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Objective The establishment of the model of myocardial ischemia-reperfusion injury (MIRI) in SD rats involves lengthy time, severe damage, and death of the rats.We aimed at an efficient and rapid method for establishing an MIRI model in rats to ensure a high success rate of modeling and survival of the animals.Methods Using the trachea intubation-assisted breathing machine, we fully exposed the hearts of 80 adult SD rats (8-10 weeks old and weighing 250-300 mg) by mutilating the 2-3 intercostal muscles.Then, we rapidly positioned and ligated the left anterior descending (LAD) coronary artery for an hour, and established the model of MIRI at 48 hours after releasing the slipknot.We performed electrocardiography (ECG) before, during, and at 1 and 48 hours after operation, ligated the same part again at 48 hours postoperatively, and measured the size of the myocardial ischemia and infarction areas using Evans-TTC double staining.Results The survival rate of the 80 rats was 90% and the success rate of MIRI modeling was 86.25%.After ligation of the LAD coronary artery, ECG showed the ST segment and T wave elevation, followed by gradual decrease of the ST segment and R wave voltage, the myocardium and cardiac apex muscle grey or dark grey below the ligation slipknot.The heart rate myocardial motion amplitude were obviously reduced after ligation.Evans-TTC double staining revealed an evident myocardial infarction area at 48 hours after modeling and the ratio of the ischemia area + infarction area to the total myocardial area of the left ventricle was 0.43 to 0.55 (P>0.05) and that of the infarction area to the ischemia area + infarction area was 0.35 to 0.45 (P>0.05).Conclusion The modified rat model of MIRI can be fast and efficiently established, with a high success rate of modeling and a low mortality of the animals.
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Objective Previous studies have shown that vitamin D deficiency is closely related to cardiac remodeling. How?ever, the underlying mechanisms have not been fully elucidated. Moreover, oxidative stress plays an important role on the pathologies of cardiac remodeling. The aim of this study was to explore the influence of VD deficiency on cardiac oxidative stress and the potential sig?nal pathway. Methods The male C57 mice ( 3 weeks old) were randomly divided into three groups: vitamin D deficiency ( VDD ) group ( vitamin D deficiency feed for 10 weeks) , vitamin D deficiency ( VDA) group ( vitamin D sufficiency feed for 10 weeks) and VDD+calcitriol ( CAL) group ( vitamin D deficiency feed for 10 weeks and then vitamin D sufficiency feed and calcitriol treatment for 10 weeks) . Results There were significant differences between the VDD group and the VDA group in the left ventricular end?diastolic diameter and left ventricular mass index (3.82±0.125 mm vs 3.748±0.092 mm, P<0.05) (119.30±8.54 vs 97.60±3.65, P<0.05). The number of myocardial cells stained with 8?OHDG was higher in the VDD group compared with the VDA group ( 65. 4 ± 2. 3 vs 21. 8 ± 1. 6, P<0.05) whereas was lower after calcitriol supplement. Furthermore, the expression of thioredoxin interacting protein (TXNIP) was sig?nificantly up?regulated and the ratio of p?ASK?1/ASK?1, cytochrome C release, and caspase3 activation were increased in the VDD group . Conclusion VDD can lead to cardiac oxidative injury and the up?regulation of TXNIP and the activation of ASK?1 related apoptotic signal cascade may be involved in this procedure.
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Objective To evaluate the effect of high load application of atorvastatin on the clinical outcome of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).Methods Eighty patients diagnosed with AMI were continuously enrolled in this study and randomly divided into two groups:high dose group(n=40) and control group(n=40).Application of high load atorvastatin before operation in loading group.The levels of serum lipid and cardiac function were measured and analyzed.Results The levels of BNP((204±60.3) pg/mL vs.(328.3±67.5) pg/mL;t=1.938,P=0.0315) on 7 days after PCI and levels of LVEF((50.3±6.0)％ vs.(56.9±7.3)％;t=2.169,P=0.019) on 1 month after PCI in high dose group were significantly better than those in control group.Correlation analysis showed that the administration of statin was negatively associated with levels of BNP(r=-0.157,P=0.021) on 7 days after PCI and positively associated with LVEF(r=-0.328,P=0.026) on 1 month after PCI.Conclusion The treatment of high dose statin before PCI may reduce the ischemia-reperfusion injury and prevent the no-reflow development,which therefore improve the cardiac function of AMI patients.
