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BACKGROUND@#Preliminary studies have indicated that Shexiang Baoxin Pill (MUSKARDIA) has a coronary artery dilation effect and increases the coronary blood flow, relieving the symptoms of angina. This study aimed to evaluate the benefit of MUSKARDIA on patients with stable coronary artery disease (CAD) and diabetes mellitus (DM).@*METHODS@#This was a subgroup analysis of a multicenter, randomized, placebo-controlled phase IV trial. CAD patients with a medical history of DM or baseline fasting blood glucose (FBG) ≥7.0 mmol/L were grouped according to the treatment (standard therapy plus MUSKARDIA or placebo). The primary outcome was major adverse cardiovascular events (MACEs), which was the composite outcome of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. The secondary outcome was the composite outcome of all-cause death, non-fatal myocardial infarction, non-fatal stroke, hospitalization for unstable angina or heart failure, and coronary angioplasty.@*RESULTS@#MACEs occurred in 2.6% (9/340) and 4.8% (18/376) of patients in the MUSKARDIA and placebo groups, respectively ( P = 0.192). Secondary composite outcome was significantly less frequent with MUSKARDIA than with placebo (15.3% [52/340] vs . 22.6% [85/376], P = 0.017). Risk of MACEs (hazard ratio [HR] = 0.69, 95% confidence interval [CI]: 0.31-1.57) was comparable between two groups. In patients with uncontrolled DM (≥4 measurements of FBG ≥7 mmol/L in five times of follow-up), the risk of secondary outcome was significantly lower with MUSKARDIA (5/83, 6.0%) than with placebo (15/91, 16.5%) (HR = 0.35, 95%CI: 0.13-0.95).@*CONCLUSION@#As an add-on to standard therapy, MUSKARDIA shows a trend of reduced MACEs in patients with stable CAD and DM. Furthermore, MUSKARDIA may reduce the frequency of all-cause death, hospitalization, and coronary angioplasty in this population, especially in those with uncontrolled DM.@*TRIAL REGISTRATION@#ChiCTR.org.cn, ChiCTR-TRC-12003513.
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Humans , Coronary Artery Disease/complications , Diabetes Mellitus, Type 2/drug therapy , Myocardial Infarction/complications , Stroke/epidemiologyABSTRACT
Interstitial fluid (ISF) flow through vascular adventitia has been discovered recently. However, its kinetic pattern was unclear. We used histological and topographical identification to observe ISF flow along venous vessels in rabbits. By magnetic resonance imaging (MRI) in live subjects, the inherent pathways of ISF flow from the ankle dermis through the legs, abdomen, and thorax were enhanced by paramagnetic contrast. By fluorescence stereomicroscopy and layer-by-layer dissection after the rabbits were sacrificed, the perivascular and adventitial connective tissues (PACTs) along the saphenous veins and inferior vena cava were found to be stained by sodium fluorescein from the ankle dermis, which coincided with the findings by MRI. The direction of ISF transport in a venous PACT pathway was the same as that of venous blood flow. By confocal microscopy and histological analysis, the stained PACT pathways were verified to be the fibrous connective tissues, consisting of longitudinally assembled fibers. Real-time observations by fluorescence stereomicroscopy revealed at least two types of spaces for ISF flow: one along adventitial fibers and another one between the vascular adventitia and its covering fascia. Using nanoparticles and surfactants, a PACT pathway was found to be accessible by a nanoparticle of <100 nm and contained two parts: a transport channel and an absorptive part. The calculated velocity of continuous ISF flow along fibers of the PACT pathway was 3.6‒15.6 mm/s. These data revealed that a PACT pathway was a "slit-shaped" porous biomaterial, comprising a longitudinal transport channel and an absorptive part for imbibition. The use of surfactants suggested that interfacial tension might play an essential role in layers of continuous ISF flow along vascular vessels. A hypothetical "gel pump" is proposed based on interfacial tension and interactions to regulate ISF flow. These experimental findings may inspire future studies to explore the physiological and pathophysiological functions of vascular ISF or interfacial fluid flow among interstitial connective tissues throughout the body.
