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Cardiovascular disease is a leading cause of death among the elderly and the incidence of coronary artery disease progressively increases with advancing age.Traditional risk factors are incompletely predictive of cardiovascular disease development.With the advent of high-throughput next-generation genome sequencing technologies in recent years, some studies have indicated that aging is associated with an increased frequency of somatic mutations of hematological neoplasm-related genes in the hematopoietic system, providing a competitive growth advantage for mutant hematopoietic cells and thus allowing for their clonal expansion, a phenomenon known as clonal hematopoiesis of indeterminate potential(CHIP). CHIP is common in middle-aged and elderly populations and is associated with increased risks of hematological cancer and all-cause death.There is growing evidence that CHIP is involved in the development and progression of multiple cardiovascular disorders through the activation of inflammatory responses.In this review, we will give an overview of current advances in the understanding of clonal hematopoiesis in cardiovascular disease.
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Objective:To evaluate the diagnostic performance of non-contrast-enhanced Dixon water-fat separation Compressed SENSE (CS-SENSE) whole-heart coronary magnetic resonance angiography (CMRA) at 3.0 T on patients with suspected coronary artery disease (CAD).Method:The study complied with the Declaration of Helsinki. Local ethics committee approved this study and written informed consent was obtained from each patient. In this prospective study, from March 2021 to September 2021, 53 consecutive participants with suspected CAD who were scheduled for X-ray coronary angiography (CAG) were prospectively recruited in Zhongshan Hospital. CMRA was performed with a 3.0 T scanner without contrast agent enhancement during free breathing with Dixon water-fat separation and CS-SENSE methods. The accuracy of CMRA for detecting a ≥ 50% reduction in diameter was determined using CAG as the reference method.Results:Acquisition of whole-heart CMRA images was successfully performed in 46 (86.8%) of 53 patients with an average imaging time of (7.8±1.8) min. The sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of CMRA according to a patient-based analysis were 95.8%(95%CI 78.9%-99.9%), 81.8%(95%CI 59.7%-94.8%), 85.2%(95%CI 66.3%-95.8%), 94.7%(95%CI 74.0%-99.9%), 89.1%(95%CI 76.4%-96.4%), respectively. The areas under the receiver-operator characteristic curve (AUC) from CMRA images according to patient-, vessel-and segment-based analyses were 0.876(95%CI 0.745-0.955), 0.880(95%CI 0.814-0.929), 0.903(95%CI 0.877-0.926), respectively.Conclusion:3.0 T non-contrast-enhanced Dixon water-fat separation CS-SENSE whole-heart CMRA is a promising technique to detect clinically significant coronary stenosis on patients with suspected CAD.
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Objective@#To investigate the safety and efficacy of rotational atherectomy in the interventional treatment of coronary chronic total occlusion lesions.@*Methods@#In this retrospective study,a total of 31 consecutive patients with coronary chronic total occlusion(CTO) lesions underwent rotational atherectomy in our hospital from February 2004 to December 2016 were enrolled,and the clinical features were analyzed. Coronary atherectomy was performed if balloon failed to cross the CTO lesions or balloon could not be fully dilated in the CTO lesions after wire crossing. The definition of procedure success was defined as residual stenosis less than 20% after implantation of drug eluting stent and rotational atherectomy. After the procedure, the patients were followed up to observe major adverse cardiac and cerebral vascular events which including cardiogenic death, myocardial infarction, cerebrovascular accident, and target lesion revascularization.@*Results@#The 1.25 mm diameter burr was firstly selected in 80.6% (25/31) patients,and 96.8%(30/31) patients used only 1 burr to complete the rotational atherectomy procedure. The complication rate was 9.8% (3/31) including 1 patient with coronary dissection and 3 patients with slow flow or no flow. There was 1 patent with both coronary dissection and slow flow. The procedure success rate was 96.8%(30/31). Interventional treatment related myocardial infarction occurred in 3 patients during hospitalization.The 30 patients with procedure success were followed up 36(11, 96) months. The incidence rate of major adverse cardiac and cerebral vascular events was 13.3% (4/30), of which the cardiogenic death rate was 3.3% (1/30), the myocardial infarction rate was 6.7% (2/30), cerebrovascular accident rate was 3.3%(1/30),and the target lesion revascularization rate was 6.7% (2/30).@*Conclusion@#Rotational atherectomy is safe and effective in the interventional treatment of coronary CTO lesions.