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Objective Ischemic preconditioning and postconditioning can provide certain protection for myocardium .The ar-ticle was designed to observe the protective effect of salidroside on myocardial ischemia reperfusion injury ( MIRI) and explore its mech-anisms. Methods SD rats were randomly divided into 6 groups with 6 rats for each: sham operation group (S group), ischemia-reperfusion group(I/R group), salidroside preventive group(salidroside treatment followed by ischemia-reperfusion), salidroside treat-ment group (ischemia-reperfusion followed by salidroside treatment ), salidroside preventive+LY group(LY294002 preventive group) and salidroside treatment+LY group(LY294002 treatment group).Salidroside was administered once a day for three days before mod-elling in both salidroside preventive group and LY 294002 preventive group;while salidroside was given immediately after the reperfu-sion in both salidroside treatment group and LY 294002 treatment group .The same volume of NS was administered only to the rats in S group and I/R group.The PI3K inhibitor(LY294002) was given additionally 35 mins before LAD ligation in both LY294002 preventive group and LY294002 treatment group .All injections were given intraperitoneally .Akt, p-Akt, GSK-3βand p-GSK-3βin myocardium were examined with immunocytochemical method in all groups .The protein expression and phosphorrylation status of Akt /GSK-3βwere determined by western blot. Results The levels of Akt/GSK-3βin myocardium of S group(0.246 ±0.002), I/R group(0.457 ± 0.012), LY294002 preventive group(0.303 ±0.005), LY294002 treatment group(0.361 ±0.019) decreased significantly in com-parison to those of salidroside preventive group (0.857 ±0.014) and salidroside treatment group(0.683 ±0.009)(P0.05). Conclusion The result indicates that salidro-side protects myocardium against MIRI in rats .The cardioprotective effect might be associated with the increased protein expression and the phosphorylation rate of Akt/GSK-3β.
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Objective To observe the clinical efficacy and safety of ticagrelor,a new antiplatelet agent,in patients with ST-Segment elevation myocardial infarction (STEMI) underwent emergency PCI.Methods Selected 174 patients with STEMI receiving emergency PCI treatment from January 2013 to July 2014 in Nanjing General Hospital of Nanjing Military Area Command,and randomly divided into clopidogrel group (preoperative taking 600 mg of clopidogrel,n =88) and ticagrelor group (preoperative taking 180 mg of ticagrelor,n =86).Compared platelet inhibition rate,renal function before and after treatment,major clinical cardiovascular events and bleeding events 30 d after treatment,adverse drug reactions of two groups.Results (1) Arachidonic acid pathway inhibition rate of the two groups were compared,the difference was not statistically significant (P ＞0.05).Compared two groups of patients with adenosine phosphate pathway inhibition rate,ticagrelor group was higher,the difference was statistically significant ((71.82 ± 19.97) ％ vs.(38.96 ± 27.55) ％;t =-7.569,P ＜0.001).(2) Compared major cardiovascular events of ticagrelor group(5 cases) and clopidogrel group (15 cases),ticagrelor group was decreased.There was significant differences (P =0.02) between the two groups.Bleeding events compared to between ticagrelor group (15 cases) and clopidogrel group (11 cases),no statistically significant difference was found(P =0.617).Conclusion Clinical efficacy of ticagrelor in acute ST-segment elevation myocardial infarction treated with primary PCI is superior to clopidogrel in which can reduce the risk of cardiovascular events in patients and without an increase in severe bleeding.
