Changes of plasma CD40L and PAPP-A in patients with acute coronary syndrome after the PCI operation / 中南大学学报(医学版)

OBJECTIVE@#To observe the changes and significance of plasma CD40L and pregnancy-associated plasma protein-A (PAPP-A) in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI) operation.@*METHODS@#According to the occurrence of primary heart events or restenosis 6 months after the PCI, 68 patients were divided into the ACS group and the stable angina pectoris (SAP) group. Plasma CD40L and PAPP-A after the PCI operation were measured and compared. Thirty-six patients underwent repeated angiography after the PCI. Their baseline and follow up angiograms were compared by quantitative coronary angiography to assess the incidence of restenosis.@*RESULTS@#CD40L and PAPP-A after the PCI operation were higher in the ACS group than that in the SAP group.The group having primary heart events within 6 months had higher level of PAPP-A after the PCI. The group having restenosis 6 months had higher level of PAPP-A after the PCI. The change of later loss index of coronary artery lumen diameter was correlated with PAPP-A level after the PCI.@*CONCLUSION@#CD40L and PAPP-A were higher in the ACS group, indicating the possible mechanism by which CD40L facilitates the plaque rupture via up-regulating the PAPP-A expression.Plasma PAPP-A level after the PCI possibly for cases the occurrence of primary heart events or restenosis within 6 months.

Peripheral vascular complications after the cardiac catheterization / 中南大学学报(医学版)

OBJECTIVE@#To explore the cause, the clinical manifestation and the management of peripheral vascular complications after cardiac catheterization.@*METHODS@#Clinical data of patients with peripheral vascular complications were analyzed retrospectively.@*RESULTS@#Of the 4,531 patients, 122 (2.7%) had peripheral vascular complications, including local hematoma (86 cases, 1.90%), pseudoaneurysm (15 cases, 0.33%), arteriovenous fistula (8 cases, 0.18%), femoral venous thrombosis (5 cases, 0.11%), excessive hemorrhage (5 cases, 0.11%), femoral arterial thrombosis (2 cases, 0.04%), and femoral nerve malfunction (1 case, 0.02%). All complications were relieved after conservative therapy except that one case needed surgery.@*CONCLUSION@#Peripheral vascular complications are associated with anticoagulation, diabetes, and hypertension. Prognosis of overwhelming complications is good, as long as patients are treated timely and appropriately.

Characterizations of atrial contractions triggering paroxysmal atrial fibrillation and the effect of atrial fibrillation prevention pacing / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the electrocardiographic characterizations of atrial contractions(AC) triggering paroxysmal atrial fibrillation(AF), and to explore the effects of AF prevention pacing on their electrocardiographic characterizations.@*METHODS@#Twenty-four patients with the implantation of AF therapy pacemaker(Vitatron 900E) were analyzed by AC triggering paroxysmal AF with Holter monitoring in the study. AC compluing interval, compensatory pause and frequency 2 minutes before the AF or during the AC were compared between the induced paroxysmal AF group and noinduced paroxysmal AF group, and the preventive effect of AF on the post-PAC response program was investigated.@*RESULTS@#There was significant difference in the AC compluing interval [(352.3 +/-30.4) vs (421.8 42.5)ms], compensatory pause [(963 +/-109) vs (733 +/-124) ms], and frequency [(34.8 +/-18.9) vs (12.7 +/-8.7)/min] 2 minutes before the AF or during the AC in the induced paroxysmal AF group, compared with those in the noinduced paroxysmal AF group (all P<0.05). The AF of 7 patients were controlled by atrial overdrive pacing therapy, 17 patients by post-AC-response or/and post-exercise control therapy, 6 patients by the above therapy combining with cordarone (0.2g/d).@*CONCLUSION@#AC triggering paroxysmal AF is related to the compluing interval, compensatory pause and frequency 2 minutes before the paroxysmal AF or during the AC, AF prevention pacing may be helpful for the paroxysmal AF induced by AC.

