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Objective To evaluate the diagnostic performance of the automated quantitative analysis by coronary computed tomography angiography (CCTA) for lesion specific hemodynamic significance assessed by fractional flow reserve(FFR). Methods One hundred and fifteen patients with one hundred and fifty?one vessels,who successively underwent invasive coronary angiography with evaluation of FFR(values≤0.8 were defined as lesion specific hemodynamically significant), were analyzed by coronary CT angiography. FFR≤0.80 was found in 54(35.76％) of the 151 vessels, which was divided into two groups (group of hemodynamically significant and group of hemodynamically non-significant). CCTA images were quantitatively analyzed with automated software to obtain the following index:minimal lumen diameter(MLD), maximum diameter stenosis(MDS％), minimal lumen area(MLA), maximum area stenosis(MAS％), lesion length (LL), total plaque volume(TPV), total plaque burden(TPB), calcified plaque volume(CPV), calcified plaque burden (CPB), non-calcified plaque volume(NCPV), non-calcified plaque burden(NCPB), lipid plaque volume(LPV), lipid plaque burden(LPB), fibrous plaque volume(FPV), fibrous plaque burden(FPB), napkin-ring sign(NRS), remodeling index(RI) and eccentric index(EI). Logistic regression and area under the receiver operating characteristics were used for statistical analysis. Results MDS％(65.04％± 8.20％), MAS％(73.91％± 7.58％), TPB(57.96％± 11.17％), CPB[4.32％(0.11％, 5.34％)], LPB[14.89％(9.30％, 19.23％)], CPV[30.68 (0.29, 33.36)mm3], LPV[(81.72(33.92, 94.68)mm3]in the group with hemodynamic significance were larger than those in group with normal hemodynamic status[58.27％± 9.50％, 64.83％± 8.31％, 53.88％± 11.77％, 2.05％(0.00％, 3.42％), 11.83％(6.34％, 16.8％), 12.53(0.00, 13.24)mm3, 60.71(24.1, 75.11)mm3, respectively], which was statistically significant(t=4.41,P<0.01;Z=6.63,P<0.01;t=2.08,P<0.05;Z=-2.47,P<0.01;Z=-2.30,P<0.05;Z=-2.48, P<0.01;Z=-2.55, P<0.01, respectively). MLD[1.24(1.04, 1.46)mm]and MLA[3.61(2.40, 4.80) mm2]in the group with hemodynamic significance were smaller than those in group with normal hemodynamic status[1.53(1.32,1.72)mm, 5.28(4.00,6.40)mm2],which was statistically significant[Z=-4.82,-5.40, respectively;P<0.01].In logistic regression analysis, only MAS％(OR:1.08,95％CI:1.01-1.15,P=0.02), CPB (OR:1.16,95％CI:1.02-1.33,P=0.02) and LPB(OR:1.10,95％CI:1.01-1.19,P=0.02), MLA(OR:0.69, 95％CI:0.49-0.98,P=0.04)were significant predictors of hemodynamic significance. For predicting lesion specific hemodynamic significance, compared with MLA(0.76), MDS％(0.71), CPB(0.62) and LPB(0.61), except for MLA(Z=0.77, P=0.44), the AUC of MAS％(0.79) was significantly increased(Z=2.54, P=0.01;Z=2.91, P<0.01;Z=2.94, P<0.01, respectively). However, combination of other index to MAS％[MAS％+MLA％(0.81), MAS％+MDS％(0.80), MAS％+TPB(0.80), MAS％+CPB(0.80), MAS％+LPB(0.81)] did not show significantly difference over MAS％(Z=1.10, 0.71, 0.40, 0.54, 1.07, respectively;P>0.05). Conclusion Compared with diameter stenosis, area stenosis substantially improves the prediction of lesion specific hemodynamic significance.
