Feasibility and safety of paclitaxel-eluting balloon for the treatment of de novo coronary lesions / 中华心血管病杂志

Objective@#To evaluate the safety and feasibility of treating de novo coronary lesions with paclitaxel-eluting balloon.@*Methods@#This is a retrospective study, which enrolled 76 patients with 80 de novo coronary lesions treated with paclitaxel-eluting balloons(<30% residual stenosis and there was no blood flow limited dissection after pretreatment) from April 2015 to November 2016 in Guangdong general hospital. The data of basic characteristics,procedures,devices and follow-up information were retrieved and analyzed. The primary endpoint was the composite of cardiac death, recurrent myocardial infarction and target lesion revascularization.@*Results@#(1)The age was (63.3±10.3) years. There were 68.4%(52/76) acute coronary syndrome patients, prevalence of type 2 diabetes was 36.8%(28/76), and 64.5%(49/76)patients with at least one high bleeding risk. (2)The lesion length was (17.4±7.6)mm, and the stenosis was (88.1±8.2)%.The reference vessel diameter≥2.75 mm accounted for 51.2% (41/80), and bifurcation stenosis accounted for 67.5%(54/80). (3)53.7%(43/80) lesions were pretreated with scoring balloon to optimize plaque modification. The paclitaxel-eluting balloon length and diameter were (22.3±5.5)mm and (2.74±0.52)mm.The residual stenosis was (12.3±10.3)%. Procedural success was 88.8%(71/80).Bail-out stenting rate was 5.0%(4/80). (4)The median follow-up duration was 12(6, 25) months. Primary endpoint occurred in 3 cases (3.9%), including 2 cardiac deaths(1 patient died of recurrent myocardial infarction, and 1 patient died of acute heart failure induced by severe mitral insufficiency), and one patient receivedtarget lesion revascularization.@*Conclusion@#In case of no more than 30% residual stenosis and no blood flow limited dissection after lesion pretreatment,it is safe and feasible to treat de novo coronary lesionsusing paclitaxel-eluting balloon.

Association between body mass index and cardiovascular events in male elderly hypertensive patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the long-term relationship between body mass index (BMI) and cardiovascular events in male elderly hypertensive patients.</p><p><b>METHODS</b>A total of 839 male elderly (>65 years old) hypertensive patients were included in this prospective study. Baseline data were obtained on January 2004 and participants were followed up yearly till January 2014. Patients were divided into 3 groups according to their BMI: normal weight group (18.5 kg/m² ≤ BMI<24.0 kg/²), overweight group (24.0 kg/m² ≤ BMI<28.0 kg/m²), obese group (BMI ≥ 28.0 kg/m²). All-cause death and cardiovascular events were compared.</p><p><b>RESULTS</b>The average age of all 839 hypertension men was (75.4 ± 4.8) years at baseline. Baseline systolic blood pressure was (133.7 ± 14.6) mmHg (1 mmHg=0.133 kPa), diastolic blood pressure was (74.3 ± 9.3)mmHg. Baseline systolic and diastolic blood pressure was similar among the three groups. All 839 patients completed follow-up. There were 178 all-cause deaths, 54 cardiovascular deaths, 51 new/recurrent myocardial infarctions and 105 new/recurrent strokes during follow up. Incidence of all-cause mortality in overweight group (16.74%,72/430) was significantly lower than in normal weight group (27.01% (74/274), P<0.05). Kaplan-Meier curves showed the all-cause mortality and cardiovascular mortality were higher in normal weight group than in the other two groups. According to the Cox proportional hazards regression model, the risk of all-cause mortality (RR=0.867, 95% CI: 0.792-0.949) and cardiovascular death (RR=0.179, 95% CI : 0.05-0.645) in patients with a BMI ≥ 24.0 kg/m² were lower than in the group with BMI<24.0 kg/m².</p><p><b>CONCLUSION</b>Obesity paradox phenomenon is observed in elderly male hypertensive patients in that higher BMI is associated with lower mortality risks in elderly male hypertensive patients during the 10 years follow-up.</p>

Clinical features of 17 cases of rhabdomyolysis / 中华心血管病杂志

<p><b>OBJECTIVE</b>We retrospectively analyzed the causes, diagnosis, clinical characteristics, treatment and prognosis of 17 patients with rhabdomyolysis.</p><p><b>METHODS</b>Rhabdomyolysis cases diagnosed from January 2005 to March 2014 in our department were included.</p><p><b>RESULTS</b>A total of 17 rhabdomyolysis patients (male 13, mean age (60.4 ± 15.7) years) were analyzed.Four cases had coronary heart disease combined with hypertension, hyperlipaemia, atrial fibrillation, 10 cases had dilated cardiomyopathy combined with coronary heart disease, hyperlipaemia, atrial fibrillation, 8 cases had atrial fibrillation combined with hypertension, coronary heart disease, hyperlipaemia, 1 patient had pulmonary embolism combined with hyperlipaemia, 1 patient had aortic dissection combined with hypertension, 10 hypertension patients were combined with coronary heart disease, hyperlipaemia, atrial fibrillation, aortic dissection and 1 patient with ventricular tachycardia was combined with depression.Various degrees of liver and kidney dysfunction, reduced hemoglobin and myoglobinuria were found in all patients.Fever was found in 7 cases, relevant neurological signs in 5 cases. Digestive tract discomfort and muscle weakness or muscle pain symptoms were seen in all patients during hospitalization. All cases underwent renal replacement therapy and respirator was used in 14 patients to support breathing. Post therapy, 10 cases improved but 7 cases died. All 17 patients had history of statin use.</p><p><b>CONCLUSION</b>Statin may be the major cause of rhabdomyolysis in these patients, and the mortality of rhabdomyolysis is high despite various therapy stratigies.</p>

Impact of simultaneous renal artery and coronary artery stenting on cardiac and renal function in patients with renal artery stenosis and coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the impact of simultaneous percutaneous transluminal renal artery stenting (PTRAS) and percutaneous coronary artery interventions (PCI) on cardiac and renal function in patients with renal artery stenosis (RAS) and coronary artery disease (CAD), and explore the factors affecting the long-term prognosis.</p><p><b>METHODS</b>This retrospective cohort study enrolled 169 patients with RAS and CAD from January 2006 to January 2010, 149 patients were intervened with PTRAS and PCI simultaneously (combined group) and the remaining 20 patients were treated with PCI (PCI group). All patients were followed up for at least 2 years. Clinical data including blood pressure, estimated glomerular filtration rate (eGFR), echocardiography and major adverse events were obtained.</p><p><b>RESULTS</b>The average stenotic ratio of the left and right renal artery in PCI group were significantly lower than those in combined group (both P < 0.01). After 2 years, there was a significant decrease in systolic blood pressure compared to baseline level in the combined group (P < 0.01). In the PCI group, both systolic blood pressure and diastolic blood pressure were significantly lower during follow-up than at the baseline level (both P < 0.01) . Echocardiography examination showed that left ventricular mass index (LVMI) during follow up was significantly lower than the baseline value in both groups, and the reduction extent in the combined group was larger than in PCI group (-55.6 g/m(2) vs.-12.8 g/m(2), P < 0.01) . In the combined group, the eGFR value decreased from (44.7 ± 17.4) ml×min(-1)×1.73 m(-2) to (41.7 ± 18.9) ml×min(-1)×1.73 m(-2) (P < 0.01). eGFR level remained unchanged in PCI group (P > 0.05). Multivariate Cox regression analysis demonstrated that baseline renal dysfunction was not significantly related to the long-term adverse prognosis in combined group (HR = 0.986, P > 0.05).</p><p><b>CONCLUSIONS</b>Simultaneous PTRAS and PCI are safe and effective for treating patients with RAS and CAD. Simultaneous PTRAS and PCI are beneficial on controlling blood pressure and reducing left ventricular mass index but has no impact on renal function change.</p>

Clinical characteristics of 42 patients with cardiac amyloidosis / 中华内科杂志

Objective To characterize the clinical features of patients with cardiac amyloidosis (CA).Methods Totally 42 patients with CA admitted to Guangdong General Hospital since 2008 were included and retrospectively analyzed in the present study.CA was confirmed by abdomen and endocardium biopsy examination.Clinical manifestations,electrocardiogram and echocardiography were collected for the evaluation.Results Several clinic features are common in CA.In the present study,37 cases (88.1％) presented with chest tightness,dyspnea,20 cases(47.6％) with chest pain,27 cases(64.3％) with right heart failure,27 cases (64.3％) with fatigue,and 30 cases (71.4％) with renal insufficiency and proteinuria.Electrocardiogram (ECG) showed that 32 of the patients (76.2％) were with low voltage in limb leads,29 cases (69％) of them were with poor R wave progression in precordial leads,17 cases (40.5％) with ST-T change,28 cases(66.7％) with pseudo-necrotic Q wave and 36 cases (85.7％) with various kinds of arrhythmia.Echocardiography indicated that all of the subjects (100％) were with different degrees of left ventricular posterior wall or ventricular septal thickness,and left atrial hypertrophy with different degree of myocardial grain appearance or ground-glass opacity.Thirty-six cases (85.7％) were with pericardial effusion,and 27 cases (64.3％) were with abnormal left ventricular eject function.Conclusion For those who were with unexplained clinical cardiac insufficiency,renal insufficiency,myocardial hypertrophy,but normal of ventricular size in echocardiography and low voltage on ECG limb leads,a tissue biopsy from abdomen,labial glands or endocardium should be considered in the diagnosis of CA.

The diagnostic value of left atrial volume index for heart failure with preserved ejection fraction / 实用医学杂志

Objective To explore the value of left atrium volume index (LAVI) in the diagnosis of heart failure with preserved ejection fraction (HFPEF). Methods Seventy-seven patients with HFPEF and 33 patients without HFPEF who had been treated from May 2012 to September 2013 in Guangdong General Hospital were en-rolled. The clinical data and a series of ultrasound parameters were collected and analysed. The relationship between LAVI, LAV, and other indexes of diastolic function was determined by Pearson correlation analysis. The value of LAVI and LAV for diagnosing HFPEF was compared by the ROC curve. Results LAVI and LAV of were signifi-cantly greater in HFPEF group than in non-HFPEF group. LAV and LAVI were significantly associated wtih HEPEF. The area under the ROC curve (AUC) of LAVI increased significantly as compared with the AUC of LAV (0.832 vs. 0.799, P<0.05). With a cut-off value of 30 mL/m2, the specificity and sensitivity for diagnosing HEPEF were 64.9%and 84.8%, respectively. Conclusions LAVI may be valuable in the diagnosis of HFPEF.

Relationship between carbon dioxide combining power and contrast- induced acute kidney injury in patients with ST segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the relationship between carbon dioxide combining power(CO₂-CP) and contrast-induced acute kidney injury (CI-AKI) in patients with ST segment elevation myocardial infarction and undergoing percutaneous coronary intervention.</p><p><b>METHODS</b>We retrospectively analyzed 174 patients admitted to our hospital from March 2012 to August 2013 with ST segment elevation myocardial infarction and underwent emergency percutaneous coronary intervention. Patients were divided into three tertiles according to pre-operative CO₂-CP: T1 (CO₂-CP < 22.62 mmol/L), T2(CO₂-CP 22.62-24.30 mmol/L), T3(CO₂-CP > 24.30 mmol/L). Baseline clinical data, CI-AKI incidence, in-hospital mortality and dialysis rate were compared among groups. An increase in serum creatinine of >26.4 µmol/L and/or >50% from baseline within 48 hours after contrast exposure was defined as CI-AKI. Univariate logistic regression analysis was used to identify the risk factors of CI-AKI. The relationship between CO₂-CP and CI-AKI was assessed by multivariate logistic regression analysis. Receiver operating characteristic curve was used to identify the optimal cutoff of the CO₂-CP for predicting CI-AKI.</p><p><b>RESULTS</b>CI-AKI occurred in 25 (14.4%) patients, and lower CO₂-CP was related to higher incidence of CI-AKI (27.6% (16/58) in group T1, 5.3% (3/57) in group T2, 1.7 % (1/59) in group T3, P = 0.002) and higher in-hospital mortality (10.3% (6/58) vs. 0 and 1.7% (1/59), P = 0.010). Dialysis rate was similar among 3 groups (5.2% (3/58) vs. 0 and 1.7% (1/59), P = 0.168). The incidence of CI-AKI was significantly associated with CO₂-CP < 22.00 mmol/L in univariate analyses (OR = 6.767, 95% CI 2.731-16.768, P < 0.001). After adjusting for potential confounding risk factors, CO₂-CP < 22.00 mmol/L remained significantly associated with the incidence of CI-AKI (OR = 5.835, 95%CI 1.800-18.914, P = 0.003) in multivariate logistic regression. ROC analysis revealed that the optimal cutoff of CO₂-CP to predict CI-AKI was 22.00 mmol/L (sensitivity 64.0%, specificity 79.1%, AUC = 0.714).</p><p><b>CONCLUSIONS</b>Pre-percutaneous coronary intervention CO₂-CP in patients with ST segment elevation myocardial infarction undergoing percutaneous coronary intervention is related to CI-AKI. CO₂-CP < 22.00 mmol/L predicts higher risk of CI-AKI in this patient cohort.</p>