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Objective@#To evaluate the efficacy of paclitaxel-coated balloon for de novo coronary lesions with diameters ≥ 2.8 mm.@*Methods@#This prospective study included 215 consecutive patients with 238 de novo lesions, who received paclitaxel-coated balloon angioplasty in Beijing Hospital from May 2014 to June 2016. According to the reference vessel diameter, the patients were divided into large vessel disease (LVD) group (reference vessel diameter≥2.8 mm, 85 patients and 90 lesions) and small vessel disease (SVD) group (reference vessel diameter<2.8 mm, 130 patients and 148 lesions). Clinical characteristics, interventional procedures and major adverse cardiovascular events (includingall-cause mortality, non-fatal myocardial infarction and target lesion revascularization) after procedure were compared between the 2 groups.@*Results@#(1)Patients in LVD group were younger than SVD group ((60.1±11.1) years old vs. (65.0±10.6) years old, P<0.01), and less patients had diabetes (24.7% (21/85) vs. 43.1%(56/130), P<0.01).(2)Prevalence of three-vessel disease (35.5%(30/85) vs. 53.6%(67/130), P<0.05) and complex lesions (type B2/C,34.4% (31/90) vs. 50.0%(74/148), P<0.05) were significantly lower in LVD group than in SVD group.(3) During pre-dilation, the rate with plain balloons use was significantly higher in SVD group than in LVD group(76.4%(113/148) vs. 58.9%(53/90), P<0.01), while the proportion of additional use of non-compliant balloons was significantly higher in LVD groupthan in SVD group(20.0% (18/90) vs. 3.4% (5/148) , P<0.01). The ratio of paclitaxel-coated balloon diameter/RVD was significantly lower (0.87±0.12 vs. 0.96±0.15, P<0.01) and the duration of dilationwas significantly shorter ((41.5±9.5) seconds vs. (45.1±9.1) seconds, P<0.01) in LVD group than those in SVD group. Each group had 1 failure case that was bailout stented with drug-eluting stents. The success rate of paclitaxel-coated balloon treatment was similar in LVD group and SVD group (98.9% (89/90) vs. 99.3%(147/148), P>0.05).(4) At the fourth day of procedure, there was 1 acute myocardial infarction requiring emergent target lesion revascularization in SVD group. No major adverse cardiovascular event was observed in LVD group during hospitalization. Forty-two patients with 53 lesions, including 27 LVD lesions and 26 SVD lesions,underwent coronary angiography at (9.4±4.6) months after paclitaxel-coated balloon intervention. The quantitative coronary angiography analysis showed that minimal lumen diameter significantlyincreased during follow-up than that of post-procedurein SVD group ((1.71±0.36)mm vs. (1.52±0.30)mm, P<0.05) , while in LVD group the minimal lumen diameter was similar between during follow-up and post-procedure ((2.35±0.48)mm vs. (2.19±0.34)mm, P>0.05). Major adverse cardiovascular event rate was 0 in LVD group and 2.3%(3/130) in SVD group (P>0.05) during follow up. No death was observed in this patient cohort.@*Conclusion@#Treatment with paclitaxel-coated balloon for de novo coronary lesions with diameters≥2.8 mm is safe and effective.
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Objective To investigate the clinical,laboratory and MRI imaging features of a spontaneous spinal subarachnoid hemorrhage(S-SAH)so as to improve the recognition of spontaneous (S-SAH).Methods The data of clinical,laboratory,MRI imaging features,treatment and prognosis of the spontaneous(S-SAH)were collected and statistically analyzed.Relevant literatures were then reviewed.Results The patient was a 75-year-old woman with neuromyelitisoptica spectrum disorders.During the course of hospitalization for intravenous infusion of high-dose methylprednisolone,the patient suffered from a sudden and severe migrating back pain that gradually progressed from the back to the neck and head,and signs of meningeal irritation occurred.After the exclusion of aortic dissection,acute coronary syndrome,pulmonary embolism,and fractures,further MRI scans of the head and spinal cord were performed.The MRI confirmed subarachnoid hemorrhage located in spinal cord and posterior cranial foss,and the diagnosis was spontaneous S-SAH.Conclusions Migrating back pain combined with signs of meningeal irritation is a characteristic clinical manifestation of S-SAH,and a prompt MRI evaluation of spinal cord is helpful to improve the early diagnosis and treatment.