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Objective To investigate the relationship between white-matter hyperintensities (WMHs) and hemorrhagic transformation and neurological outcome at 3 months after recombinant tissue plasminogen activator (rt-PA) treatment in patients with acute ischemic stroke.Methods The chnical data of 132 patients with acute ischemic stroke who had received intravenous rt-PA therapy were retrospectively reviewed.The severity of WMHs according to the modified Schelten scale was assessed.Hemorrhagic transformation included hemorrhagic infarct (HI) and cerebral parenchymal hemorrhage (PH).Hemorrhagic transformation after thrombolytic therapy and clinical neurological outcome based on modified Rankin scale (mRS) at 3 months was also analyzed.Favorable neurological outcome as mRS 0-1 score and unfavorable neurological outcome as mRS 2-6 scores was defined.Results Hemorrhagic transformation was found in 26 patients (19.7％,26/132) among 132 patients receiving intravenous rt-PA treatment.Seventeen patients were HI type and 9 patients were PH type.Multiple Logistic regression analysis showed that baseline American National Institute of Health Stroke Scale (NIHSS) score,diastolic pressure,WMHs score was not correlated with HI type hemorrhagic transformation (P ＞ 0.05) ; and WMHs score was not correlated with PH type hemorrhagic transformation (P ＞0.05),but baseline NIHSS score,diastolic pressure was the independent risk factor of PH type hemorrhagic transformation (P ＜ 0.05).Dicho-Logistic regression analysis showed that WMHs score was the independent risk factor of unfavorable neurological outcome (OR =1.136,95％ CI 1.037-1.245,P =0.008).Conclusion Severe WMHs are not associated with hemorrhagic transformation but independently associated with unfavorable neurological outcome after thrombolytic therapy in patients with acute ischemic stroke.
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Objeetive To explore the correlative factors of early progressive motor deficits in cerebral infarction of moderately size in basal ganglia and the relationship between motor deficit progression and the stem lesion of middle cerebral artery.Methods One hundred and fifty patients with single acute infarction located in white matter of basal ganglia region were recruited in this study retrospectively.All patients were performed brain and neck MRI and magnetic resonance angiography (MRA) within 72 h after onset.They were divided into two groups based on the maximal diameter of infarction on diffuse weighing imaging(DWI):moderate size infarction group(75 patients,maximal diameter of infarction from 1.5 cm to 3.0 cm) and lacunar infarction group(75 patients,maximal diameter of infarction lower than 1.5 cm).The scores of dynamic National Institutes of Health Stroke Scale(NIHSS) in 7 d after the admission and multiple Logistic regression analysis were used and the risk factors of the early progressive motor deficits were analyzed.Results The rate of early progressive motor deficits in moderate size infarction group was significant higher than that in lacunar infarction group [32.0 ％ (24/75) vs.8.0 ％ (6f75)] (P ＜ 0.05).The multiple Logistic regression analysis showed that elevated systolic blood pressure on admission was the independent risk factor for early progressive motor deficits (P =0.016).The rate of stem lesion of middle cerebral artery in moderate size infarction group was significantly higher than that in lacunar infarction group [41.3 ％ (31/75) vs.9.3 ％ (7/75)] (P ＜ 0.01).Conclusions Patients with acute single infarction located in white matter of basal ganglia and with the diameter of 1.5-3.0 cm are more prone to early progressive motor deficits and elevated systolic blood pressure on admission is the most significantly independent factor.The pathogenic mechanism may be associated with the stem lesion of middle cerebral artery.
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Forty patients with hypertension suspected to stenosis of renal artery were selected from Department of Cardiology, General Hospital of Chinese PLA between June 2007 and March 2008, including 28 males and 12 females with an average age of (60.0?15.6). Capoten test and renal artery angioplasty were performed in all patients to detect brain natriuretic peptide changes before and after the Capoten test and renal artery stent implantation. Among 40 patients underwent Capoten test, 30 showed positive result and 10 negative. The levels of brain natriuretic peptide before and after Capoten test in patients with positive result were statistically different (P 0.05). Among thirty patients with positive Capoten test undergoing renal artery angioplasty, twenty-three patients underwent stent implantation, and their brain natriuretic peptide showed statistical differences between before and after stent implantation (P 0.05). The results of the study show that levels of brain natriuretic peptide can be used to evaluate possible effect of stent implantation for patients with hypertension suspected to stenosis of renal artery.
