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Objective To explore the therapeutic effect of erythropoietin (EPO)combined oral iron in patients with chronic congestive heart failure( CHF)accompanied by anemia. MethodsNinety six patients with CHF accompanied by anemia, whom were consecutively hospitalized from January 2007 to December 2009, were enrolled into this study. They were randomly divided into treatment group accepted routine anti-heart failure therapy combined EPO and oral iron, and control group solely accepted routine anti-heart failure therapy. After 6 months follow up, the changes of hemoglobin ( Hb ), cardiac function classification, left ventricular ejection fraction(LVEF) ,6-minute walking distance,readmission rate of CHF and cardiac death were compared between two groups. ResultsCompared with those before therapy, we found significant improvements of hemoglobin level ( [ 120. 12 ± 10. 42 ] g/L vs [ 86.40 ± 14. 30 ] g/L, P ＜ 0. 01 ), cardiac function classification ( 2. 65 ± 0. 67 vs 3. 13 ±0. 61, P ＜ 0. 01 ), LVEF ( [ 37.21 ± 4. 96 ]％ vs [ 33. 92 ± 7. 28 ]％, P ＜ 0. 01 ), 6-minute walking distance ( [ 443.52 ± 97. 39 ] mvs [ 379. 15 ± 59. 34 ] m, P ＜ 0. 01 ) in treatment group after EPO combined oral iron administration. After 6 months follow up, we also found significant improvements of Hb level ( [ 120. 12 ±10. 42 ] g/L vs [ 86. 40 ± 14. 30 ] g/L, P ＜ 0. 01 ), cardiac function classification ( 2.65 ± 0. 67 vs 2. 98 ± 0. 81,P＜0.01),LVEF([37.21 ± 4.96]％ vs [34.67 ±4.10]％,P ＜ 0. 01),6-minute walking distance ( [443.52 ±97. 39 ] mvs [ 379. 15 ± 59. 34 ] m, P ＜ 0. 01 ) in the comparison between treatment and control group. The readmission rate of CHF fell significantly in treatment group compared to control (20. 83％ vs 39. 58％ ,P ＜ 0. 05 ). However, we found no significant difference in cardiac death rate ( 0％ vs 4. 17％, P ＞0. 05). ConclusionTreatment of EPO combined oral iron could significantly improve the cardiac function,increase exercise tolerance,lower the readmission rate of CHF in patients with chronic congestive heart failure (CHF)accompanied by anemia.
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Objecfive To study the clinical characteristics of acute inferior myocardial infarction.Methods 100 patients with acute inferior infarction were divided into 2 groups according to coronary angiography:group A (n=76) with right coronary artery occlusion;group B(n=24) with left circumflex artery occlusion.Results The frequencies of Electrocardiogram(ECG) ST segment elevation ST Ⅲ>ST Ⅱ and ST segment depression STAVL>STI in group A was significantly higher than that in group B(P<0.05);The frequency of ECG ST segment elevation STⅢ<STⅡ in group A wag significantly lower than that in group B(P<0.01);The frequency of ECG STV4R elevation >O.1 mV in group A was significantly higher than that in group B(P<0.05);The number of ECG with precor-dial lcads V1～6 ST segment depression >0.1 mv with lesion of left anterior descending coronary was more significant than that without precordial Vl-6 leads ST segment depression (P<0.05).Left ventricular ejection fraction (LVEF)(51%±14%) in group A was significant lower than that in group B(57%±10%)(P<0.05);The patients in group A with right ventricular infarction were more significant than those in group B(P<0.05);The total hospital mortality of patients with acute inferior myocardial infarction was 6%,and they were all in group A.But there was no significance between the two groups about cardiogenic shock,heart failure,Ⅱ degree and Ⅲ degree atrial ventricular b1ock,ventrieular tachycardia/ventrieular fibrillation and the hospital mortality.The mortality with cardiogenic shock was 83.3%.Conclusion The changes of ECG ST segment in Ⅲ,Ⅱ,Ⅰ,AVL and V4R leads can predict relatedinfarct coronary artery with acute inferior myocardial infarction.The patients with precordial Vl～6 leads ST segment depression indicates lesion of LAD.The LVEF of patients with RCA occlusion is lower than that with LCX occlusion. The primary cause of death is eardiogenic shock.