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<p><b>OBJECTIVE</b>To investigate the relation of epicardial adipose tissue volume (EATV) determined by dual-source CT (DSCT) cardiac angiography and EAT-derived inflammatory factors to coronary heart disease (CHD) and vulnerable plaque.</p><p><b>METHODS</b>A total of 260 patients underwent cardiac computed tomography to evaluate stenosis of coronary artery, and blood samples were obtained from each patient. CHD was confirmed in 180 patients by DSA and CHD was excluded in the remaining 80 patients (NCHD). Vascular remodeling index and plaque vulnerability parameters (fatty volume, fibrous volume and calcification volume and fiber volume) were measured in CHD patients and correlation with EATV was analyzed. Epicardial adipose tissue (EAT) and intrathoracic adipose tissue (TAT) were collected from 40 CHD patients undergoing CABG surgery, and, mRNA and protein expressions of leptin and MMP9 were detected by RT-PCR and Western blot analysis.</p><p><b>RESULTS</b>(1) The EATV was significantly higher in the CHD group than in NCHD group ((121.2 ± 40.6) mm³ vs. (74.7 ± 18.1) mm³, P = 0.01). (2) Subgroup analysis of the CHD patients demonstrated that EATV was significantly higher in patients with positive remodeling than in patients without positive remodeling ((97.6 ± 42.0) cm³ vs. (75.5 ± 25.4) cm³, P = 0.01). Lipid plaque volume was positively correlated with EATV (r = 0.34, P = 0.002); however, fiber plaque volume was negatively correlated with EATV (r = -0.30, P = 0.008). (3) Logistic regression analysis indicated that EATV was an independent risk factor for positive vascular remodeling (OR = 2.01, 95% CI: 1.30-2.32, P = 0.01). (4) mRNA and protein expression of leptin and MMP9 in EAT was significantly upregulated in 40 CHD patients who received CABG surgery compared to 40 NCHD patients (P < 0.01). However, there was no significant difference (P > 0.05) in mRNA and protein expression of leptin and MMP9 from the SAT between CHD and NCHD patients. (5) In the CHD group, leptin and MMP9 levels in EAT and EATV were positively correlated with lipid plaque volume and fibrous plaque volume (P < 0.05).</p><p><b>CONCLUSIONS</b>EATV is an independent risk factors of coronary heart disease and plaque vulnerability; EAT secretion of inflammatory cytokines from CHD patients is significant increased compared to NCHD patients, EAT secretion of inflammatory cytokines are positively correlated with EATV, both of which are determinants affecting vascular remodeling. Reducing EATV might help to attenuate inflammation and plaque vulnerability and reduce the risk of coronary heart disease.</p>
Subject(s)
Humans , Adipose Tissue , Angiography , Atherosclerosis , Calcinosis , Constriction, Pathologic , Coronary Artery Disease , Diagnosis , Fibrosis , Leptin , Pericardium , Plaque, Atherosclerotic , Risk Factors , Tomography, X-Ray ComputedABSTRACT
To describe a case with acute myocardial infarction caused by gastric carcinoma-associated thrombotic thrombocytopenic purpura. A 79-year-old man was admitted with abdominal pain and pyrexia. He later developed cardiac complications and microangiopathy that indicated worsening progression. Manifold evidence confirmed the diagnosis of myocardial infarction caused by thrombotic thrombocytopenic purpura. The patient was treated mainly with plasma transfusion incorporated with steroids. This case should remind physicians to consider microangiopathy as a differential diagnosis in patients with unexplained cardiac symptoms or atypical presentation. Early diagnosis and treatment are helpful in decreasing the sequelae of this syndrome
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One hundred and eleven patients with acute myocardial infarction and without known diabetes mellitus who underwent continuous glucose monitoring were divided into normoglycemia(n = 30),transient hyperglycemia(n = 36),and persistent hyperglycemia(n = 45)groups.Compared with other two groups,higher mean blood glucose,standard deviation of blood glucose,largest amplitude of glycemic excursions,mean amplitude of glycemic excursions,and absolute mean of daily differences were observed in the patients with persistent hyperglycemia group(all P<0.01),who were more likely to be female with the history of hypertension and old myocardial infarction(all P<0.05).It was shown that the levels of aspartate aminotransferase,creatine phosphokinase(CK),CK-MB,total cholesterol,triglyceride,low-density lipoprotein cholesterol,HbA1C,and C reactive protein levels were higher in these patients(P<0.01).
