and at a mean of 3 years (1.9+/-1.2, P<0.001). Nitrate usage was significantly reduced at late follow-up; however, ejection fraction did not change over time. In a multivariate analysis, angina improvement at 1 year was found to be a significant independent predictor of both survival and angina improvement at late follow-up.

CONCLUSION: We conclude that percutaneous myocardial laser therapy in selected patients with severe, medically refractory angina not treatable with conventional revascularization induces significant and sustained symptomatic benefit.

Klin Med (Mosk). 2002;80(4):31-3.  

Diagnostic implications of changed red blood cell count in low-intensity laser radiation of blood in elderly patients with coronary heart disease

[Article in Russian]

Simonenko VB, Siuch NI, Vokuev IA.

Intravenous laser therapy in combination with medication was conducted in 41 elderly patients with coronary heart disease (633 nm, 1 mW, 124 mW/cm2). The study of qualitative and quantitative (osmotic resistance) erythrocyte indices of blood demonstrated the change of erythrocyte number in circulating blood by the third laser procedure. Frequency of these changes correlated with duration of the treatment course. Intravenous laser therapy had a wider spectrum of effects on erythrocyte number than medication. Changes in erythrocyte number in the peripheral blood upon intravenous laser radiation reflects efficiency of treatment of coronary heart disease patients.

J Clin Laser Med Surg. 2001 Oct;19(5):261-5.  

 

Optimal dosing of intravascular low-power red laser light as an adjunct to coronary stent implantation: insights from a porcine coronary stent model.

De Scheerder IK, Wang K, Zhou XR, Szilard M, Verbeken E, Ping QB, Yanming H, Jianhua H, Nikolaychik V, Moses JW, Kipshidze N, Van de Werf F.
University Hospitals, Leuven, Belgium.

BACKGROUND: It is believed that restenosis following coronary interventions is the result of endothelial denudation that leads to thrombus formation, vascular remodeling, and smooth muscle cell proliferation. Low-power red laser light (LPRLL) irradiation enhances endothelial cell growth in vitro and in vivo, and reduces restenosis in animal models. The present study investigated the optimal dose of intravascular LPRLL therapy in the prevention of in-stent stenosis in a porcine coronary stent model. METHODS AND RESULTS: Selected right coronary artery segments were pretreated with a LPRLL balloon, delivering a dose of 0 mW during 1 min (group 1, n = 10), 50 mW during 1 min (group II, n = 10), or 100 mW during 1 min (group III, n = 10) before stenting. Quantitative coronary analysis of the stented vessel was performed before stenting, immediately after stenting, and at 6 weeks follow-up. The pigs were sacrificed, and histologic and morphometric analyses were conducted. At 6 weeks, minimal luminal stent diameter was significantly narrower in the control group compared to the 50-mW dose group (p < 0.05). These results were confirmed by morphometric analysis. Neointimal area was also significantly decreased in the 50-mW dose group. CONCLUSIONS: Intravascular LPRLL contributes to reduction of angiographic in-stent restenosis and neointimal hyperplasia in this animal model. The optimal dose using the LPRLL balloon system seems to be approximately 5 mW delivered during 1 min.

J Invasive Cardiol. 1998 Nov;10(9):534-538.  

 

Intravascular Red Light Therapy after Coronary Stenting N Angiographic and Clinical Follow-up Study in Humans.

Kaul U, Singh B, Sudan D, Ghose T, Kipshidze N.
Director, Interventional Cardiology, Batra Hospital and Medical Research Centre 1, Tughlakabad Institutional Area, Mehrauli Badarpur Road, New Delhi-110 062, India.

In animal models of coronary restenosis, intravascular red light therapy (IRLT) using a diode laser source has been shown to reduce neointimal hyperplasia following balloon-induced injury and coronary stenting. We studied the safety and efficacy of catheter-based IRLT for preventing restenosis after coronary stenting in 22 patients with angina pectoris. IRLT was performed using a diode laser (650 nm) at an energy level of 10 megawatts delivered through a rapid exchange balloon system containing the fiberoptics. The procedure was successful in all patients, with no procedural or in-hospital complications. Two patients with recurrence of symptoms had angiography at 3 and 4.1 months respectively. Angiographic follow-up was also done after 6 months in the 20 remaining asymptomatic patients. The mean minimal lumen diameter (MLD) for the whole group at 6 months follow-up was 2.57 +/- 0.62 mm. The calculated late lumen loss was 0.49 +/- 1.12 mm with a late loss index of 0.21 +/- 0.54. Four patients (2 symptomatic and 2 asymptomatic) in the series developed angiographic restenosis. Clinical events at follow-up of 10.9 +/- 3.5 months were repeat angioplasty in 2 patients for symptomatic restenosis with a 91% event free survival. These preliminary results demonstrate that IRLT after coronary artery stenting is safe and feasible; it is associated with low rates of angiographic indices of restenosis