Influence of acute hyperglycemia on the assessment of cardiac function with N-terminal pro-brain natriuretic peptide / 中华急诊医学杂志

Objective To investigate the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) derived cardiac function index (Tei index) in patients with acute coronary syndrome under different plasma glucose levels and to evaluate the influence of hyperglycemia on the preciseness of cardiac function assessment with NT-proBNP.Methods Consecutive patients with acute coronary syndrome admitted to the department of cardiology in Guangdong General Hospital were prospectively enrolled.Based on their plasma fasting glucose level,patients were divided into hyperglycemia group (fasting plasma glucose ≥ 6.1 mmol/L) and euglycemia group (fasting plasma glucose ＜ 6.1 mmol/L).All the patients underwent transthoracic echocardiagraphy and tissue Doppler imaging (TDI) investigations.Blood samples were obtained within 24 hours of hospitalization for measurment of NT-proBNP level.Relationship between TDI-Tei index and the level of NT-proBNP in the two groups were analyzed respectively.Results The TDI-Tei index,the systolic index and the diastolic index were all significant higher in the hyperglycemia group (n =27) than those in the euglycemia group (n =35)(0.68±0.14) vs.(0.61 ±0.10),P =0.03; (0.29±0.07) vs.(0.26±0.05),P =0.045; (0.38±0.08) vs.(0.35 ±0.050,P =0.03,respectively.In both groups,TDI-Tei and In NT-proBNP showed significant linear regression.In the hyperglycemia group,TDI-Tei =0.175 + 0.068 In NT-proBNP,R2 =0.702,P ＜ 0.01.In the euglycemia group,TDI-Tei =0.185 + 0.060 In NT-proBNP,R2 =0.405,P ＜ 0.01.Conclusions (1) Compared with patients suffering from an acute coronary syndrome with euglycemia,the global cardiac function of patients with hyperglycemia is poorer; (2) NT-proBNP correlates significantly with TDI-Tei in both hyperglycemia and euglycemia patients with acute heart syndrome.It is appropriate to assess global cardiac function with NT-proBNP in patients suffering from ACS complicated with hyperglycemia.

Correlation between mitral regurgitation grading and left ventricular ejection fraction in elderly patients: a follow-up study / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the correlation between mitral regurgitation grading and left ventricular ejection fraction in elderly patients (>60 years of age) in a 2-year follow-up.</p><p><b>METHODS</b>A total of 455 patients with the diagnosis of at least mild mitral regurgitation by echocardiography were divided into ischemic mitral regurgitation (IMR) group and non-ischemic regurgitation (NIMR) group. The patients were followed up with echocardiography every 6 months and the data were analyzed at the end of 24 months.</p><p><b>RESULTS</b>Mitral regurgitation grade was inversely correlated with left ventricular ejection fraction (LVEF). Patients with moderate and severe IMR had a lower LVEF than those with NIMR (P<0.05). After adjustment for age, sex, body mass index, high blood pressure, diabetes, atrial fibrillation and cardiomyopathy, the mean LVEF at 2 years was lowered by 2.7% (1.4%-4.1%), 2.7% (1.3%-4.0%), and 5.2% (3.5%-6.9%) in mild, moderate and severe IMR patients, respectively (P<0.04), and by 3.2% (1.6%-4.8%), and 3.0% (1.4%-4.5%), and 1.7%(-0.5%-3.9%) in mild, moderate and severe NIMR patients (P=0.30).</p><p><b>CONCLUSION</b>The mean LVEF in IMR patients is significantly lowered compared to that in NIMR patients. The grade of mitral regurgitation is inversely correlated with the regurgitation area in IMR patients. Stratified management might help improve LVEF in severe IMR patients.</p>