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Objective To explore the disparity of severity of cardiac dysfunction and recovery among different glycometabolic patients in the early phase of acute myocardial infarction (AMI) . Methods Consecutive 111 AMI patients without known diabetes underwent continuous glucose monitoring. Patients with different glycometabolic status were compared in terms of cadiac dysfunction and recovery at admission and 3month follow up. Results Compared to patients with normglycemia and transient hyperglycemia, patitents with persistent hyperglycemia were more likely to grade Killip Ⅱ or above,which were 13.3% (4/30) ,33. 3% ( 12/36) ,55. 6% (25/45), 20. 0% ( 6/30), 41.7% ( 15/36 ) and 93.3% (42/45) ( Ps ＜ 0. 01 ). In-hospital left ventricular ejection fraction (LVEF), mitral valve protodiastolic E peak velocities (E) and its ratio to late diastolic (E/A) decreased significantly ( LVEF :0. 52 ± 0. 02,0. 48 ± 0. 01 and 0. 37 ± 0. 02; E: [0. 65 ± 0. 41]m/s,[0.55 ± 0.02] m/s and [0.39 ±0. 12]m/s;E/A:1. 15 ±0.08,1.02 ±0.06 and 0.61 ±0.02,respectively) ( Ps ＜ 0. 01 ), whereas LVESV and WMSI increased significantly ( LVESV: [25.83 ± 0. 51] ml,[31.26 ± 1.23] ml, [37, 72 ± 1.01] ml; WMSI: 1.5 ± 0. 3,1.8 ± 0. 2 and 2. 6 ± 0. 4, respectively) ( Ps ＜ 0. 01 )There months after AMI,patitents with persistent hyperglycemia were more likely to grade NYHA Ⅱ or above compared to patients with normglycemia and transient hyperglycemia [67.5% (27/40), 10.0% (3/30) and 11.8% (4/34),respectively] (P ＜0. 01 ). Echocardiographic recovery was observed in each group,but less in persistent hyperglycemia patients. Conclusion Cardiac function of patients with persistent hyperglycemia suffered more severely from AMI and difficult to recover.
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Objective To evaluate efficacy and safety of fixed combination of nitrendipine and atenolol in treatment for patients with mild to moderate essential hypertension and their optimal dosage matching.Methods Totally,275 patients with essential hypertension were selcted from seven hospitals in Shanghai,Nanjing and Suzhou,China and randomized into five groups with same proportional probability in a double-blind,double-dummy,parallel active-controlled,multi-center clinical trial,receiving fixed combination of nitrendipine and atenolol at three different dosage matching (nitrendipine/atenolol 5/12.5 mg,5/10 mg,5/7.5 mg for groups 1,2 and 3),and nitrendipine (10 mg for group 4) or atenolol (25 mg for group 5),respectively for eight weeks.Results Mean reduction of diastolic blood pressure (DBP)was (17±7) mm Hg,(18±9) mm Hg and (17±7) mm Hg for groupl,2 and 3,respectively from the baseline,significantly greater than that in groups 4 and 5[(13±7) mm Hg and (12±6) mm Hg,respectively].Mean reduction of systolic blood pressure (SBP) was (21 ±11)mm Hg,(24±12) mm Hg,(23±11) mm Hg,(19±13) mm Hg and (18±9) mm Hg,respectively for the five groups from the baseline,and the reduction in group 2 was significantly greater than that in group 5,with an overall efficacy of 94.4%,98.1% and 88.2% for groups 1,2 and 3,respectively,all statistically higher than that in group 5 (71.4%) with P＜0.01,eight weeks after treatment.The ratio of patients with increased dose of antihypertensive agents in week 5 was lower in group 2 than that in the other four groups,with mild adverse reaction only,no obvious change in laboratory biochemical examinations,and no needs in special management.Conclusions Fixed combination of atenolol and nitrendipine with an optimal doses of 5 mg and 10 mg respepctively was effective and safe for mild and moderate hypertension with good tolerance.
