Concomitant treatment with oral L-arginine improves the efficacy of surgical angiogenesis in patients with severe diffuse coronary artery disease: The.

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Concomitant treatment with oral L-arginine improves the efficacy of surgical angiogenesis in patients with severe diffuse coronary artery disease: The Endothelial Modulation in Angiogenic Therapy randomized controlled trial Marc Ruel, MD, MPH, Robert S. Beanlands, MD, Mireille Lortie, PhD, Vincent Chan, MD, Nancy Camack, RN, Robert A. deKemp, PhD, Erik J. Suuronen, PhD, Fraser D. Rubens, MD, Jean N. DaSilva, PhD, Frank W. Sellke, MD, Duncan J. Stewart, MD, Thierry G. Mesana, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 4, Pages 762-770.e1 (April 2008) DOI: 10.1016/j.jtcvs.2007.09.073 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Myocardial flow reserve in a remote, noninjected myocardial territory (mid-inferior wall) and in the injected myocardial territory (the anterior wall) on 13N-ammonia PET at baseline and 3-month follow-up. Treatment groups are denoted as P (either or both placebos), V (VEGF), A (L-arginine), and C (combination of VEGF + L-arginine). There was no difference in flow reserve in the noninjected (mid-inferior) myocardial territory at any time point between groups (top); however, there was increased flow reserve at 3 months' follow-up in the injected (anterior) myocardium of patients who received VEGF + L-arginine (middle). This was observed on flow reserve at follow-up and by a trend toward a significantly greater difference from baseline flow reserve. The increase in anterior myocardial flow reserve in the VEGF + L-arginine combination group from baseline to follow-up was also seen when this group was compared with all other groups (bottom). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 762-770.e1DOI: (10.1016/j.jtcvs.2007.09.073) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Three-dimensional left ventricular representation of stress perfusion at 3 months' follow-up in a patient who received VEGF along the proximal and mid-LAD arteries + daily placebo oral supplementation for 3 months (left) versus a patient who received VEGF + daily L-arginine oral supplementation for 3 months (right). VEGF, Vascular endothelial growth factor; Ant, anterior wall; Inf, inferior wall; Sep, septum. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 762-770.e1DOI: (10.1016/j.jtcvs.2007.09.073) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Changes in rest and stress defect size between baseline and 3 months' follow-up, as measured by 13N-ammonia PET. The defects decreased in size in the VEGF + L-arginine combination group (C), whereas the reverse was observed in groups who received either or both placebos (P). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 762-770.e1DOI: (10.1016/j.jtcvs.2007.09.073) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions