ABSTRACT
Objective:To investigate the effect of enhanced external counterpulsation(EECP)on heart failure with preserved ejection fraction(HFpEF)and hemodynamics in elderly patients.Methods:Clinical data of 66 elderly HFpEF patients admitted to the enhanced external counterpulsation center of our hospital from January 2018 to December 2019 were retrospectively analyzed.The primary assessment parameter was the six-minute walk distance, and the secondary parameters included the Minnesota Living with Heart Failure Questionnaire(MLHFQ). Noninvasive hemodynamic parameters including the cardiac index(CI), stroke volume(SV), isovolumic relaxation period(A2-mitral valve opening, A2-O), pulmonary capillary wedge pressure(PCWP)and total peripheral resistance(TPR)were monitored and mean arterial blood pressure(MAP)was calculated.Results:After EECP treatment, the six-minute walk distance increased(372±87 m vs.341±85 m, P<0.05), the score of MLHFQ decreased(47.0±16.0 vs.50.0±17.0, P<0.05), CI increased(2.8±0.7)L·min -1·m -2vs.(2.6±0.6)L·min -1·m -2( P<0.05), SV, PCWP and A2-O did not show significant change(73.3±16.4 ml vs.71.5±17.1 ml, 10.0±3.3 mmHg vs.11.0±3.6 mmHg, 1 mmHg=0.133 kPa, 98.0±29.5 ms vs.91.0±29.1 ms, P>0.05), TPR decreased(1 719.0±427.0 DS/cm 5vs.1 821.0±508.0 DS/cm 5, P<0.05), and there was no significant change in MAP(96.9±10.7 mmHg vs.98.8±13.1 mmHg, P>0.05), compared with pre-EECP treatment levels.Compared with patients without hypertension, MAP decreased in patients with hypertension(14 cases), when stratified by the initial MAP( P<0.05). Conclusions:For elderly patients with HFpEF, EECP can increase the six-minute walk distance, improve the quality of life and hemodynamic parameters, and is a safe adjuvant treatment.
ABSTRACT
Objective To investigate the comprehensive improvement of multi-system diseases in elderly patients treated with enhanced external counterpulsation(EECP).Methods Clinical data of an elderly patient with multiple systemic diseases were collected and analyzed.The therapeutic effect of EECP was assessed and EECP-related literatures were reviewed.Results The 62-year-old male patient was diagnosed with coronary atherosclerotic heart disease,unstable angina,New York Heart Association(NYHA)functional class Ⅱ,hypertension(grade 3,very high risk),type 2 diabetes,acute cerebral infarction (recovery period)and benign prostatic hyperplasia.After two courses of EECP treatment,angina in the patient was significantly relieved,cardiac systolic and diastolic function was improved,activity tolerance was increased and the corresponding dosage of therapeutic drugs was reduced.In addition,the patient's blood pressure and blood glucose levels were decreased after versus before treatment and the retinal superficial blood flow was enhanced in both eyes assessed by optical coherence tomography.The frequency and volume of nocturia were reduced.The symptoms of numbness on the left side were improved.Conclusions EECP treatment has shown significant therapeutic effects on multi-system diseases in the elderly patient.EECP is safe,effective and simple and has a broad application prospect in geriatrics.
ABSTRACT
<p><b>BACKGROUND</b>Ouabain is a mammalian adrenocortical hormone that is involved in the pathogenesis of hypertension by inhibiting Na-K ATPase activity. It also participates in a variety of kinase-mediated signaling pathways associated with Na-K ATPase. Previous studies have shown that ouabain can cause cardiac remodeling independent of elevated blood pressure and that proliferating cell nuclear antigen (PCNA) plays a coordinating role for numerous proteins involved in multiple processes associated with DNA synthesis. Therefore, we hypothesized that ouabain might play a role in the cerebral cortex through signaling pathways independent of hypertension. And PCNA might be involved in this process.</p><p><b>METHODS</b>Male Sprague-Dawley rats were treated with ouabain or with 0.9% nitric sodium as the control group. Systolic blood pressure was recorded weekly. After four weeks of treatment, morphological changes in the cerebral cortex were analyzed using light and transmission electron microscopy. The expression of PCNA in the cerebral cortex was evaluated by immunohistochemistry, real time quantitative PCR, and Western blotting.</p><p><b>RESULTS</b>After 4-week treatment, there was no significant difference in systolic blood pressure compared with the control group, but both structural deterioration and up-regulated expression of PCNA in the brain was induced by ouabain treatment.</p><p><b>CONCLUSIONS</b>These results suggest that ouabain induces alterations in the brain structure, and this effect is independent of blood pressure. PCNA might be involved in the repair process of ouabain-induced brain damage.</p>
Subject(s)
Animals , Male , Rats , Blood Pressure , Hypertension , Drug Therapy , Metabolism , Immunohistochemistry , Ouabain , Therapeutic Uses , Proliferating Cell Nuclear Antigen , Metabolism , Rats, Sprague-Dawley , Real-Time Polymerase Chain Reaction , Sodium-Potassium-Exchanging ATPase , MetabolismABSTRACT
Objective To observe the effect of grape seed proanthocyanidin extract (GSPE) on vascular remodeling in ouabain-induced hypertensive rats.Methods A total of 30 male SpragueDawley rats were randomized into 3 groups:control group (received 0.9％ 1 ml normal saline by intraperitoneal injection and oral gavage in the morning),ouabain treatment group (received 2 mg/kg ouabain by intraperitoneal injection and 0.9 ％ 1 ml normal saline by oral gavage in the morning),and GSPE treatment group (received 2 mg/kg ouabain by intraperitoneal injection and 250 mg Kg 1 d-1 GSPE by oral gavage in the morning).Blood pressure was determined before and 5 weeks after the treatment.The aortas were observed 5 weeks after the treatment.The mRNA and protein levels of nuclear factor-κB (NF-κB p65) and transforming growth factor-β1 (TGF-β1) in rat aorta were detected using real-time PCR and Western blot,respectively.Morphological observations were obtained by Hemotoxylin and Eosin staining and Electron microscope.Results The systolic blood pressure was significantly lower in GSPE treatment group than in ouabain treatment group [(133.6±6.0) mm Hg vs.(146.5±7.9) mm Hg,1 mm Hg=0.133 kPa,P＜0.01].Morphological observation showed that the thickening aortic intimal and structural disorder were found in the ouabain treatment group,and aortic intimal structural integrity were normal in the other two groups.The mRNA and protein levels of NF-κB p65 and TGF-β1 were significantly lower in GSPE treatment group than in the ouabain treatment group (NF-κBp65:2.77±0.58 vs.3.14±0.64,0.73±0.20 vs.0.93±0.21,both P＜0.05; TGF-β1:5.80±0.67 vs.6.09±0.95,0.42±0.14 vs.0.69±0.16,both P＜0.05).Conclusions GSPE may inhibit endogenous ouabain,and delay the process of elevated blood pressure and vascular remodeling by inhibiting NF-κ B p65 and (or) TGF-β3 1 pathways.
ABSTRACT
Objective To observe the effects of grape seed proanthocyanidin extract (GSPE)combined with atorvastatin on carotid atherosclerosis of the elderly. Methods Consecutivly 122 patient aged( 73.2 ±12.8) years with hypercholesterolemia and diagnosed as asymptomatic carotid artery plaques were randomly assigned to single atorvastatin(20 mg/d) treatment group (n=63) and combination treatment (atorvastatin 10 mg/d plus GSPE 400 mg/d) group (n=59).Serum total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C) and high-sensitive C-reactive protein (hs-CRP) levels were detected before treatment and 3,6,12 months after treatment.Mean maximum carotid intima-media thickness (CIMT),plaque score and stability were also assessed by carotid ultrasound. Results After 3 months of treatment,serum levels of TC,TG and LDL-C in both groups were lower than before treatment (all P＜0.01),but no difference was found between the two groups (P＞0.05).HDL-C levels was enhanced by 20.2％ in combination treatment group after 3 months of treatment (P＜0.05),there was difference after 6 months treatment between two groups (P＜0.05).Serum hs-CRP concentrations were decreased by 1.7 mg/L and 3.6 mg/L,3.8 mg/L and 6.3 mg/L,5.9 mg/L and 8.3 mg/L after 3,6 and 12 months treatment as compared with pretreatment,respectively in the two groups (P＜0.05 or P＜0.01).There was difference in hs-CRP levels between groups after 6 and 1.2months of treatment (P＜0.05 or P＜0.01).There were MMCIMT reduction by 1.3％ and 2.0％ (P＞0.05),3.4％ and 5.3％(P＞0.05 and P＜0.05 ),5.1％ and 8.6％ after 3,6 and 12 months of treatment(P＜0.05 and P＜0.01) in the two groups,with distinct difference after 12 month treatment (P＜ 0.01 ).The plaque scores were declined by 6.8 ％ and 13.1％ ( both P ＞ 0.05 ),14.5 ％ and 28.0％ (P＞0.05 and P＜0.05),19.2％ and 45.0％(P＜0.05 and P＜0.01)after 3,6 and 12 months of treatment while significant difference was found between the two groups after 12 months treatment (P＜0.05).Unstable plaque and the total number of plaque was dropped by 8 and 14 in single group,19 and 28 in combination group,respectively,after 12 months of treatment. Conclusions GSPE combined with atorvastatin may inhibit the development of carotid intima-media thickness,reduce carotid plaque and promote stabilization of carotid plaque.