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Objective Myocardial bridging is a congenital anomaly.However,little data is available for patients with myocardial bridging (MB) associated with acute myocardial infarction (AMI).The goals of this study are to evaluate characteristics of MB in patients with AMI.Methods From March 1999 to February 2006,137 patients with both MB and AMI,were identified by coronary angiography,including 117 men and 20 women with an average age of 60.77±12.01 years (range 30-83 years) were enrolled in the present study.Results There were 119 patients with MB at the middle segment of left anterior descending artery (LAD),15 patients at distal segment of LAD,2 patients at middle segment of left circumflex (LCX),and 1 at the proximal segment of the obtuse marginal branch (OM) of LCX.There are 36 patients with non-ST elevation acute myocardial infarction (NSTEAMI),38 patients with anterior ST elevation AMI (STEAMI),40 patients with inferior STEAMI and 23 patients with inferior-posterior STEAMI.Risk factors such as hypertension,diabetes,hyperlipidemia and smoking were not different among four groups.Patients with anterior AMI included 8 patients who showed no stenosis at the segment of MB.Conclusion Patients with MB and ST elevation AMI were mainly inferior AMI.MB might be one of the causes of AMI.
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Objective To observe the efficacy of antithrombotic treatment of acute ST-segment elevation myocardial infarction patients with failure primary percutaneous coronary intervention because of high thrombus burden,and its effect on elective percutaneous coronary intervention.Methods Eight acute ST-segment elevation myocardial infarction patients were enrolled,who suffered from failure of primary percutaneous coronary intervention because of high thrombus burden.Summarize the antithrombotic strategies in perioperative and postoperative period,the operative strategies and the follow-up coronary intervention were recorded and reviewed.Results All the patients were male and most of them had acute inferior myocardial infarction with right coronary occluded because of high thrombus burden.Four patients received thrombus aspiration and balloon dilation.One patient received thrombus aspiration and the other three patients did not receive coronary intervention.Tirofiban were given in perioperative period to all the patients.Low molecular weight heparin was given to 6 patients.Dual antiplatelet therapy was given to 6 patients (aspirin 100 mg/day plus clopidogrel 75 mg/day) and 1 patient required up-titration of aspirin to 200 mg/day.Coronary angiography were repeated (29.00 ± 23.25) days later,and the thrombus in the culprit vessels disappeared in two patients,and coronary stent implantation was performed in three patients.Conclusions The routine antithrombotic strategies play limited roles in thrombus clearance in acute ST segment elevation myocardial infarction patients with failure primary percutaneous coronary intervention because of high thrombus burden.The time for the thrombus to be totally organized and the timing of elective percutaneous coronary intervention are still uncertain and need to be further studied.
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OBJECTIVE: To assess magnetic resonance imaging (MRI) features of coronary microembolization in a swine model induced by small-sized microemboli, which may cause microinfarcts invisible to the naked eye. MATERIALS AND METHODS: Eleven pigs underwent intracoronary injection of small-sized microspheres (42 microm) and catheter coronary angiography was obtained before and after microembolization. Cardiac MRI and measurement of cardiac troponin T (cTnT) were performed at baseline, 6 hours, and 1 week after microembolization. Postmortem evaluation was performed after completion of the imaging studies. RESULTS: Coronary angiography pre- and post-microembolization revealed normal epicardial coronary arteries. Systolic wall thickening of the microembolized regions decreased significantly from 42.6 +/- 2.0% at baseline to 20.3 +/- 2.3% at 6 hours and 31.5 +/- 2.1% at 1 week after coronary microembolization (p < 0.001 for both). First-pass perfusion defect was visualized at 6 hours but the extent was largely decreased at 1 week. Delayed contrast enhancement MRI (DE-MRI) demonstrated hyperenhancement within the target area at 6 hours but not at 1 week. The microinfarcts on gross specimen stained with nitrobluetetrazolium chloride were invisible to the naked eye and only detectable microscopically. Increased cTnT was observed at 6 hours and 1 week after microembolization. CONCLUSION: Coronary microembolization induced by a certain load of small-sized microemboli may result in microinfarcts invisible to the naked eye with normal epicardial coronary arteries. MRI features of myocardial impairment secondary to such microembolization include the decline in left ventricular function and myocardial perfusion at cine and first-pass perfusion imaging, and transient hyperenhancement at DE-MRI.
