Einfluss der direkten myokardialen Revaskularisation mittels Laser auf die globale und regionale linksventrikuläre Funktion : Ergebnisse einer randomisierten, doppelblinden und placebokontrollierten Multicenterstudie
Background: Direct myocardial revascularization (DMR) has been developed as a novel approach in the therapy of patients with refractory anginal symptoms not amenable to conventional treatment of end-stage ischemic heart disease. Methods: DMR applies catheter-based laser systems inserted into the left ventricular chamber to create small channels in the ischemic myocardium. This study investigated the impact of DMR on the global and regional left ventricular performance as a subanalysis of a randomized, double-blinded, placebo-controlled multicenter trial (EURODIRECT). Six month follow-up was completed for 29 “no-option” patients receiving either DMR (n=14) or placebo-treatment (n=15).Results: Evaluation of the contrast ventriculograms acquired prior to and six month after DMR- or placebo-treatment showed a marginal decrease of the global left ventricular function expressed by the ejection fraction in both groups. Regional left ventricular function measured with the centerline method was slightly enhanced in the DMR- and placebo-group with the exception of a minor functional decrease in the cardiac regions supplied by the left anterior descending artery in DMR-treated patients. However, the differences found between the DMR and placebo-treatment group were not statistically significant. Conclusions: DMR-treatment failed to demonstrate a beneficial impact on the global and regional left ventricular function compared with placebo-treatment. Our findings support the results of other relevant studies that a placebo-effect might be responsible for the positive effects of DMR-treatment reported in the past. It is to be noted that the small number of patients included in our studies limits the statistical power of our findings.
info:eu-repo/classification/ddc/610, Koronare Herzkrankheit, Angina pectoris, Medizin, Myokardiale Laserrevaskularisation, Coronary heart disease, Myocardial laser revascularization
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