Clinical effects of bird's nest nursing on premature infants / 中国实用护理杂志

Objective To study the effect of bird's nest nursing on the vital signs,gastroenteric function,body weight and growth of premature infants.Methods 456 cases of premature infants were divided into the warm box group and the bird's nest group randomly according to odd and even number of birth,namely 228 cases in each group.The warm box group adopted routine nursing care.The bird's nest group adopted routine nursing care and bird's nest nursing in the mean time,namely the bird's nest wag put into the warm box,the premature infants slept in the pre-heated bird's nest.The condition of the two groups Was compared.Results On the first day of birth,there were no statistical difference(P＞0.05)between the two groups in respiration,heart rate,milk amount and body weight.On the seventh and fourteenth day,respiration and heart rate were stable and milk amount and body weight increased rapidly in bird's nest group.There Was statistical difference(P＜0.05)between the two groups.In bird's nest group,the premature had long sleeping time and body temperature-fluctuation was reduced.There was statistical differencere(P＜0.01)between the two groups.Conclusions After the bird's nest was used in premature care,diseases were recovered rapidly,hospitalization days were shortened and it was beneficial to the development of intelligence and body and mind of the premature infants.

Clinical analysis on vulnerable coronary atherosclerotic plaque by intravascular ultrasound / 中华超声影像学杂志

Objective To find out the sensitivity and s pecificity of intravascular ultrasound (IVUS) in identification of unstable atherosclerotic plaques. Methods Fourty-three patients diagnosed coronary heart disease, receiving coronary angiography and intravascular ultrasound examination,were divided into soft plaque and hard plaque group according to the echo reflectivity of atherosclerotic plaque by IVUS. Quantitative determination was performed between the two groups. Results The sensitivity of IVUS in detecting soft plaques from patients with acute coronary artery syndrome was 81.4 %, specificity 75.0 %, accuracy 79.1 %, positive predictive value 84.6 %. The lipid core areas and lipid to plaque ratio of soft plaques were significantly larger than those of hard plaques (P 0.05 ).Conclusions IVUS had higher sensitivity and specificity in detecting coronary vulnerable plaques in live bodies.

Investigation of clinical outcomes of percutaneous carotid artery stenting / 中国介入心脏病学杂志

Objective To investigate the safety and feasibility of carotid artery stenting (CAS) and evaluate its clinical outcomes. Methods From July 1998 to December 2003, 30 consecutive patients with 32 lesions underwent extracranial CAS procedures. Thirteen patients had a history of stroke or TIAs, 22 were hypertensive, 11 were diabetic and 8 had history of MI. Neurological assessment, Carotid duplex ultrasound, carotid and intracranial angiography were done before CAS in all patients. All the cases were done percutanously from femoral arteries and stenting was applied in all procedures. Carotid duplex ultrasound, cardiac and neurological elevation were performed post procedure. Results 30 patients (26 male and 4 female) underwent a total of 32 CAS procedures. Total 32 self-expandable stents and 1 tubular stent were implanted in all the cases. Direct stenting technique was applied in 9 cases. The other 21 procedures were performed with distal filtration supporting devices. The device can not be delivered due to tortuous target vessel in one case (success rate 95%) and CAS success rate was 97%. The particles were found in all filter baskets. Four patients underwent coronary artery bypass grafting 1 month later post CAS without perioperative neurological and cardiac events. One patient had contralateral cerebral hemorrhage during CAS and died three days later. Another patient died three days after CAS due to acute pulmonary edema. No restenosis was found by means of carotid duplex ultrasound during the follow-up (3-60 months) study. Conclusion CAS is safe and feasible in preventing ischemic stroke. This new alternative has satisfied clinical outcomes in managing cardiac and neurological ischemic diseases. Operative embolic complication can be potentially prevented by neurological protective device.