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Animals , Female , Coronary Angiography/methods , Coronary Vessels/pathology , Disease Models, Animal , Embolism/pathology , Heart/diagnostic imaging , Image Processing, Computer-Assisted , Magnetic Resonance Imaging/methods , Microspheres , Myocardial Contraction/physiology , Myocardial Infarction/pathology , Myocardium/pathology , Nitroblue Tetrazolium , Staining and Labeling , Swine , Troponin T/blood , Ventricular Function, LeftABSTRACT
Objective To assess the MR characterization of coronary microembolization (CME)in an animal model as well as the evolution using MR cardiac cine,first-pass perfusion,and delay enhancement imaging.Methods Coronary microembolization models were established through intracoronary infusion of 120 000 microspheres (42 μm)into the left anterior descending artery in 1 1 pigs. Coronary angiography was performed at baseline and immediately after the injection of microspheres.MR imaging was carried out at baseline,6 hours,and 1 week after microembolization.Then,postmortem evaluation was performed using NBT and HE staining.Re-sults Coronary angiography after the injection of microspheres showed normal-appearing epicardial arteries in all animals.Coronary microembolization caused a significant decline in systolic wall thickening of the microembolized myocardial segments on cine MR ima-ges [from (42.6±2.0)% at baseline to (20.3±2.3)% at 6 hours and (31.5±2.1)% at 1 week after CME;P < 0.001 for both]. First-pass perfusion deficit was visualized at 6 hours after microembolization,and was less pronounced at 1 week.Hyperenhanced myocardium was found on delay enhancement MRI at 6 hours after microembolization in microembolized segments,but was not shown at 1 week. The microinfarcts were detectable microscopically through HE staining but invisible for the naked eye on gross NBT specimen.Con-clusion Coronary microembolization may cause a persistent decline in myocardial contraction and its MR characterization may vary with different stages.A combined use of different cardiac MRI techniques and follow-up examinations may be helpful for evaluating myocardial impairment due to coronary microembolization.
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Objective The aim of this study was to evaluate the safety and efficacy of 135 cm Corsair microcatheter inpercutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) with antegrade approach via radial artery. Methods From June 2010 to February 2014, a total of 81 patients with CTO lesions treated with 135cm Corsair microcatheter (Asahi Intec Co, Japan) and transradial antegrade approach was enrolled in this study. The success rate of CTO-PCI, the rate of Corsair microcatheter crossing the CTO lesions and the number of balloon catheters utilization were retrospectively analyzed. Unique complications related to the Corsair microcatheter were also documented. Results Success recanalization of CTO were achieved in 73 (90.1%) patients. Crossing the CTO body with Corsair microcatheter was found in 56(84.8%) patients. The number of balloon utilized after Corsair microcatheter crossing the CTO was much lower than that of patients who Corsair microcatheter failed to cross (1.3±0.6 per patient versus 2.8±1.2per patient, P < 0.05). The success recanalization rate of combined using Fielder XT guidewire with Corsair microcatheter was 51.5%. There was no complications related to Corsair microcatheter during the index procedure, no major adverse cardiac events during in-hospital clinical follow-up. Conclusions Corsair microcatheter was safe and effective in the recanalization for CTO with transradialantegrade approach. It can simplify the CTO-PCI procedure and reduce the number of balloon catheters.
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Objective To study the influence of different microembolism on left ventricular systolic synchronism in pigs by detecting the real-time dypyridamole stress contrast echocardiography (RT-MCE).Methods Eighteen miniature pigs were randomly divided into three groups and underwent microembolization injection procedure through the middle of anterior descending coronary artery with different numbers of microsphere injection,as:group A(dosage 50 thousands,3 pigs),group B (dosage 120 thousands,8 pigs) and group C (dosage 150 thousands,7 pigs).The peak values and the time-to-peak circumferential strain(Circ.Strain),radial velocity (Radial Vel.) and radial strain (Radial Strain) were obtained both at mitral valve level and papillary muscle level at left ventricle short axis views using two-dimensional speckle tracking imaging(STI)analyzed by Philips Q-Lab 8.1 workshop,respectively.Results No significant difference in the presence of contraction synchrony was observed using RT-MCE.The time-to-peak Circ.Strain of microembolism related segments were prolonged at 1 week after microembolism detecting with dypyridamole stress RT-MCE (P＜0.05,both intro-group and inter-group).While time-to-peak radial strain were extended since 6 hours after the intervention to 1 week after the procedure.Conclusions Dypyridamole stress RT-MCE can be used to measure the myocardial perfusion accurately.The elongation of time-to-peak circ.strain and radial strain were developed with time in microembolism related segments.