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BACKGROUND:The safety and efficacy of paclitaxel-eluting stents (Taxus DES) has been proved by international researchers in clinic investigations.Based on further inclusion criteria,the incidence of in-stent restenosis is still lower than that of bare-metal stent.OBJECTIVE:TO observe restenosis of Taxus DES and the effect on local vessels through applying the follow up of coronary angiography and to investigate the biocompatibility of stent and host.DESIGN:Following-up observation.SETTING:Department of Cardiology,General Hospital of Chinese PLA.PARTICIPANTS:A total of 297 patients who had undergone coronary Taxus DES implantation for coronary artery disease were selected from Cardiovascular Department of General Hospital of Chinese PLA from May 2003 to May 2005.There were 265 males and 32 females and their ages ranged from 36 to 76 years.All patients provided informed consent,and the experiment had got confirmed consent from local ethic committee.METHODS:All patients were implanted Taxus DES and received the follow up within 6 and 12 months.In addition,at 6 months after operation,coronary angiography was used to measure the reference vessel diameter (RVD) and the minimal lumen diameter(MLD),calculate diameter restenosis rate and observe late loss.MAIN OUTCOME MEASURES:Coronary angiography at 6 months after Taxus DES implantation and biocompatibility of stent and host.RESULTS:①Quantitative angiographic analysis(QCA):Angiographic follow-up showed that the late loss of in-stent was significantly higher than that of pro-in-lesion and dis-in-lesion(P＜0.05).②Coronary angiography in-stent restenosis:In 134 angiographic follow-up patients,a total of 14 patients experienced restenosis,and the incidence was 10.4%(14/134).The patterns of restenosis were diffuse in-stent in 7 patients and the rate of revascularization was 6.7%.③Stent aneurysm:Angiographic evidence of aneurysm was observed in one patient among follow-up cases,and the rate of which was 0.75% (1/134).④Clinic follow-up major adverse cardiac events(MACE):Among 297 patients,one patient was attracted sudden death 5 months after intervention (0.34%; 1/297),and one patient was suffered subacute thrombosis 5 days after stent implant (0.34%;1/297),and late thrombosis occurred in 2 patients.The general rate of MACE was 1.35%.CONCLUSION:①The late loss of Taxus DES mainly takes place in in-stent.The patterns of restenosis of Taxus DES are in majority of diffuse in-stent,and the incidence of MACE is low.②Taxus DES possibly results aneurysm in local vessels.The follow up indicates that Taxus DES has a good biocompatibility to patients.
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50%). All the patients were catagorized into 3 groups according to the intervention (stenting, PTCA or no touch) applied in the side branches and the clinical outomes of the three different groups were compared. Results Among the 93 patients, 21 patients received stenting and 24 patients received balloon angioplasty in the side branches. No intervention was given in 48 patients. Although patients in the stenting group and the PTCA group could maintain a greater vessel lumen in the side branches compared with patients without intervention (40.21%, 41.76% and 80.23%, P
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Objective To evaluate the angiographic effectiveness of stenting for non-protected left main coronary leisions. Methods The follow-up angiograms of 18 patients who had received stent implantation for non-protected left main disease during 1997-2004 were assessed. Results (1) There were totally 9 patients implanted with two stents in distal left main bifurcation lesion. Among the 6 patients who had implanted two drug eluting stents using V technique, 4 of them had ostial restenosis of the branches and had TLR. Another 2 patients with bare metal stents implanted using T-stest technique also experienced restenosis and had TLR. (2) In the 9 patients with single stent implanted, 5 patients implanted the stents crossing-over the LCX and only 1 of them had restenosis. Among the 3 patients who had received left main body stenting, one patient had diffuse restenosis and performed TLR. Conclusion (1) Implantation of 2 stents in distal left main lesion showed a high restenosis rate. On the other hand, crossing over the LCX can be applied safely in left main bifurcation lesions and show a better prognosis.
