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Objective To evaluate the clinical improvements after autologous bone marrow mononuclear cells (BMMNCs) percutaneously injected into coronary artery in patients with heart failure due to non-ischemic cardiomyopathy using PET myocardial peffusion/metabolic imaging.Methods From February 2011 to October 2012,40 patients with heart failure due to non-ischemic cardiomyopathy were selected.The test group including 15 patients (13 males,2 females,average age (57.5±14.5) years) received the autologous BMMNCs intracoronary injection on the basis of drug treatment.The other 25 cases (21 males,4 females,average age (58.0±12.0) years) were taken as the control group and only received the drug treatment.All patients were followed up for 24 months,and the myocardial perfusion/metabolism imaging,echocardiography,brain natriuretic peptide (BNP) test,6-minute walking experiment were performed.The data were analyzed by two-sample t test.Results During the follow-up period,the test group had no ventricular arrhythmia and other serious complications,and the patients' symptoms had been improved.There was no change in myocardial perfusion after treatment of autologous BMMNCs,but the myocardial metabolic defect by volume reduced from (43.79± 17.99) cm3 to (28.19±9.27) cm3 (t =3.33,P＜0.01) 24 months after the treatment.The myocardial metabolic defect by volume at the baseline and after 24 months in the control group was (43.30±15.70) cm3,(48.51±15.77) cm3 respectively (t=1.01,P＞0.05).In the test group,the left ventricular end-diastolic diameter decreased from (64.0±8.0) mm to (59.0±7.0) mm 24 months after the treatment (t=2.04,P＜0.05),and the left ventricular ejection fraction was significantly higher than that before treatment:(45.0±4.0) ％ vs (27.0±6.0) ％ (t =10.81,P＜0.01).Conclusion PET myocardial perfusion/metabolic imaging can be used as tools in evaluating the therapeutic effect of autologous BMMNCs in patients with heart failure due to non-ischemic cardiomyopathy.
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Objective To investigate the effectiveness and safety of drug-eluting stent implantation following rotational atherectomy (RA)for severe coronary arteries calcification in elderly patients. Methods A total of 21 patients receiving RA and drug-eluting stent implantation were enrolled in this study in our cardiology department from Sep.2014 to Sep.2017. Twenty-one patients with 27 severe calcified lesions were treated with the stent implantation following RA . The primary endpoints of the study were the immediate operation success rate and the rate of major adverse cardiac and cerebral events (MACCE)at 6 month after surgery ,including angina recurrence ,need for target vessel revascularization ,myocardial infarction ,stent thrombosis and cardiovascular death. Results 14 patients(66.7% ,14/21)received RA by using 1.5 mm burr ,and 7 patients(33.3% ,7/21)by using both 1.25 mm and 1.5 mm burrs. The average ratio of burr to artery diameter was (0.5 ± 0.1). A total of 29 stents were successfully implanted in all patients (100% ,21/21 patients).None of the patients experienced any acute coronary artery rupture or other severe complications during percutaneous coronary intervention (PCI ) after RA. Two cases (2/21 ,9.5% ) suffered from slow flow ,and the coronary blood flow was restored to TIMI grade Ⅲ after treatment. The coronary blood flow in the other 19 cases(19/21 ,90.4% )was TIMI grade Ⅲ after RA.Intravascular ultrasonography (IVUS) showed that the stents were well adhered without stent rupture and intimal tear in 12 cases(12/21 , 57.1% ) ,and postdilation was performed in 9 cases(9/21 ,42.9% ).All patients were followed up for at least 6 months ,and target vessel revascularization and death were not found. Conclusions A drug-eluting stent implantation following rotational atherectomy is effective and safe for treating severe coronary arteries calcification in elderly coronary heart disease patients. The IVUS-guided rotational atherectomy combined with drug-eluting stent implantation can reduce the risk of MACCE ,such as under-expansion stent ,stent thrombosis ,myocardial infarction ,cardiovascular death ,and improve clinical outcomes in elderly patients with severe coronary arteries calcification.
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BACKGROUND:A cardiac model can be established by finite element analysis based on patient's MRI imaging data.The established model can be used to evaluate the rheological changes of the coronary artery by liquid-solid coupling.OBJECTIVE:To establish finite element models of the heart and coronary artery in patients with type A coronary artery disease using finite element analysis software,followed by three-dimensional (3D) printing,thereby providing a scientific basis for further simulation of interventional surgery.METHODS:Three patients with type A coronary artery lesions underwent MRI scanning from the aortic arch to the apex.The MRI images were then imported into the Mimics 17.0 software in Dicom format,and a complete cardiac model involving the coronary arteries was established by modeling and geometry cleanup.The 3D model was imported into Geomagic Studio 11.0 software,and was further processed.Finally,the 3D model was imported into ANSYS14.0 finite element analysis software.The finite element model with biofunction was established by attaching the material properties,followed by 3D printing on a 3D printer.RESULTS AND CONCLUSION:The 3D finite element model of type A coronary artery lesion was established successfully in three cases.The established heart model in each case presented with grid-based hexahedral solid elements.The number of solid elements was 24 532,25 771,and 24 330,respectively.In the meanwhile,the model of each coronary branch was established:the number of element at the right coronary artery was 3 320,3 518,and 3 310;the number of elements at the circumflex branch was 1 148,1 176,and 1 164;and the number of elements at the anterior descending coronary artery was 1 025,1 049,and 1 068,respectively.Afterwards,the 3D printing was performed successfully.These results suggest that the established 3D finite element model of the heart with coronary arteries,after 3D printing,displays the right coronary artery,anterior descending artery,circumflex artery and coronary sinus clearly,which paves ways for interventional simulation.Most importantly,it lays a solid foundation for the study on the blood-vessel dual-directional coupling,which is expected to be a new scientific method for rheological research.
