ABSTRACT
<p><b>OBJECTIVE</b>To observe the effect of ischemia postconditioning during the first minutes of reperfusion for the myocardial reperfusion injury in ST-segment elevation acute myocardial infarction (STEMI) patients undergoing emergency percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>STEMI patients undergoing emergency PCI in affiliated hospital of Beihua University between October 2006 and January 2009 were randomly divided into two groups: the control group (n = 34) without any intervention after PTCA, and the postconditioning group (n = 30) with ischemia postconditioning within first minutes of reflow by 3 episodes of 30-second inflation and 30-second deflation with the angioplasty balloon. Reperfusion arrhythmias, CK and CKMB, corrected TIMI frame count (CTFC), wall motion score index (WMSI) and left ventricular ejection fraction (LVEF) by echocardiography were compared between the two groups. MI areas were evaluated with the ECG-54 criteria/32 system and myocardial blush grade (MBG) was measured.</p><p><b>RESULTS</b>The incidence of reperfusion arrhythmias-frequent ventricular premature (26.7% vs. 52.9%) and short array ventricular tachycardia beat (23.3% vs. 58.8%) as well as values of peaks CK [(1162 ± 548) U/L vs. (1732 ± 480) U/L, P < 0.01], CKMB [(165 ± 70) U/L vs. (280 ± 99) U/L, P < 0.01], CTFC (22.23 ± 3.81 vs. 26.97 ± 3.42), WMSI (1.27 ± 0.52 vs. 1.82 ± 0.83), and infarction areas determined by ECG methods (10.60% ± 4.97% vs.14.65% ± 6.88%, all P < 0.05) were all significantly lower in the postconditioning group than in control group while LVEF (0.55 ± 0.08 vs. 0.47 ± 0.10) and MBG (2.27 ± 0.64 vs. 1.47 ± 0.61, all P < 0.05) were significantly higher in the postconditioning group than in control group.</p><p><b>CONCLUSIONS</b>Ischemia postconditioning can significantly reduce myocardial reperfusion injury in patients with STEMI.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Ischemic Postconditioning , Myocardial Infarction , Therapeutics , Myocardial Reperfusion InjuryABSTRACT
<p><b>OBJECTIVE</b>To retrospectively analyze the clinical and electrocardiographic features of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).</p><p><b>METHODS</b>The clinical, electrocardiographic features and the efficacy of various therapies were analyzed in 31 patients (27 males) diagnosed as ARVC according to the criteria established by European Society of Cardiology.</p><p><b>RESULTS</b>The averaged age when the ARVC was first diagnosed was (34.7 +/- 9.4) years (19 - 58 years), palpitation was present in 28 patients (90.3%) and syncope in 13 patients (41.9%), a family history of sudden death was present in 1 patient. Dilatated right ventricle was documented in 29 patients by echocardiography and (or) magnetic resonance imaging (MRI), 2 of them with dilated left ventricles. ECG changes included: T wave inversion, mostly seen in precordial leads (100%); epsilon (epsilon) wave (54.8%); QRS duration >or= 110 ms in V(1) to V(3) (83.9%); reduced extremity amplitude (41.9%); the first degree of AV block (22.6%); sustained VT (100%) including 15 monomorphic VT (48.4%) and 16 polymorphic VT (51.6%). The mean values of QRS duration in leads of V(1 - 3) [(120.8 +/- 13.7) ms] was significantly longer than that in V(4 - 6) [(99.4 +/- 13.7) ms, P < 0.05]. Fourteen patients underwent radiofrequency catheter ablation (RFCA) with an immediate success rate of 78.6% (11/14). During follow up (18.3 +/- 10.2) months, VT reoccurred in 6 patients (54.5%). The remaining 17 patients were treated with conventional medications, 7 of them were medicated under implanted cardioverter defibrillator (ICD). During the follow-up (35.6 +/- 19.0) months, VT reoccurred in 11 patients (64.7%) and one patient died suddenly.</p><p><b>CONCLUSIONS</b>ARVC patients developed symptoms at mid-30s with significant ECG changes including appearance of an epsilon wave, T wave inversion and QRS duration >or= 110 ms in leads of V(1 - 3). The long term therapy efficacy was not satisfactory both for RFCA and conventional medications and ICD implantation should be recommended to patients with ARVC.</p>