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Objective To assess the effect of ultrasound contrast agent SonoVue on the dimensions and systolic function of left and right ventricle in pigs. Methods Sixteen pigs were randomly assigned to two groups. Intravenous injection of 1 ml of SonoVue were given in study group, and repeated 20 min later. The control group was given the same doses of saline. Before and after the administration of contrast agent, the end-diastolic dimension (LVEDD, RVEDD). end-systolic dimension ( LVESD, RVESD) and fractional shortening(LVFS,RVFS) of left and right ventricle were measured. The time to reach the extreme value of these parameters and the time to return to the baseline were recorded. Results There was no significant difference regarding the parameters at baseline between the two groups. After injection of SonoVue,RVEDD significantly increased from (25. 88 ± 1. 38) mm at baseline to its maximum of (33. 26 ± 0. 99)mm( P < 0. 05). Accordingly,RVFS significantly increased from (26. 90 ± 1. 92) % to (33. 92 ± 2. 53) % ( P <0. 05). Meanwhile,LVEDD remarkably decreased from (38.10 ± 1. 39)mm at baseline to its minimum of (26.25 ± 0. 65)mm( P <0. 05) and LVFS remarkably decreased from (36. 24 ± 1. 93) % to (29.13 ± 3.00) % ( P < 0. 05). There was no change in the control group after administration of the saline. When SonoVue was given repeatedly, the maximum RVEDD and RVFS was (29. 98 ± 1. 23) mm and (31. 09 + 1.90) % , respectively, which had less increase compared to the first time. Minimum LVEDD and LVFS was (31. 91 ± 1, 64)mm and (32. 17 ± 2. 31)%,respectively,with less decrease compared with which at first injection. It took (10. 15±0. 59) min for the right and left ventricle to reach the extreme value and (9.00± 0. 56) min to return to the baseline at the first injection. The time used for the right and left ventricle to reach its peak change and back to baseline after second injection of SonoVue were shorter [(8.73± 0.55) min and (6.89± 0.43) min, respectively,both P <0.05]. Conclusions Administration of SonoVue was associated with acute, transient dilation of right ventricle and compression of left ventricle. The influence of SonoVue on the right and left ventricle became less at it second injection.
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Objective To prospectively evaluate the correlation between a single breath-hold three-dimensional (3 D) and several breath-hold two-dimensional (2D) delayed enhancement MR imaging sequences in the assessment of myocardial infarction size and the differences on image quality. Methods Fifteen patients with myocardial infarction underwent MR scan by using a single breath-hold 3D inversion-recovery fast low-angle shot (FLASH) sequence and several breath-hold 2D turbo-FLASH as the reference standard. Paired-samples t test was used to compare the ratio of the infarction areas in two sequences. Two-way ANOVA was used to assess the contrast-to-noise ratio (CNR) on 3D,2D magnitude-reconstructed and 2D phase-sensitive (PS) images. P value less than 0.05 was considered to indicate a significant difference. Meanwhile subjective visual evaluation was also performed to compare the image quality. Results The infarction ratio determined by 3D MR imaging 31.28% was no significant difference with that of 2D MR imaging 30.91% and had a good correlation (t = -0.505,P =0.621,r =0.990). The CNR was significantly higher in 3D and 2D magnitude-reconstructed groups than in 2D-PS group (3D and 2D magnitude-reconstructed images, 2D P5 image, 43.43±20.67 and 34.10±14.29, 7.59±2.59, respectively) (F = 24.376, P < 0.01). However, the contrast between normal and infracted myocardium was the highest in 2D-PS group with subjective visual evaluation (scores of 3D, 2D magnitude-reconstructed and 2D-PS images, 2.33, 2.13 and 2.73, respectively). On the other hand, the background noise on 2D-PS images was the highest in 3 groups (scores of 3 D, 2 D magnitude-reconstructed and 2 D-PS images, 2.67, 2.53 and 1.20, respectively). Conclusion The myocardial infarction ratio obtained with 3D MR imaging sequence is accurate, and the image quality is good.