 

Vopr Kurortol Fizioter Lech Fiz Kult. 1997 Sep-Oct;(5):9-11.  

The dynamics of the clinico-functional indices in patients with ischemic heart disease under the influence of repeated courses of laser therapy

[Article in Russian]

Vasil’ev AP, Strel’tsova NN.

Repeated courses of laser therapy given to patients with ischemic heart disease, angina of effort class I-IV for 2 years brought about stabilization of coronary insufficiency and improvement of clinical and functional conditions. Microcirculatory picture of the bulbar conjunctiva, coronary reserve improved. The treatment had also a hypotensive effect.

INFLUENCE OF INTRAVENOUS BLOOD IRRADIATION WITH HE-NE LASER ON THE ANTIANGINAL EFFECT OF NITROGLYCERIN IN PATIENTS WITH STABLE EFFORT ANGINA PECTORIS

A.I. Koryakov, N.N. Koryakova, A.I. Iofin

Sverdlovsk Regional Clinical Psychoneurological Hospital of the Disabled Soldiers, Yekaterinburg, Russia

We reported about the significant antianginal effect of intravenous He-Ne laser irradiation of blood (ILIB) in patients with serious stable effort angina functional classes 3-4. The goal of this work was to investigate an action of ILIB on an increase of the tolerance to exercise after the sublingual taking nitroglycerin in dose 0.5 mg in patients with stenocardia. We observed 27 men with stable effort angina functional classes II-IV. All patients were subjected two conjugate loading tests on veloergometer with nitroglycerin both before and after of the seven-day treatment. The antianginal effect of nitroglycerin was calculated as the magnitude of the increase maximum workload after taking nitroglycerin in comparison with the initial level of the maximum exercise power. Patients were divided randomly into main and control groups (17 and 10 men accordingly). Patients from the master group were subjected to six seances of ILIB. Power at the light-guide end was 1-2 mW, the accumulated dose was 21.6±0.8 J. The control group received the course of 6 invasive 45-minute placebo procedures that outwardly were like seances of ILIB. Both the intravascular laser treatment and its imitation were performed with three-wave laser therapy device “Adept”. In all patients invasive procedures were combined with antianginal medication treatment that was abolished 1 -2 days before loading tests. Although after the treatment the increase of antianginal effect of nitroglycerin was not statistically significant in both groups, nevertheless after ILIB the rise of nitroglycerin’s effect was more by 63 per cent as compared with placebo (p> 0.9). Thus, ILIB not only increases tolerance to exercise in patients with severe stable effort angina, but also it is not decreases the antianginal effect of nitroglycerin.

Vopr Kurortol Fizioter Lech Fiz Kult. 2002 Jul-Aug;(4):9-11.  

Use of infrared laser therapy in patients with ischemic heart disease associated with diabetes mellitus type 2 in health resort

[Article in Russian]

Zin’kovskaia TM, Zavrazhnykh LA, Golubev AD.

Infrared laser therapy (300 Hz) combined with balneotherapy and patients’ education is more effective than standard sanatorium rehabilitation in patients with ischemic heart disease associated with diabetes mellitus type 2. 81.8% patients showed good response manifesting in less frequent anginal attacks, episodes of pain and painless ischemia and lower doses of antianginal drugs. Systolic and diastolic arterial pressure lowered by 18 and 10 mm Hg on the average, respectively. Multimodality rehabilitation of IHD patients with type 2 diabetes mellitus improves hemostasis, carbohydrate and lipid metabolism. Coronary circulation response lasted for 24 weeks.

Sov Med. 1990;(3):12-5.  