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Objective To assess the effectiveness and safety of paclitaxel-coated balloons for in-stent restenosis in patients aged 65 years and over.Methods Sixty elderly patients(≥65 years old)with in-stent restenosis were enrolled at the Department of Cardiology,the First Affiliated Hospital of Inner Mongolian Medical University.Based on different treatment methods for in-stent restenosis,patients were divided into the drug-eluting balloon(DEB,n=32)group and the drug-eluting stent(DES,n=28)group.The primary end point was late luminal loss,determined by angiography.Secondary end points included rates of restenosis and major adverse cardiac events (MACEs).Results Quantitative coronary angiography revealed no significant differences in baseline data At 3 months after treatment,the rate of MACEs was 28.6％ in the DES group and 12.5％ in the DEB group(P＜0.05).At 6 months after treatment,angiography showed that the (x)±s of insegment late luminal loss was(0.21±0.04)mm in the DES group versus(0.12±0.06)mm in the DEB group(P ＜0.05).Furthermore,7 of 28 patients (25 ％) in the DES group had restenosis,compared with 4 of 32 patients (12.5 ％)in the DEB group(P =0.03).Conclusions Paclitaxel-coated balloons for coronary in-stent restenosis in patients aged 65 years or over can significantly reduce the incidence of restenosis and lower the rate of MACEs.The procedure is safe with no serious complications,eliminates the need for additional stent implantation,and should be further assessed in future clinical trials.
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Objective To assess the effectiveness and safety of paclitaxel-coated balloons for in-stent restenosis in patients aged 65 years and over.Methods Sixty elderly patients(≥65 years old)with in-stent restenosis were enrolled at the Department of Cardiology,the First Affiliated Hospital of Inner Mongolian Medical University.Based on different treatment methods for in-stent restenosis,patients were divided into the drug-eluting balloon(DEB,n=32)group and the drug-eluting stent(DES,n=28)group.The primary end point was late luminal loss,determined by angiography.Secondary end points included rates of restenosis and major adverse cardiac events (MACEs).Results Quantitative coronary angiography revealed no significant differences in baseline data At 3 months after treatment,the rate of MACEs was 28.6％ in the DES group and 12.5％ in the DEB group(P＜0.05).At 6 months after treatment,angiography showed that the (x)±s of insegment late luminal loss was(0.21±0.04)mm in the DES group versus(0.12±0.06)mm in the DEB group(P ＜0.05).Furthermore,7 of 28 patients (25 ％) in the DES group had restenosis,compared with 4 of 32 patients (12.5 ％)in the DEB group(P =0.03).Conclusions Paclitaxel-coated balloons for coronary in-stent restenosis in patients aged 65 years or over can significantly reduce the incidence of restenosis and lower the rate of MACEs.The procedure is safe with no serious complications,eliminates the need for additional stent implantation,and should be further assessed in future clinical trials.
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Objective To understand the epidemiological characteristics and distribution of mild cognitive impairment (MCI) in elderly populations from Mongolian and Han nationalities living in the pastoral areas of Inner Mongolia Autonomous Region of China.Methods According to the MCI clinical diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders 4th revised edition (DSM-Ⅳ ) by American Psychiatric Association,the individuals under study were at the age of 55 or over,with Mongolian or Han ethnicities and living in the pastoral area of Inner Mongolia.Results The crude MCI morbidity rates of Mongolian and Han of the study populations in the pastoral area of Inner Mongolia Autonomous Region of China was 19.48％ (1782/9146)and the standardization morbidity was 18.98％.The crude MCI morbidity rates of both Mongolian and Han cthnicities were 17.46％ (the standardization morbidity was 16.99％) and 20.60％ (the standardization morbidity was 19.98％ ),respectively.There showed a significant positive correlation between the crude morbidities and age,also significantly increasing with the latter.In the Mongolian population,the morbidity increased from 12.17％ at the age 55-59 to 27.78％ at 85 while in the Han population,the morbidity increased from 15.50％ at the age 55-59 to 23.53％ at 85.In both the populations of Mongolian and Han,there was a statistically difference found between the morbidities of MCI ( x2=13.229,P=0.000).The morbidity was higher in Hans than in the Mongolians.However,there was no statistically significant difference noticed between the morbidities of MCI in the Mongolian males and females ( x 2 =2.376,P =0.123 ).There was statistically significant difference found between the morbidities of MCI in the Han males and females,with females having higher risk than males (x2=24.470,P=0.000).Conclusion The morbidity of MCI in the elderly Mongolian and Han populations from the pastoral area of Inner Mongolia Autonomous Region of China was considered to be quite high and correlated to age and gender.