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Objective To investigate whether timing of image acquisition influenced infarct size estimation using delayed CeMRI,and the association of left ventricular ejection fraction between magnetic resol3anee imaging and left ventrieulography Was also studied.Method From Junary 2005 to April 2006,27 first,onset AMI patients [23 male,mean age(54.3±10.5)years]were enrolledinthistudr.Allpatients receivedleft ventrictdographyas well as coronary angiography.The average checking time was(13.2±5.2)clays after the onset of AMI.MR imaging was performed with a 1.5-T magnet(SIMENS).After breath-hold eine images were acquired,patients re.ceived afI intravenous bolus of 0.05 mmol/kg Gd-DTPA at a rate of 5 ml/8.A first-pass perfusion scan was ac.qllired.Then a second bolus of 0.15 mmoVkg Gd-DTPA was give.at a rate of 2 mE/Is.After the hyperenhancement localized,the typical short axis slice with hyperenhancement WaS chosen to repeat imaging for IlleasuriIin.farct size every5minutesfrom5minutes after secondinjection ofcontrast until 20minutes.Results Twexty-seren patients showed hyperenhancement at the delayed CeMRI and hypoenhancement at the first pass enhancement(FPE).The average infarct size estimated by CeMRI WaS(17.9士9.8)%of LV nlass.Myocardial enhancement at a repesentative short-axis slice WIllS(7.2±6.2)%of LV Imss at 5 minutes,(8.5±7.4)%at 10 minutes,(7.3±6.3)%at 15 minutes and(6.9-t-6.4)%at 20 minutes respectively.There WltlS significant difference be-tween lmfninmes and 20-minutes enhancement size(P<0.05).Correlations of EF obtained by cineventriculo-grapIIy and MR irr,lg were significant(r=0.867,P<0.01).There were also correlations between infarction size and pe.k CK(r:O.819,P<O.01),a8 well ills peaI[cTNT(r=0.517,P<0.05)levels.Tuning of image acquisition iufluenced infarct size quantification using delayed CeMRI when TI Was kept constant.
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Objective To investigate the safety and efficiency of China-made stent in patients with acute myocardial infarction(AMI).Methods Thirty-six patients with AMI were enrolled in our study,with mean age(57?9.7)years old.China-made stent were implanted successfully.Eighteen patients had acute anterior myocardial infarction,14 had acute inferior myocardial infarction,2 had acute lateral myocardial infarction,2 had acute posterior accompanied with right ventricular myocardial infarction.There were 12 patients with diabetes,20 patients with hypertension,18 patients with smoking.Results Thirty-seven China-made stents were implanted in the 36 patients.There were no complications during the procedure.All have acquired TIMI 3 flow.There were no thrombosis in the stent in 20 patients at the 7-day following up.Conclusion It is safe and efficient with the China-made stent implanted in patients with acute myocardial infarction.
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Objective To understand the current status and related factors of unexpected injuries during hospitalization in old patients in Shaoxing city. Methods By way of convenient sampling methods, 850 old patients aged over 65 years were chosen from five of grade 3 hospitals in Shaoxing city. The status and consequence of unexpected injuries during their hospitalization in past one year were retrospectively investigated with face to face questionnaire at patients home. Results The occurrence of unexpected injuries in 850 hospitalization old patients were 54(6.35%) during their hospitalization in past one year. The occurrence rate in female (9.27%) was significantly higher than that in male (4.25%) (?2=7.57, P
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Induced current electrical impedance tomography (ICEIT) is a new branch of electrical impedance tomography (EIT). We have designed and set up a high accuracy ICEIT hardware system with 32 electrodes based on physical phantom, and we have brought forward a new method to reduce the additive electromotive force (EMF) in circuit of the electrode leads. By use of the technique of twisted pair wire, the additive EMF in the circuit of the electrode leads has been reduced to 10% of that before use and the precision of the system has been improved. The precision of the final results is better than 0.5% after 1000 measurement data averaged. Applying the reconstructive algorithm, we have obtained preliminary images based on physical phantom.