Safety and efficacy of transradial percutaneous coronary intervention for unprotected left main coronary artery lesions with 6 French guiding catheter / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the safety, medium-term and long-term efficacy of transradial percutaneous coronary intervention for unprotected left main coronary artery lesions with 6 French guiding catheter.</p><p><b>METHODS</b>Sixty-one patients with unprotected left main coronary artery lesions were treated by 6 French transradial percutaneous coronary intervention between January 2008 and December 2009. The mean age of patients was (66.03 ±10.02)years (44-87). Among 61 cases, 40 had hypertension and 14 had diabetes mellitus; 22 had a history of smoking. The average left ventricle ejection fraction was (62.96 ±12.15)% (range: 28-86) and the average plasma creatinine level was (82.92 ±18.30)μmol/L (range: 44-130). The major adverse cardiac events (MACE) after the procedure were evaluated.</p><p><b>RESULTS</b>Procedural success was achieved in all cases. A total of 67 stents were implanted. No in-hospital death occurred. Mean clinical follow-up period was (26.25 ±5.92) months (range: 19-44 months). MACE developed in 6 cases (9.8%) during the follow-up period, including 2 death (3.3%) and 4 case of target lesion revascularization (6.6%). Compared with low-risk group (SYNTAX score<33), MACE was increased in the high-risk group (SYNTAX score>32).</p><p><b>CONCLUSION</b>6 French transradial percutaneous coronary intervention for patients with unprotected left main coronary artery lesions is safe and feasible procedure with desirable medium-and long-term outcomes.</p>

Effects of proton pump inhibitors on in-stent restenosis in patients receiving clopidogrel: a retrospective analysis / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To determine the effect of proton pump inhibitor (PPI) on in-stent restenosis (ISR) in patients receiving clopidogrel therapy.</p><p><b>METHODS</b>Total 439 patients underwent percutaneous coronary intervention (PCI) were enrolled in the study,including 250 post-PCI patients discharged on clopidogrel alone and 189 patients discharged on clopidogrel with PPI. The in-stent restenosis (ISR) ratio of the patients in these two groups were observed.</p><p><b>RESULTS</b>During a mean follow-up period of (13 ± 5.9) months, the post-PCI patients discharged on concomitant clopidogrel-PPI therapy had higher risk of ISR than those discharged on clopidogrel alone (19.6% Compared with 8%, P<0.001).</p><p><b>CONCLUSION</b>Concomitant use of clopidogrel and PPI after hospital discharge would increase the risk of ISR for post-PCI patients.</p>

Treatment of coronary bifurcation lesions with 6F-guiding catheter by transradial approach / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the feasibility and safety in treatment of coronary bifurcation lesions with 6F-guiding catheter by transradial approach.</p><p><b>METHODS</b>Clinical data of 1258 patients who were treated with 6F-guiding catheter by transradial approach from Oct. 2003 to Feb. 2007 were reviewed. The most common approach in the treatment of bifurcations was one-stent technique on the main branch; if the side branch was large enough and the lesion was involved in the ostium and proximal part of side branch, two-stent technique was used.</p><p><b>RESULT</b>Of 295 bifurcation lesions, 204 were originally planed to be treated by one stent; but finally 2 side branches were provisional stented due to dissection in this group. Ninety-one cases were planed to use double-stent technique: 73 with crushing stent (46 step crushing, 24 modified balloon crushing, 3 reverse crushing), 5 with T-stent, 3 with Cullote-stent, 5 with modified V-stent, 5 with step kissing stent. There was no acute myocardial infarction or death occurred but 1 case was complicated with cardiac tamponade secondary from coronary perforation.</p><p><b>CONCLUSION</b>The treatment of coronary bifurcation lesions with 6F-guiding catheter by transradial approach is a feasible and safe procedure.</p>

The effect of chelerythrine on the hypertrophy of cardiac myocytes of neonatal rats induced by different glucose levels and its mechanism / 药学学报

The purpose of this study is to investigate the effect of chelerythrine on the hypertrophy of cardiomyocytes of neonatal rats induced by different glucose levels and its mechanism. Using cultured neonatal ventricular myocytes as a model, groups were divided as: control (5 mmol x L(-1)); high glucose level (10, 15, 20, and 25.5 mmol x L(-1)); high glucose level (25.5 mmol x L(-1)) add different concentrations of chelerythrine (1 and 8 micromol x L(-1)); and control glucose level (5 mmol x L(-1)) add different concentrations of chelerythrine (1 and 8 micromol x L(-1)). Different groups of cardiomyocytes after adding corresponding treat factors were cultured for 48 hours. Cardiomyocytes' diameters and protein level were measured and the expression of PKC-alpha, PKC-beta2, p-PKC-alpha, and p-PKC-beta2 were measured by Western blotting. Compared with control group, neonatal myocytes cultured in high glucose levels showed increased cellular volumes, protein level and expression of PKC-alpha, PKC-beta2, p-PKC-alpha, p-PKC-beta2. When chelerythrine was added, cellular volumes, protein level and expression of PKC-alpha, PKC-beta2, p-PKC-alpha, p-PKC-beta2 were significantly reduced. But in 1 micromol x L(-1) chelerythrine group, the expression of PKC-beta2 was not significantly reduced. The result suggested that chelerythrine can reverse the hypertrophy induced by different glucose levels on the cardiac myocytes, it may have protective effect against diabetic cardiomyopathy via PKC passageway.