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Objective To investigate possible changes of lipoprotein(a) [Lp(a)] and oxidized Lp (a) [ox-Lp(a) ] levels after PCI and it mechanisms. Methods Bloods were selected from 75 patients with ACS undergoing PCI, and at 24 hours, 2 and 3 days, and 6 months pre-and post-PCI treatment, and from 29 control patients pre-and post-coronary angiography without undergoing PCI. The levels of Lp(a) , ox-Lp(a) , Lp(a) immune complexes (IC) and its autoantibody were determined by ELISA. The extents of CAD were determined by coronary angiography. The differences of variants pre-and post-operations were analyzed by paired samples t test. The differences of levels of Lp(a) and ox-Lp(a) among time points after PCI were analyzed by ANOVA. Correlations between Lp(a) and ox-Lp(a) , and between angiographic variables and Lp(a), ox-Lp(a) levels were calculated. Results Compared to pre-PCI, Lp(a) [233.10 (152.86-328.79) mg/L vs 202.05 (106.15-271.42) mg/L, t=6. 81, P<0.01], ox-Lp(a) [19.05 (10.98-31.80) mg/L vs 10. 51 (4.98-17.97) μg/ml, t = 13. 22,P <0. 01] and Lp(a)-IC [2.72 (1.604.91) AU vs 2. 11 (1.04-3. 97) AU, t = 3. 34, P < 0. 01 ] levels significantly increased immediately in post-PCI, while its antoantibody levels significantly decreased (A = 0. 81 ± 0. 33 vs A = 0. 72 ± 0. 28, t = 5.58, P < 0. 01). Strong correlations were noted between levels of ox-Lp( a) and Lp( a) both in pre-PCI (r =0. 66, P <0.01) and post-PCI (r = 0. 62, P <0. 01). PCI resulted in rapidrise of Lp(a) and ox-Lp(a) levels and then decreased quickly in 24 hours, returned to baseline in 2-3 days. The changes of Lp(a) and ox-Lp(a) levels in pre-and post-PCI were positively related with severity of ACS. In contrast, in the angiography-only control group, no significant changes were noted in Lp(a) , ox-Lp(a) , Lp(a)-IC and Lp(a) autoantibodies levels between the pre-and post-angiography samples. Conclusion PCI results in acute plasma acute increases of levels of Lp(a) and ox-Lp(a) ,and the changes are related with lesion severity of the coronary artery.
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Objective To approach the effect of hyperglycemia on admission on the prognosis in female pa-tients with acute myocardial infarction (AMI) during hospital stay. Methods 171 female AMI patients without a history of diabetes mellitus from January 1998 to December 2007 were divided into 3 groups according to the blood glucose level on admission. Group Ⅰ included 69 cases with blood glucose <6. 1 mmol/L,group Ⅱ included 49 cases with blood glucose between 6.1 and 7.8 mmol/L,and group Ⅲ included 53 cases with blood glucose >7.8 mmoL/ L. The basic clinical profile, infarct sites, the incidence rates of the main complications and the mortality of the pa-rhythmia among group Ⅲ ,group Ⅰ and group Ⅱ were significantly different ( the incidence rate of cardiac failure was 30.43% (21/69) ,32.65% (16/49) and 58.49% (31/53), the incidence rate of cardiogenic shock was 5.80% (4/69) ,8.16% (4/49) and 24.53% (13/53) ; the incidence rate of severe arrhythmia was 24.64% (17/69) ,30. 61% (15/49) and 54.72% ( 29/53), respeetivley in group Ⅰ, group Ⅱ and group Ⅲ, P < 0.05 for each). The in-hospital mortality in group Ⅲ (28.30% (15/53) ) was remarkably higher than group Ⅰ ( 13.04% (6/69)) ,with significant difference ( P < 0.05 ). Conclusions Elevated blood glucose level on admission is associated with s markedly increased risk of cardiac failure,severe arrhythmia,cardiogenic shock and mortality during hospital stay in female patients suffering from AMI.
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Objectives To explore cholesteryl ester transfer protein(CETP)level in male patients with different degrees of coronary artery lesion and its clinical significance.Methods ELISA was used to measure CETP of 42 male patients with coronary heart disease(CHD)and 49 healthy male controls.The patients of CHD groups were subdivided into mono-vessel,ambi-vessel,multi-vessel lesion groups;localized,diffuse lesion groups;and mild,severe stenosis groups according to coronary angiography.Results The CETP level of patients with CHD(1.37?1.07 mg/L)was significantly higher than that of healthy control(0.99?0.53 mg/L)(P
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Objective: To assess the regional systolic and diastolic function of left ventricle by pulsed wave Doppler tissue imaging ( PW-DTI) in patients with coronary artery disease ( CAD ) . Methods : Seventy-seven cases of coronary angiography were adopted for study and grouped in terms of severity of coronary arterial lesion. Peak systolic, peak early diastolic, and peak late diastolic motion velocities (Sm, Em and Am, respectively) were recorded at 6 different sites on the basal and medial segments corresponding to the anteroseptal, posteroseptal, lateral, anterior, inferior, and posterior walls of the left ventricle with PW-DTI. Results: Am in segments corresponding to normal coronary arteries (group A) was lower than in segments corresponding to slightly stenosed coronaries (group B). There was no significant difference in Sm and Em between group A and group B. Compared with group A, Sm, Em and Am were significantly decreased in segments corresponding to severely stenosed coronary arteries ( group D). Conclusion : PW-DTI could be used to evaluate quantitatively and accurately the regional mvocardial function of left ventricle in patients with CAD.