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Objective To analyze the clinical characteristics of hospital-acquired pneumonia in bedridden patients aged 90 years and over.Methods From January 1,2015 to August 1,2015,40 bedridden elderly patients(≥90 years)with hospital-acquired pneumonia admitted to Beijing Hospital were assigned into the observation group,with 40 non-bedridden elderly patients (≥ 90 years)with community acquired pneumonia serving as the control group.Basic clinical data,infection symptoms and inflammation markers,and changes in serological test results before and after pneumonia were compared between the groups.Results Compared with the control group,the observation group had much lower body mass index(20.7± 1.2)kg/m2 vs.(25.1 ± 3.1) kg/m2 (t=-8.43,P＜0.01),and was accompanied with more diseases and associated with more symptoms during infection (all P＜ 0.05).Meanwhile,patients with lung infections in the observation group were more likely to have atrial fibrillation,often with increased levels of brain natriuretic peptide(1 047.9 ± 193.5) pg/L vs.(3 387.8± 763.8) μg/L (t =-3.39,P＜0.01) and abnormalities in troponin,but without obvious elevations of inflammatory markers such as white blood cells,C reactive protein and procaleitonin.Conclusions Bedridden patients aged 90 years and over with hospital-acquired pneumonia may show atypical clinical presentations and increased accompanying symptoms.Comprehensive geriatric assessment is critical for good prognosis.
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Objective To evaluate the efficacy and safety of Paclitaxel drug coated balloon (DCB) (SeQuent Please) in an elderly patients with de novo coronary disease.Methods We performed a retrospective study of 158 consecutive patients (63 patients aged ≥65 yrs and 95 patients aged ＜65 yrs) received DCB therapy in Cath Lab of Beijing Hospital.Clinical characteristic was recorded and coronary angiography was analyzed with quantitative coronary angiography (QCA) software.Results In elderly group,more patients have hypertension (65.1％ vs.56.8％),atrial fibrillation (7.9％ vs.2.1％),previous percutaneous coronary intervention (PCI) history (44.4％ vs.23.2％,P＜0.01) and non ST-elevated myocardial infarction (NSTEMI) (14.3％ vs.4.2％,P ＜0.05).In non-elderly group,more patients were male (71.6％ vs.50.8％,P＜0.05) and current smoker (52.3％ vs.30.2％,P＜ 0.01).Old patients had more complicated lesions,especially calcified lesions (36.8％ vs.14.0％,P＜0.01).Despite of that,our study showed a higher success rate of PCI in elderly group.Both groups of patients showed significant acute gain in minimal lumen diameter (MLD) after DCB released.At 4 days post-operation,there was one case that underwent acute myocardial infarction requiring emergent target lesion revascularization (TLR) in non-elderly group.No major adverse cardiac event (MACE) was observed in the elderly group during hospitalization.Twenty-one patients underwent coronary angiographic followed up at average 9 months post PCI.The QCA analysis showed that MLD of lesions treated with DCB had mildly increased [(2.00±0.67) mm vs.(1.91 ± 0.47) mm,P＞0.05],the late lumen loss (LLL) was (-0.09±0.50) mm.At 9 months follow-up,the MACE rate in the elderly group was 1.6％ and 1.1％ in non-elderly group,with TLR rates at 0.0％ and 1.1％ respectively (both P＞0.05).No death was observed in either group.Conclusions The efficacy and safety of DCB on the elderly patients with de novo lesions is as good as non-elderly patients despite more complex anatomy and comorbidities.
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Four cases of pituitary acromegalic cardiomyopathy were reported and relative literature was reviewed in this article.Four patients were all males aged 45-63 y.The patients were diagnosed as pituitary adenoma,then NYHA grade Ⅲ-Ⅳ heart failure developed.One patient had both acromegaly and coronary heart disease,and all patients had arrhythmia attacks.The growth hormone levels were not under control in 3 patients,and for the remaining patient with normalized growth hormone the end-stage heart failure also developed.The onset of pituitary acromegalic cardiomyopathy is hidden; when the disease progresses to advanced heart failure,the prognosis would be poor in most cases.So early diagnosis and timely treatment is of great importance in acromegalic cardiomyopathy.