Changes in central hemodynamics and microcirculation during laser therapy in patients with coronary insufficiency

[Article in Russian]

Gel’fgat EB, Samedov RI, Kurbanova ZN, Gadzhiev GG.

The study was undertaken to examine 45 patients with Stages IIB-III heart failure (HF) by the classification developed by V. Kh. Vasilenko and N. D. Strazhesko. Thirty patients had laser therapy in addition to the routine treatment, 15 patients served as a control group. The combined drug treatment along with laser therapy in patients substantially improved peripheral circulatory parameters than in the controls. There was a positive dynamics of central hemodynamic parameters as shown by lower left ventricular volumes and higher myocardial contractile and pump functions. Improvement of microcirculatory and central hemodynamic parameters in patients treated with laser occurred in earlier periods of hospital stay than in the controls.

Vopr Kurortol Fizioter Lech Fiz Kult. 1996 Mar-Apr;(2):3-5. \

The laser therapy in patients with hypertension in combination with coronary insufficiency

[Article in Russian]

Kniazeva TA, Badtieva VA, Zubkova SM.

Hypertensive patients with coronary insufficiency have received infrared (lambda = 0.85 microns) laser radiation to the skin. The treatment is shown to have antianginal, antihypertensive effects, to improve cardiac performance, myocardial contractility, to increase myocardial, coronary and aerobic reserves. This clinicofunctional efficacy is accompanied by positive shifts in lipid metabolism, lipid peroxidation activity, antioxidant defense, hemocoagulation and microcirculation.

INFLUENCE OF LOW DOSE LASER THERAPY ON ENDOTHELIAL FUNCTION IN PATIENTS WITH CAD

S. Belousov, E. Galperin, E. Smetova

The purpose of this study was the evaluation of arterial relaxation ability in 15 patients with CAD before and after the course of infrared laser therapy. 18 controls (healthy men). With high-resolution ultrasound and impulse wave doppler we measured the increasing of volumic velocity flow (%) of the arteria poplitea at rest and during reactive hiperaemia (with increased flow causing endothelium-dependent dilatation). In controls flow-mediated mean dilatation was normal. Endothelial dysfunction is present in majority of patients with CAD, flow-mediated dilatation was much reduced of absent. Course of infrared laser therapy was benefit to restore endothelial function in patients with CAD.

THE EFFECTIVENESS AND INFLUENCE ON RHEOLOGICAL BLOOD FEATURES AND ENDOTHELIAN VESSELS FUNCTION OF INFRARED LASER THERAPY IN PATIENTS WITH ANGINA PECTORIS

T.M. Zenkovskaya, O.A. Matronchick, F.A. Khairullina, A.D. Kats

Hospital of War Invalids, Perm State Medical Academy, Russia

One can observe the impairment of endothelian vessels function (EVF) and rheological blood features (RhBF) in patients with various forms of ischemic heart disease. The task of this investigation is the study of infrared laser therapy (IRLT) influence to RhBF, EVF; the dependence of treatment effectiveness from above stated functions. 58 patients with stable angina pectoris III and IV functional class where under supervision. IRLT was performed by means of USOR and ASOR-2K apparatus with rate 300 Hz, the procedure lasted 10 minutes and it was given 10 times. To evaluate treatment effectiveness and its dependence on RhBF we have studied erythrocyte aggregation (EA), we have counted erythrocyte aggregation coefficient (EAC), the erythrocyte flowing (HF), it was marked by the index of flowing (IHF), spontaneous thrombocytcs aggregation (SThA) before and after IRLT and capillary fragility test (CFT). Before IRLT EAC was 0.78±0.04, after it was 0.89±0.06 (p<0.05), standard – 1.0. Before IRLT 1EF was 80,44±0.96%, after it was 90.47±0.91% (p<0.05). SThA was higher standard in the majority of patients before therapy. It decreased after the therapy. After CFT SThA reduced in patients given IRLT (25.81±1.50%, 20.39±0.91% and 17.51±0.11%). The lowering of SThA did not occur in patients treated only with medical preparations. The IRLT was effective in 91.7%. The effect of therapy was higher in patients with reliable lowering of EA, SThA, increased IEF. Therefore the IRLT is highly effective method of angina pectoris treatment and improves rheological properties of blood and endothelium vessels function.