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Objective:TO investigate the effects of the different factors on the quality control of PCI. Methods: Elucidating the correlation of PCI with the different personnel. Results: Success or failure of PCI is related to quality of subsystems in which the most importance is to manage and control concerning personnel including operating staff,nurses and patients. Conclusion:The organic coordination and total quality management of all parts are the safeguard of successful PCI.
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100 U/L were higher than those in group of CK-MB≤100 U/L(P
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Echocardiography was once clinically considered as a tool for diagnosing coronary artery disease with limited sensitivity and specificity. Recently with the developments of modern electronic technologies,limitations of poor image quality were overcome and several new technical modalities,such as color kinesis(CK),Doppler tissue imaging(DTI)and anatomic M-mode echocardiography(AME)have been demonstrated to be useful for enhancing the accuracy and clinical applicability of the echocardiography. These new noninvasive ultrasonic technologies,adding more direct and quantitative information on specific topics of cardiac function,may play an important role in the study of coronary artery disease.
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Objective: Oxidized low density lipoprotein(ox-LDL) plays an important role in the pathogenesis and development of atherosclerosis.The aim of this study was to explore the relationship of the ox-LDL level with the severity and risk factors of coronary heart disease(CHD).Methods: A total of 164 patients undergoing coronary angiography(CAG) were assigned to a control group(n=29) and a CHD group(n=135) according to the results of CAG.The samples of fasting plasma were collected,and the levels of ox-LDL were detected by ELISA.Based on different criteria of classification,the CHD patients were again divided into the following subgroups: acute myocardial infarction(AMI),unstable angina(UA),stable angina(SA),single-vessel disease(SVD),double-vessel disease(DVD),multi-vessel disease(MVD),localized lesion,diffuse lesion,slight stenosis group,moderate stenosis,and severe stenosis.Results: The level of ox-LDL was higher in the AMI(85.60 ? 29.21 ?g/ml) than in the UA(72.54 ? 27.75 ?g/ml) and SA groups(72.93 ? 26.50 ?g/ml),with statistically significant differences(P = 0.05 and P = 0.06).It was significantly higher in the MVD(83.78 ? 29.66 ?g/ml) than in the SVD group(68.57 ? 26.50 ?g/ml,P
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Objective:To study the significance of low-density lipoprotein immune complexes(LDL-IC) in the pathogenesis of complicated coronary lesion.Methods:Enzyme-linked immunosorbent assay(ELISA) was used to measure the serum LDL-IC in 139 patients with coronary heart disease and 111 normal controls.The patients were divided by coronary angiography into a multi-vessel diseased group,an ambi-vessel diseased group,mono-vessel diseased group;diffuse lesion group,a located lesion group,a serious stenoses group and a light stenoses group.Results: The LDL-IC level was significantly higher in the multi-vessel diseased group than in the ambi-vessel diseased group([2.75?1.22]AU vs [2.35?0.83]AU,P
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Objective:To study the significance of LDL immune complexes in the pathogenesis of acute coronary syndrome(ACS).Methods:Enzyme linked immunosorbent Assay was used to measure the plasma LDL-IC in 139 patients with coronary heart disease(76ACS;63NACS) and in 111 control subjects.The patients with coronary heart disease were divided into multi-vessel diseased group(2-vessel diseased group and 2 vessels more)and mono-vessel diseased group(1-vessel diseased group)by coronary angiography.Results:①LDL-IC level was higher in patients with ACS than that in patients with non-ACS[(2.78?1.08)AU vs(1.74?0.45)AU,P