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ObjectiveTo study the effect of different renal functions on the prognosis of elderly patients with coronary neart disease (CHD). MethodsAll 383 patients with CHD were divided into elderly group and non-elderly group. Then patients in the elderly group were assigned to 4 groups according to the quartile of the estimated glomerular filtration rate (eGFR): GFR1 group (eGFR:1.73 m-2). All patients were followed up for 2 years, and the cumulative death rate of cardiovascular diseases and the relative risk for cardiovascular death were analyzed. Results(1)The cumulative death rate of cardiovascular diseases in elderly group was higher than that in non-elderly group (9.4vs. 1.3%, P=0. 019). (2)The cumulative death rate of cardiovascular diseases in GFR1,GFR2,GFR3 group were 6.8% ,6.3% ,4.6%, respectively, and there were no statistical differences among the three groups (P>0. 05). The cumulative death rate of cardiovascular diseases was 19.4% in GFR4 group, which was higher than that in other three groups (19.4% vs. 6.8%, P=0.038;19.4% vs. 6.3%, P=0.025 ;19.4% vs. 4.6%, P=0.009) . (3)Multivariate regression analysis revealed that eGFR was an independent prognosis factor for elderly patients with CHD, and the hazard ratio for cardiovascular death was 0. 965(95% CI: 0. 946～0. 985, P=0. 001). ConclusionseGFR is an important predictor for cardiovascular death in elderly patients with CHD.
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<p><b>OBJECTIVE</b>To evaluate the feasibility, safety and diagnostic accuracy of pharmacologic stress of (99m)Technetium-MIBI single-photon emission computed tomography (SPECT) with intravenous adenosine triphosphate (ATP) in patients with suspected coronary artery disease.</p><p><b>METHODS</b>The study group included 263 patients who were suspected of having coronary artery disease. All patients underwent (99m)Tc-MIBI myocardial perfusion imaging with ATP infusion (0.16 mg/kg body weight per min for 5 min). 20 mCi of (99m)Tc-MIBI were injected 3 minutes after the start of ATP infusion. Myocardial SPECT images were obtained 60 minutes later. Then, two days later, 20 mCi of (99m)Tc-MIBI were administered at rest and myocardial SPECT was repeated. 51 patients also underwent coronary angiography within two weeks for evaluation of sensitivity and specificity of ATP-myocardial perfusion imaging in detection of coronary artery disease. The occurrence of cardiac and non-cardiac adverse effects was carefully monitored during and after intravenous ATP infusion.</p><p><b>RESULTS</b>The ATP infusion protocol was completed in all patients. Although 59% of the patients had various kinds of adverse effects, most of them were mild. No patient required aminophyline. The most severe adverse effect was second degree type II atria-ventricular block (4/263), but all events were transient. The sensitivity and specificity of ATP-myocardial perfusion imaging were 97% and 82%, respectively.</p><p><b>CONCLUSIONS</b>It is shown that (99m)Technetium-MIBI SPECT with intravenous ATP is a safe and feasible technique for detecting coronary artery disease in patients unable to perform the exercise test.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenosine Triphosphate , Coronary Angiography , Coronary Disease , Diagnosis , Heart , Diagnostic Imaging , Sensitivity and Specificity , Technetium Tc 99m Sestamibi , Tomography, Emission-Computed, Single-PhotonABSTRACT
Objective To study the association between the plasma homocysteine level and coronary artery disease(CAD), and the methylenetetrahydrofolate reductase (MTHFR) A1298C polymorphism, the methionine synthase (MS) A2756G polymorphism and their associations to the plasma homocysteine level and CAD in the elderly . Methods One hundred and twenty-nine elderly patients with CAD documented by coronary angiogram and 48 elderly patients with normal coronary angiographic results were included in this study. Plasma homocysteine level were measured by fluorescence polarization immunoassay (FPIA) method and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to analyse the MTHFR A1298C and MS A2756G genotypes. Results The plasma homocysteine level was significantly higher in CAD group than that in the control group〔(16.2?8.6) ?mol/L vs (12.7?5.0) ?mol/L,P0.05);the prevalence of MTHFR 1298CC homozygous in the CAD patients was significantly less than that in the control group (3.1% vs 14.6%, P