Oxidative stress and inflammation with angiographic morphology of coronary lesions in patients with coronary heart disease / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the role of oxidative stress and inflammation in the development of plaque rupture.@*METHODS@#One hundred and ten patients enrolled in this study. All patients underwent coronary angiography. It included 85 patients with coronary heart disease (CHD) and 25 controls. The angiographic morphology of plaques was analyzed. According to the morphologic types of plaque, CHD patients were divided into Type I (smooth borders) group (n=31), Type II (irregular lesions) group (n=35), and Type III (long lesions) group (n=19). All patients were measured of MDA-LDL, hs-CRP, creatine kinase (CK), and MB isoenzyme of CK (CK-MB) in the plasma.@*RESULTS@#Plasma MDA-LDL and hs-CRP in the Type II group were significantly higher than those in the control group, Type I group, and Type III group (P0.05). The plasma levels of MDA-LDL and hs-CRP had a significant positive correlation in patients in Type II group (r=0.630, P<0.01).@*CONCLUSION@#Oxidative stress and inflammation may cause plaque rupture in CHD patients. The oxidative stress is likely to either induce or intensify the inflammatory action, and may co-affect with inflammation factors to cause or accelerate plaque rupture.

Effect of atrial pacing on the sleep apnea syndrome in elderly patients / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy of atrial pacing to increase the heart rate during sleep in elderly patients with sleep apnea syndrome.@*METHODS@#Sixteen elderly patients with central type or obstructive type sleep apnea received permanent atrial-synchronous ventricular pacemakers for symptomatic sinus bradycardia were analysed in this study. All patients received polysomnographic evaluations for 3 consecutive nights. All patients were evaluated at the base-line, and then were randomly divided into 2 groups at the first night. In the following 2 nights, one group was monitored in spontaneous rhythm model and the other in dual-chamber pacing model with atrial overdrive (increasing by 15 beats per minute on the basic rate of the mean nocturnal sinus), and then the two groups were switched at the third night. The total duration and number of episodes of sleep apnea or hypopnea were analyzed, and compared between the two models.@*RESULTS@#The mean 24 h sinus rate in the spontaneous rhythm mode was 55+/-9 beats per minute at the base line, as compared in the 72+/-4 beats per minute in the atrial overdrive pacing model. There was statistic significant difference between the 2 models (P0.05 ]. The hypopnea index reduced from 9+/-3 in the spontaneous rhythm model to 3+/-3 in the atrial overdrive pacing model (P<0.01). The index of apnea and hypopnea was 28+/-21 in the spontaneous rhythm model, as compared with 10+/-13 in the atrial overdrive pacing model (P<0.01).@*CONCLUSION@#Atrial overdrive pacing can significantly reduce the number of episodes of central type or obstructive type sleep apnea, but doesn't decrease the total sleep time in elderly patients with sleep apnea syndrome.

Transcatheter closure for patent ductus arteriosus in children / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the results of transcatheter closure for patent ductus arteriosus (PDA) by different devices in children.@*METHODS@#Seventy-eight cases of PDA in children (7 months to 14 years old), diagnosed by physical examination and transthoracic 2-dimensional echocardiography (TTE), were included in the study. The examination included the cardiac catheterization, photograph of the thoracic aorta and conventional technique of PDA closure. Among these patients, 16 were treated with coils, 9 with Amplatzer duct occluder (ADO), and 53 with native produced PDA occluders.@*RESULTS@#TTE examination on the next day of the operation showed that PDAs were completely occluded in 76 cases, while the other 2 cases treated by coil had minimal residual shunt. Sixty-four patients, who were detected enlargement of the left ventricle before the operation, showed obvious diminishment of the cardiac size. By the end of 3 months, TTE examination showed that the closure of PDA was complete, and the left ventricle size was normal in 77 cases, while one case treated with coil had minimal residual shunt, which persisted for more than 4 years. The 3 - 80 months follow-up showed that the closure of PDA was complete in 77 cases, the configurations of the left ventricle, the thoracic aorta,and the left pulmonary artery were all normal. The occluders were well remained in situ.@*CONCLUSION@#The usual procedures of transcatheter closure for PDA are effective and safe with ADO, native produced occluders and coil in children. Interventional method, which shows minute insult, few complications, and few adverse effects, can substitute the thoracic surgery.