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BACKGROUND: The area of myocardial infarction is the determinative factor of acute myocardial infarction prognosis. Amelioration of blood transportation and replacement therapy can reduce infarction area. Bone marrow mesenchymal stem cells can differentiate into cardiovascular tissue and are easy to obtain. After cultured and expanded in vitro, they can become the ideal cells for cardiovascular replacement therapy.OBJECTIVE: To evaluate the therapeutic effect of intracoronary transplantation of bone marrow mesenchymal stem cells in the treatment of myocardial infarction. DESIGN: Self-control observation taking the patients as subjects.SETTING: Department of Cardiology, Department of Nuclear Medicine,Echocardiogram Room, Nanjing First Hospital Affiliated to Nanjing Medical University.PARTICIPANTS: Totally 20 patients with acute myocardial infarction who received the therapy of bone marrow mesenchymal stem cells transplantation in the Department of Cardiology, Nanjing First Hospital Affiliated to Nanjing Medical University during March 2003 to March 2004 were recurited. Informed consents were obtained from the patients, and the complete postoperative follow up was over 3 months. The patients include 15 male and 5 female, and they were aged (64±10) years.METHODS: All the patients underwent percutaneous coronary intervention (PCI) to treat infarction-related blood vessel. Autologous bone marrow was taken from the patients, then stem cells were extracted to be performed in vitro induction, differentiation and proliferation, and transplanted infarction-related blood vessel through coronary artery at the mean number of (21.7±30.14)× 107 within 2 weeks. Before and 3 months after transplantation of stem cells, patients underwent gated dual-isotopic myocardial perfusion/metabolic imaging (18-fluoro-2-deoxy-glucose, 18F-FDG) examination. Survived and necrotic myocardia were predicted and infarction area was obtained. At the same time, wall motion and heart function index were evaluated with ultrasound cardiography (UCG)examination, and they were re-checked 3 months after operation to evaluate the amelioration of wall motion and heart function index. A 5-point scale was used in the evaluation of gated dual-isotopic myocardial perfusion/metabolic imaging (18F-FDG) examination: point 0: normal, 1: sparse, 2:obviously sparse, 3: defected. Evaluative standard of UCG: point 1: normal,2: reduced, 3: obviously reduced, 4: no ventricular wall motion or paradoxical motion; Wall motion with 2 points or more than 2 points suggests it is improved.MAIN OUTCOME MEASURES: ① Results of gated dual-isotopic myocardial perfusion/ metabolic imaging (18F-FDG-SPECT); ②Infarctionrelated myocardial segment score and heart function index before and after stem cell transplantation of patients in ECG follow-up observation.RESULTS: All the 20 patients participated in the result analysis.Results of gated dual-isotopic myocardial perrusion/metabolic imaging (18F-FDG-SPECT): The myocardial perfusion defect area of 20 patients was significantly reduced after therapy than before therapy [(33±15)%,-(44±18)% ,P ＜ 0.05]; Metabolie defect area was significantly reduced after therapy than before therapy [(33±17)%, (43±21)% ,P ＜ 0.05];Before therapy, there were 199 segments, in which blood flow reperfusion was matched to glycometabolism defect, and they were determined as necrotic myocardium. After therapy, blood flow perfusion metabolism was improved in 79 segments, but blood flow perfusion and glycometabolism were not improved significantly in 120 segments (P ＜ 0.05). Results of UCG: ejection fraction of patients was significantly larger after therapy than before therapy [(53±8)%, (42±7)% ,P ＜ 0.05].CONCLUSION: Intracoronary transplantation of human bone marrow mesenchymal stem cells for treating myocardial infarction is simple to operate. After therapy, the infarction area is obviously reduced, myocardial blood flow perfusion and metabolism of necrotic area improve, myocardial segments without survival determined before operation reduce sigrificantly and the heart function of patients improve.