Effect of Stent Implantation on the Expression of PCNA and Cyclin E and Apoptosis in Rabbit Vascular Smooth Muscle Cells / 中山大学学报(医学科学版)

【Objective】To evaluate the impact of stent implantation on proliferation and apoptosis in media vascular smooth muscle cells and to explore the mechanism of restenosis after stent implantation.【Methods】Fifty male New Zealand rabbits were randomized into balloon group and stent group.Control group were set up.The materials were harvested on 3,7,14,28 and 56 day after operation and the following investigation were carried out.① Assessing the expression of proliferating cell nuclear antigen (PCNA) and Cyclin E of media smooth muscle cells with immunohistochemistry;② Analyzing apoptosis of media smooth muscle cells by TUNEL technique.【Results】The expressions of PCNA,Cyclin E and apoptosis in stent and balloon groups were markedly increased compared to control groups.① Stent group induced significant increased expression of PCNA and Cyclin E in the media smooth muscle cells compared to balloon group.On day 7,the positive rates of PCNA and Cyclin E were 24.36±0.55% vs 18.74±1.09% (P<0.01) and 22.65±1.00% vs 17.68±1.10% (P<0.01) respectively;② Stent group induced much more significant apoptosis than balloon group.The highest rate of apoptosis appeared on day 7:12.46±1.13% vs 5.54±0.53% (P<0.01);③By calculating the ratio of positive rates of PCNA to apoptosis and Cyclin E to apoptosis respectively,the ratio of balloongroup was higher than that of stent group.【Conclusion】Stent group induces augmented proliferation and much more significant apoptosis of media smooth muscle cells compared to balloon group.It shows that the severity of restenosis is relieved after stent implantation.

Clinical application of renal scintigraphy in elder renal arterial stenosis / 中国介入心脏病学杂志

Objective To evaluate the forecasting value of renal scintigraphy (ECT) on the diagnosis of renovascular hypertension (RVH). Methods Twenty-four cases of coronary heart disease and hypertension were selected. All of them were suspected of RVH. They underwent ECT and renal arterial angiography (RAA). Results The 24 cases were diagnosed as RVH. The diagnostic sensitivity of renal scintigraphy in RVH was 83.3% (P

Early experience of carotid artery stenting with distal filtration device--4 cases report / 中国介入心脏病学杂志

Objective The purpose of this study was to assess the effectiveness and safety of distal filtration protection devices during carotid artery stenting.Methods Between June and July in 2002, carotid artery stenting (CAS) were performed in 4 patients with asymptomatic severe carotid artery stenosis. Self-expendable stents (Smart, Cordis) and distal filtration devices (Angioguard XP, Cordis) were used in all patients. Primary endpoints were perioperative neurologic complications and mortality. Data were collected prospectively.Results All patients were male, their age were 59?4 years old. One patient had history of transient ischemic attacks(TIAs); and another had inferior myocardial infarction, and right coronary intervention was performed before CAS, and another one underwent CABG 6 months ago. There were two right internal carotid and two left internal carotid severe lesions (82.5?6.0)% were treated. The filtration devices and stents were delivered and deployed successfully in all target artery (technical success rate was 100%) and

One year effect of rapamycin eluting stent in patients with coronary heart disease / 介入放射学杂志

Objective To evaluate the long-term results of rapamycin eluting stent in patients with coronary heart disease.Methods From Dec. 2001 to Nov. 2002, 143 patients were treated with 173 rapamycin eluting stents. Sixteen stents were implanted directly, the others were implanted with pre-dilation. Post-dilations were performed in 52 stents. All patients were administered aspirin and clopidogrel regularly before and after the procedures. Results Procedural succees rate reached 99.3% with completion of the follow-up in 138 patientes averaging (12.8 ?4.3) months. Thirteen patients has suffered with recurrent angina and 1 had acute myocardial infarction. Thirty eight patients received repetition of coronary angiography within 6 to 12 months after the procedure. Five patients showed instent restenosis, of which 4 received target lesion revascularization. The restenosis rate was 13.2% by angiography.Conclusion Rapamycin eluting stent can be used safely and effectively in patient with coronary heart disease, having long-term effect to reduce the restenosis rate after PCI.