Mechanism and re-ablation strategy for postablation atrial tachyarrhythmia in atrial fibrillation patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the mechanism and re-ablation strategy of recurrent atrial tachyarrhythmia (ATA) following circumferential ablation of pulmonary veins (PV) in patients with atrial fibrillation (AF).</p><p><b>METHODS</b>Fifteen patients with recurrent ATA following first AF ablation procedure were included in this study. Under CARTO guidance, PVs were remapped and ablated subsequently for relapse of left atrium to PV conduction. The whole atrium was then remapped and individualized ablation was made to eliminate inducible ATA.</p><p><b>RESULTS</b>Left atrium to PV conduction relapses were evidenced in 14 patients. After re-ablation, there were no inducible ATA in 9 patients, inducible left atrial macro-reentry tachycardia in 3 patients and all were terminated by further linear ablation on the roof and left atrial isthmus, inducible atrial focal tachycardia from left atrial isthmus in 1 patient and was eliminated after additional focal ablation, inducible right atrial macro-reentry tachycardia in 2 patients and were eliminated by right isthmus linear ablation. During 1 - 16 (5.5 +/- 4.4) months follow-up, ATA was disappeared in 13 patients and reduced in another 2 patients.</p><p><b>CONCLUSIONS</b>Relapse of left atrium to PV conduction is one of the main mechanisms for postablation ATA in patients with AF. Atrial macro-reentry tachycardia and focal atrial tachycardia were less common mechanisms for postablation ATA. Re-ablation focused on closing the PV gaps and additional individualized focal and lineal ablation strategies were helpful for treating postablation ATA in AF patients.</p>

Influence of various glucose levels on the structure and function of cultured neonatal rats cardiomyocytes / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the influence of various glucose levels on the structure and function of cultured neonatal rats cardiomyocytes.</p><p><b>METHOD</b>Cultured neonatal ventricular cardiomyocytes were treated with various glucose levels for 5 days: control (5.5 mmol/L); high (25.5 mmol/L); intermittent high (5.5 mmol/L or 25.5 mmol/L in every 12 hours interval); high (25.5 mmol/L) + PKC inhibitor Ro-31-8220 (50 nmol/L). Then, the cell beating frequency was counted, the cardiomyocytes diameters were measured and the expressions of PKC-alpha, PKC-beta(2), p-PKC-alpha, p-PKC-beta(2), NF-kappaB and c-fos were determined by Western blot.</p><p><b>RESULTS</b>Compared with control group, cardiomyocytes beating frequency, diameters as well as the expressions of PKC-alpha, PKC-beta(2), p-PKC-alpha, p-PKC-beta(2), NF-kappaB and c-fos were significantly increased in high glucose concentration (all P < 0.05) and intermittent high glucose treatment further amplified these changes (all P < 0.05 vs. high glucose and control groups). High glucose induced changes could be significantly attenuated with PKC inhibitor Ro-31-8220.</p><p><b>CONCLUSION</b>High, especially intermittent high glucose could lead to diabetic cardiomyopathy by promoting cardiac hypertrophy, increasing beating frequency via activating PKC/NF-kappaB/c-fos pathways.</p>

Effect of a distal protection device on epicardial blood flow and myocardial perfusion in primary percutaneous coronary intervention / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated.</p><p><b>METHODS AND RESULTS</b>Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%).</p><p><b>CONCLUSION</b>Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.</p>

Effect of a distal protection device on epicardial blood flow and myocardial blush in primary percutaneous coronary intervention / 中华急诊医学杂志

Objective To study the effect of a distal protection device (Pereusurge GuardWire: GW) on epicardial blood flow and myocardial perfusion in primary percutaneous coronary intervention. Method Acute STEMI patients treated with primary PCI were eligible to be studied. Inclusion criteria were: (1) within 12 hours from the onset of chest pain;(2) culprit leision with diameter stenosis≥70% and TIMI flow grade≤2. Exclusion criteria were:(1) patients undergoing thrombolytic therapy before PCI; (2) a culprit lesion in the left main coronary artery;(3)reference vessel diameter