ABSTRACT
Objective To investigate the association between carotid-femoral pulse wave velocity (cfPWV) and composition of the ascending aorta in patients with coronary heart disease (CAD),Methods The study population comprised 60 consecutive CAD patients who underwent coronary artery bypass graft (CABG) surgery in Qilu Hospital of Shandong University.cfPWV vas measured using an automatic device (Complior,Artech,France).A quantitative study was conducted on ascending aorta specimens by histological observation (Masson staining and weigert's resorcin-fuchsin staining) and computer image analysis.Bivariate analyses were performed to study the association between composition of the ascending aortic media and cfPWV.Results cfPWV of the CAD patients was higher (14.2±2.0) m/s than that of the normal subjects.On Masson's-stained specimen slides,disorganization of smooth muscle and focal accumulations of collagen (44.1 ± 3.9)％ were visible alongthe medial aorta of the CAD patients.Weigert's-stained cross sections of the ascending aortic media in CAD patients frequently exhibited focal breakdown or discontinuous segments of elastic fibers(18.4±3.2)％,cfPWV had a positive correlation with relative contents of collagen in the ascending aorta(r=0.68,P＜0.01)and a negative correlation vith relative contents of elastin in the ascending aorta (r=-0.59,P＜0.01),but no relation with relative contents of smooth muscle(r=0.01,P＞0.05).Conclusions The reduced aortic elasticity in CAD patients can be partly ascribed to decreased elastin,increased collagen,and their disorganization.cfPWV can reflect the quantitative changes of collagen and elastin in the ascending aortic media in CAD patients.
ABSTRACT
Objective To explore the relationship between morphological features of carotid arterial atherosclerosis plaque and various cardiovascular risk factors in the aged.Methods The 321patients who underwent cerebral angiography were classified into two groups:256 patients with carotid arterial atherosclerosis and 65 patients without plaque.The relationships between carotid arterial plaque and cardiovascular risk factors including age,gender,cholesterol(TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol(LDL-C),C-reactive protein(CRP),homocysteine (HCY),hypertension,diabetes,smoking and drinking were analyzed.The relationships between morphological features,including the stenosis degree,surface fairing of plaque,and cardiovascular risk factors were analyzed.After 1 year follow-up,the prospective cardiovascular and cerebrovascular events were analyzed in the two groups.Results Carotid atherosclerosis was connected with cardiovascular risk factors such as TC,LDL-C,uric acid,CRP,hypertension,diabetes,smoking and drinking.Positive correlation was showed between the stenosis degree of carotid artery and age,smoking and diabetes.Closely correlation was showed between surface fairing of carotid arterial plaque and LDL-C,CRP,smoking and diabetes.The stenosis degree of carotid artery only showed positive correlation with cerebrovascular events,but the morphological features of surface fairing of carotid arterial plaque equally showed positive correlations with cerebrovascular events and cardiovascular events.Conclusions The development of carotid arterial atherosclerosis plaque in the aged is closely related to cardiovascular risk factors.Morphological features of carotid arterial plaque may respond the level of general atherosclerosis better than stenosis degree,and it is also in close correlation with cerebrovascular events and cardiovascular events.
ABSTRACT
Objective To observe the effects of grape seed proanthocyanidin extract(GSPE) plus atorvastatin treatment on matrix metalloproteinase-9 ( MMP-9) in experimental atherosclerosis rabbits and to explore its mechanism. Methods Thirty male New Zealand rabbits were randomized into five groups. The normal control group were fed with standard diet for 24 weeks. And the other groups were fed with standard diet containing 1 % cholesterol for 12 weeks. In the sequential 12 weeks, the model control group was fed with standard diet. The GSPE group was fed with standard diet containing 1% grape seed proanthocyanidin(GSP). The atorvastatin group was fed with standard diet containing atorvastatin(2. 5 mg · kg~(-1) · d~(-1)). The GSPE plus atorvastatin group was fed with standard diet containing 1% GSP and atorvastatin (2. 5 mg~(-1) · kg~(-1) · d~(-1)). Blood samples were drawn from ear middle arteries of rabbits just before the experiment and at the 12th and the 24th weekend of the experiment. All the rabbits were fasted for at least eight hours before the blood was drawn. The blood samples were analyzed for the matrix metalloproteinase-9 (MMP-9). All the rabbits were sacrificed at the 24th weekend, and the expression of MMP-9 was observed in the thoracic aortic tissue using immunohistochemistry technique. Results The serum level and aorta expression of MMP-9 were increased in model group compared to control group (all P< 0. 05). The severity of atherosclerosis was less in three drug groups than that in model control group. The GSPE,atorvastatin and GSPE plus atorvastatin groups versus model group showed less atherosclerotic lession, the decreased expression of aorta MMP-9 and the decreased serum level of MMP-9 C(1. 06±0. 21), ( 1. 07 ±0.20), (0.81 + 0.16) vs. (1. 32±0. 24)ng/ml,all P<0. 05]. The effect in the GSPE and atorvastatin group was most obvious. Conclusions GSPE plus atorvastatin group has the most efficacy of anti-atherogenesis, which is associated with its reducing the expression of matrix metalloproteinase.