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<p><b>OBJECTIVE</b>To determine the mid-term effects of cutting balloon angioplasty (CBA) on in-stent restenosis.</p><p><b>METHODS</b>A total of 69 patients with in-stent restenosis were divided into 2 groups randomly: cutting balloon angioplasty and plain old balloon angioplasty. The mechanisms of restenosis and dilation results were determined by quantitative coronary angiography and intravascular ultrasound. Follow-up was performed.</p><p><b>RESULTS</b>The procedural success rate was 100% without death and acute closure. One patient experienced dissection at the distal end of the stent and needed another stent. The mean follow-up period was 6.7 +/- 2.3 months. The final re-restenosis rate was 15% and 18% at 3 months and 6 months respectively, markedly lower than after plain old balloon angioplasty (38% and 43%). Acute gain by intravascular ultrasound (IVUS) was 1.72 +/- 0.52 mm after cutting balloon angioplasty, higher than 1.15 +/- 0.54 mm after plain old balloon angioplasty. The lumen diameter late loss in the cutting balloon group was 0.26 +/- 0.05 mm and 0.38 +/- 0.06 mm at 3 months and 6 months respectively, significantly lower than for those in conventional balloon group (0.78 +/- 0.19 mm and 0.89 +/- 0.16 mm, respectively, P < 0.001). As shown by IVUS, the main mechanism of cutting balloon angioplasty was marked reduction of plaque area without significant increase of vessel area (less vessel trauma).</p><p><b>CONCLUSION</b>Cutting balloon angioplasty is feasible and effective for the treatment of in-stent restenosis with less vessel trauma.</p>
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Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon , Methods , Coronary Angiography , Coronary Restenosis , Therapeutics , Coronary Vessels , Pathology , Follow-Up Studies , Stents , Time Factors , Treatment OutcomeABSTRACT
65 years old) with in-stent restenosis were randomly divided into two groups: cutting balloon(38 cases) and conventional balloon angioplasty(31 cases) group. Quantitative coronary angiography(QCA) and intravascular ultrasound(IVUS) were underwent before and immediately after the balloon inflation. Within 6-months clinical and angiographic follow-up, clinical improvements and QCA results were recorded. himary end points included myocardial infarction, coronary artery bypass graft(CABG) and revascularization. Results The procedural success rate was 100% in both groups. One patient in cutting balloon experienced dissection in the site distal to stent. Average follow-up time was (6.7?0.3) months. The angiographic stenosis rates at the 3- and 6-month in cutting balloon group were markedly lower than that in conventional balloon group(15% and 38% vs 18% and 43%, respectivelly, P
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70% were enrolled into the study. Intravascular ultrasound (IVUS) was used before procedure, immediately after the final inflation of balloon and at the time of 3 month follow up. Cross sectional area(CSA) at the site of lesions, proximal and distal reference segment(vessel CSA,lumen CSA, plaque CSA) and remodeling ration were calculated respectively. Percutaneous cutting balloon angioplasty and intravascular irradiation was adopted to treat restenotic lesions during 3 month follow up period. Results Thirty seven of 76 cases had positive remodeling .There was no difference in the age, gender and other clinical parameters between positive and non positive remodeling(39 cases) groups. The remodeling ration in positive group [( 1.40 ? 0.13 )mm 2] was larger than that in the control group [( 0.79 ? 0.11 )mm 2,P
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36 mm?Hg. No permanent cardiac pacemaker was implanted. Transit trifascicular was seen in 3 cases, of whom, 2 disappeared with 1 hour after the procedure and, 1 trifascicular disappeared with 3 days. Permanent branch blocks were demonstrated in 36% patients. Conclusion PTSMA was feasible for HOCM with controllable complications. Precise position was the key point to prevent the alcohol leakage which will induce large area myocardial infarction and cardiac shock. Further study was needed to appreciate the more long-term follow-up.
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Objective To determine the lesion characteristics and effect of intervention on diseased grafts in older patients. Methods Thirty-eight patients with angina after coronary artery bypass grafts (CABG) were enrolled into Nanjing First Hospital. Interventions were performed after multiple-view angiogram and formal consent from relatives received. Angiographic follow-up was conducted within 6 months. Cardiac events were recorded during the 6-month clinical follow-up. Results Of the 38 patients (36 males and 2 females), the average age was 63.2 years. Angina occurred 11.5 months after CABG. Angipgrams were performed 4.8 years after CABG. Diabetes was complicated in 10 cases and old myocardial infarction in 8, respectively. Left ventricular ejection fraction was increased from 52%?10% to 58%?14% (P
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Objective To determine the effect and feasibility of kissing dilating with cutting balloon and conventional balloon for bifurcated lesions Methods We divided 34 patients with true bifurcated stenosis into cutting ballon group (13 patients) and stenting group (21 patients) Intravascular ultrasound (IVUS) was performed before and immediately after the interventional procedure Several indexes including minimal lumen diameter, external vessel crossectional area, lumen crossectional area, plaque crossectional area, vessel/lumen diameter and %diameter stenosis were calculated, respectively Results In cutting balloon group, more common lesions were found in left anterior descending artery and first diagonal (43 5% vs 28 9%, P