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Objective: To investigate the effects of bone marrow-derived mononuclear cells (BMC) transplantation for the therapy of myocardial infarction (MI) in rabbits. Methods: 20 rabbits were randomly divided into 2 groups. MI was induced by ligation of the left anterior descending artery.In transplantation group(T,n=10), BMC transplantation was performed on 5-7 days after MI . Bone marrow (3-5 ml) was obtained from iliac crest and labeled with bromodeoxyuridine (Brdu) for 24-48 hours, BMC were transplanted into infracted myocardium through intramyocardial injection. Control animals (C,n=10) didn′t receive any treatment after MI. Echocardiography was performed for evaluating the cardiac function in 1 week and 5 weeks after MI. Hemodynamic and histological studies were performed in the 5 th weeks after MI. Results: LV ejection fraction of group T had no change, but group C decreased in the 1st week and 5th weeks after MI. The results of Group T having higher LV max +dP/dt and max-dp/dt, lower LV end-diastolic pressure showed comparing with that of group C in the 5th weeks after MI. Histological studies revealed that there were Brdu positive cells in the infarcted area in group T, and the vascular density of group T in the infarcted area was significantly greater in comparision with group C. No regeneration of smooth muscle cell and cardiomyocyte were found in the infarcted area. Conclusion: Transplantation of BMC may avoid the deterioration of cardiac function through vasculogenesis in the infarcted area,but the efficacy in amelioration of cardiac function is limited.
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Objective To evaluate the efficacy of Cypher and Taxus drug eluting stent (DES)in the treatment of coronary artery diease. Methods A total 162 patients underwent coronary artery stenting with eigher the Cypher (n=93) or the Taxus (n=69) drug eluting stent. All patients received follow up angiography. Results The angiographic restenosis rate and TLR rate were 10.8% and 5.4% in the Cypher group whereas 11.6% and 5.8% in the Taxus group. There were no statistical differences between the two groups. In-Stent Late Loss and In-Lesion Late Loss were found less in the Cypher group than in the Taxus group. Conclusion Both the Cypher DES and the Taxus DES decreased the restenosis and TLR rates but the Cypher stent has a lower late loss rate than the Taxus stent.
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AIM: To compare bone marrow stem cell mobilization with bone marrow-derived mononuclear cells (BMCs) transplantation for the therapy of myocardial infarction (MI) in rabbits, and to explore more effective and practical stem cell therapeutic strategy for MI. METHODS: In mobilization group (M, n=10), granulocyte-colony stimulating factor (G-CSF) (30 ?g?kg~ -1 ?d~ -1 ) was injected subcutaneously 3 hours after MI and every 24 hours for 5 days. On the 5th day, the BMCs from 10 mL peripheral blood were labeled with bromodeoxyuridine (BrdU) for 24-48 hours, then reinjected intravenously. In transplantation group (T, n=10), BMCs transplantation was performed 5-7 days after MI. After being obtained from bone marrow (3- 5 mL ) of iliac crest and labeled with BrdU for 24-48 hours, BMCs were transplanted into infracted myocardium through intramyocardial injection. Control animals (C, n=10) did not receive any treatment after MI. Echocardiography were performed for the evaluation of cardiac function 1 week and 5 weeks after MI. Hemodynamic studies and histological study were performed 5 weeks after MI. RESULTS: LV ejection fraction increased significantly in group M, had no change in group T, and decreased 1 week and 5 weeks after MI in group C. Group M and group T had higher LV max +dp/dt and max -dp/dt, lower LV end-diastolic pressure compared with group C 5 weeks after MI. Histological studies revealed that there were BrdU positive cells in the infarcted area in group M and group T. The vascular density of group M and group T in the infarcted area was significantly greater in comparison with group C. No regeneration of smooth muscle cells and cardiomyocytes were found in the infarcted area. CONCLUSION: Bone marrow stem cell mobilization with G-CSF and transplantation of BMCs both significantly improve the cardiac function for the therapy of MI through vascular genesis in the infarcted area. Bone marrow stem cell mobilization may offer a new and non-invasive therapeutic strategy for MI.