Alterations of myocardial ultrastructure and gene expression of calcium handling proteins in diabetic rat heart / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the ultrastructure of myocardium and gene expression of calcium handling proteins in diabetic rat heart.</p><p><b>METHODS</b>Diabetes was induced in male Sprague-Dawley rats by a single injection of alloxanm (40 mg/kg ) and the rats in control group were injected with normal saline. At the end of 2, 4, 6 weeks after the induction of diabetes, the animals were sacrificed. The expression of calcium handling proteins was detected by reverse transcription-polymerase chain reaction (RT-PCR) and actin mRNA was used as internal standard. Heart tissue at the apex was obtained for light and electron microscope study.</p><p><b>RESULTS</b>At the end of 4 and 6 weeks, cardiosomatic ratio of diabetic rats was higher than that of control. Electron microscopy revealed a spectrum of subcellular remodeling in myocardium which was characterized by damaged myofibrils and mitochondria, dilated and swollen sarcoplasmic reticulum. Expression of phospholamban mRNAs was significantly increased, but 1,4,5-trisphosphate inositol receptor type 2, ryanodine receptor type 2 mRNAs were significantly decreased compared with those in the age-matched control rats. In contrast, the expression of sarco/endoplasmic reticulum Ca(2+)-ATPase mRNAs was not affected.</p><p><b>CONCLUSION</b>In diabetic rat heart, gene expression of calcium handling proteins was characterized by up-regulation of phospholamban and down-regulation of sarcoplasmic reticulum calcium release channel while electron microscopic analysis of myocardium revealed a spectrum of subcellular remodeling.</p>

Segmental radiofrequency ablation of pulmonary vein ostia for patients with refractory paroxysmal atrial fibrillation using multi-slice spiral computed tomography guidance / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>To evaluate the safety and clinical efficacy of segmental radiofrequency ablation of pulmonary vein (PV) ostia for patients with refractory paroxysmal atrial fibrillation (AF) under multi-slice spiral computed tomography (MSCT) guidance before the procedure.</p><p><b>METHODS</b>A series of 58 consecutive patients with refractory paroxysmal AF were enrolled to undergo segmental radiofrequency ablation of PV ostia. The 36 male and 22 female patients with mean age of (57.4+/-9.5) (32-79) years and no obvious organic heart disease. Before ablation, patients received MSCT to generate 3-dimensional image of the left atrium (LA) and proximal PVs. Patients then underwent segmental radiofrequency ablation of PV ostia using PV circular mapping catheter manipulated several times to ensure complete isolation between PVs and LA.</p><p><b>RESULTS</b>No complications occurred during the procedure. One patient developed delayed cardiac tamponade, which was drained percutaneously. The mean follow-up time was (17.1+/-9.3) months. Forty-one patients (95%) experienced improved quality of life one month after the procedure. Thirty-six patients (83%) showed stable sinus rhythm, while 10 patients (23%) required additional anti-arrhythmic drugs. AF returned> or =1 time in 6 (14%) patients who underwent anti-arrhythmic drug therapy, but the number of episodes was less than that before the procedure. However, one patient experienced recurrent episodes of atrial flutter.</p><p><b>CONCLUSION</b>It is safe and effective to perform segmental radiofrequency ablation of PV ostia for patients with refractory paroxysmal AF using MSCT guidance mappening.</p>

Tissue Doppler imaging evaluate the effect of optimal biventricular resynchronization for congestive heart disease in left ventricular synchrony and function / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the immediate change of left ventricular systolic performance and asynchronization between simultaneous biventricular pacing and sequential biventricular pacing by tissue synchronization imaging (TSI) and tissue velocity imaging (TVI) in patients with congestive heart failure. The effect of sequential biventricular resynchronization therapy was also observed.</p><p><b>METHODS</b>Ten patients with dilated cardiomyopathy who received sequential biventricular resynchronization were enrolled. The TVI and TSI imagings were performed by GE vivid7 with M3S probe. The left ventricular ejection fraction (LVEF), stroke volume (SV), aortic velocity time integral (VTI), left ventricular end diastolic diameter (LVEDd), the standard deviation of the electro-mechanical delay (EMD-SD) of 6 segments and TSI index were measured before implanting of InSync 8042 and 1 month, 3 months, 6 months after implanting respectively.</p><p><b>RESULTS</b>After 6 months of implanting, the LVEF, SV and VTI were obviously increased from (22.0 +/- 8.8)% to (38.0 +/- 9.9)%; (36.0 +/- 14.9) ml to (57.0 +/- 15.7) ml; (20.22 +/- 5.72) cm to (26.20 +/- 5.98) cm, P < 0.05, respectively, compared with the before of implanting. The LVEDd was decreased from (6.6 +/- 0.6) cm, to (6.0 +/- 0.9) cm, P < 0.05. The EMD-SD and TSI-index were declined gradually after implanting, which was more evident in the 6 months after implanting, from (83.07 +/- 46.99) ms to (22.37 +/- 16.38) ms; (2.20 +/- 0.36) to (1.50 +/- 0.43), P < 0.05, respectively, but the immediate EMD-SD did not change obviously between simultaneous biventricular pacing and sequential biventricular pacing, whereas, the TSI index and VTI were significantly improved from (1.87 +/- 0.31) to (1.71 +/- 0.29); (22.44 +/- 5.43) cm to (25.44 +/- 5.36) cm, P < 0.05, respectively, in the sequential biventricular pacing.</p><p><b>CONCLUSION</b>Sequential biventricular resynchronization could improve the left ventricular systolic function and synchronism of wall motion in the patients with congestive heart failure, which is more effective than simultaneous biventricular pacing after implanting immediately.</p>