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Journal of Cardiothoracic Surgery
Published in: Journal of Cardiothoracic Surgery 1/2017

Open Access 01-12-2017 | Review

Clinical outcomes meta-analysis: measuring subendocardial perfusion and efficacy of transmyocardial laser revascularization with nuclear imaging

Authors: Jessika Iwanski, Shannon M. Knapp, Ryan Avery, Isabel Oliva, Raymond K. Wong, Raymond B. Runyan, Zain Khalpey

Published in: Journal of Cardiothoracic Surgery | Issue 1/2017

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Abstract

Introduction

Randomized and nonrandomized clinical trials have tried to assess whether or not TMR patients experience an increase in myocardial perfusion. However there have been inconsistencies reported in the literature due to the use of different nuclear imaging modalities to test this metric. The primary purpose of this meta-analysis was to determine whether SPECT, MUGA and PET scans demonstrate changes in myocardial perfusion between lased and non-lased subjects and whether laser type affects myocardial perfusion. The secondary purpose was to examine the overall effect of laser therapy on clinical outcomes including survival, hospital re-admission and angina reduction.

Methods

Sixteen studies were included in the primary endpoint analysis after excluding all other non-imaging TMR papers. Standardized mean difference was used as the effect size for all quantitative outcomes and log odds ratio was used as the effect size for all binary outcomes.

Results

Statistically significant improvements in myocardial perfusion were observed between control and treatment groups in myocardial perfusion at 6-month follow up using PET imaging with a porcine model. However non-significant differences were observed in patients at 3 and 12 months using SPECT, PET or MUGA scans. Both CO2 and Ho:YAG laser systems demonstrated an increase in myocardial perfusion however this effect was not statistically significant. In addition both laser types displayed statistically significant decreases in patient angina at 3, 6 and 12 months but non-significant increases in survival rates and decreases in hospital re-admissions.

Conclusion

In order to properly assess myocardial perfusion in TMR subjects, subendocardial perfusion needs to be analyzed via nuclear imaging. PET scans can provide this level of sensitivity and should be utilized in future studies to monitor and detect perfusion changes in lased and non-lased subjects.
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Metadata
Title
Clinical outcomes meta-analysis: measuring subendocardial perfusion and efficacy of transmyocardial laser revascularization with nuclear imaging
Authors
Jessika Iwanski
Shannon M. Knapp
Ryan Avery
Isabel Oliva
Raymond K. Wong
Raymond B. Runyan
Zain Khalpey
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2017
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/s13019-017-0602-8

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