Thrombosis and morphology of plaque rupture using optical coherence tomography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Thrombosis following plaque rupture is the main cause of acute coronary syndrome, but not all plaque ruptures lead to thrombosis. There are limited in vivo data on the relationship between the morphology of ruptured plaque and thrombosis.</p><p><b>METHODS</b>We used optical coherence tomography (OCT) to investigate the morphology of plaque rupture and its relation to coronary artery thrombosis in patients with coronary heart disease. Forty-two patients with coronary artery plaque rupture detected by OCT were divided into two groups (with or without thrombus) and the morphological characteristics of ruptured plaque, including fibrous cap thickness and broken cap site, were recorded.</p><p><b>RESULTS</b>The fibrous cap of ruptured plaque with thrombus was significantly thinner compared to caps without thrombus ((57.00 ± 17.00) µm vs. (96.00 ± 48.00) µm; P = 0.0076).</p><p><b>CONCLUSIONS</b>Plaque rupture associated with thrombosis occurs primarily in plaque covered by a thin fibrous cap. Thick fibrous caps are associated with greater stability of ruptured plaque.</p>

Efficacy and safety of the treatment: combination of benazepril/lercanidipine vs. benazepril alone in patients with mild-to-moderate hypertension / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Combination therapy is an effective method to reduce the blood pressure (BP) for patients with hypertension. This study was performed to evaluate the efficacy and safety of benazepril/lercanidipine compared with benazepril alone in patients with mild-to-moderate hypertension.</p><p><b>METHODS</b>One hundred and eighty-one patients with mild-to-moderate primary hypertension were assigned in this randomized, single-blind, parallel-group study and were randomly divided into group A (benazepril 10 mg/lercanidipine 10 mg) and group B (benazepril 10 mg) for 8 weeks. At 4 weeks, the dosage of Benazepril was titrated up to 20 mg if the diastolic blood pressure (DBP) remained ≥ 90 mmHg. BP control and side effects were evaluated at the end of 1, 4 and 8 weeks.</p><p><b>RESULTS</b>The baseline characteristics of the two groups were similar. The BP in both groups decreased from the baseline (P < 0.05). At the end of 4 and 8 weeks, Benazepril/Lercanidipine produced greater BP reduction than Benazepril alone (P < 0.05). The comparison of the rate of BP control for the benazepril/lercanidipine and benazepril groups at the end of 1, 4, and 8 weeks were 41.2% vs. 37.6% (P > 0.05), 67.1% vs. 44.7% (P < 0.05), and 71.8% vs. 45.9% (P < 0.05). There was no significant difference of side effects between the two groups.</p><p><b>CONCLUSION</b>The benazepril/lercanidipine combination is more effective in reducing BP than benazepril alone, while it does not increase the incidence of side effects.</p>

Optical coherence tomography assessment of edge dissections after drug-eluting stent implantation in coronary artery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent implantation were reportedly different using different imaging techniques. We used optical coherence tomography (OCT) to assess the incidence, morphological findings and related factors of edge dissections after drug-eluting stent (DES) implantation.</p><p><b>METHODS</b>Totally 42 patients with 43 de novo lesions in 43 native arteries undergoing DES implantation with OCT imaging were enrolled in this study.</p><p><b>RESULTS</b>Nine edge dissections were detected in 43 arteries after DES implantation. There were four morphological patterns of stent edge dissections indentified in this study: (1) superficial intimal tears (n = 3), (2) subintimal dissections (n = 4), (3) split of media (n = 1), (4) disruption of the fibrotic cap of plaque (n = 1). Stent edge expansion and stent expansion were both higher in the group with dissections than those in the group without dissections (1.682 ± 0.425 vs. 1.229 ± 0.285, P = 0.0290; 1.507 ± 0.445 vs. 1.174 ± 0.265, P = 0.0072).</p><p><b>CONCLUSIONS</b>The incidence of stent edge dissections detected by OCT was 21%. Stent edge dissection is related with stent edge expansion and stent expansion.</p>

Prevention of restenosis in the canine coronary stents through local delivery of paclitaxel using the double-balloon perfusion catheter / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the safety and efficiency of local paclitaxel delivery using the double-balloon perfusion catheter to prevent restenosis in the canine coronary artery.</p><p><b>METHODS</b>Twenty domestic canines underwent bare-mental stent implantation after balloon injure of the left coronary artery. A novel double-balloon perfusion catheter was used to deliver the drug locally in the canine coronary artery. In the treatment group (n = 15), paclitaxel (10 ml, 20 micromol/L) was delivered using the double-balloon perfusion catheter before stent implantation. In the control group (n = 5), 10 ml saline was delivered using the double-balloon perfusion catheter before stent implantation. The perfusion time in both groups was (26.45 +/- 5.18) s. Animals underwent coronary angiography and optical coherence tomography (OCT) 90 days after stent implantation and were sacrificed. Vessels were perfusion-fixed and morphometric analysis was performed using conventional techniques.</p><p><b>RESULTS</b>Coronary angiography results showed restenosis rate in control group was significantly higher than that in treatment group (60% vs. 33.33%, P < 0.05). The parameters of OCT showed in treatment group and control group: the neointimal thickness was (0.19 +/- 0.08) mm and (0.38 +/- 0.03) mm, the neointimal area was (1.52 +/- 0.49) mm2 and (2.51 +/- 0.47) mm2, the lumen area was (3.50 +/- 0.66) mm2 and (2.78 +/- 0.57) mm2, the extent of stenosis was (30.13 +/- 8.56)% and (47.40 +/- 4.50)%, and all the variances above were significantly different between the two groups (P < 0.05). The histologic parameters showed in treatment group and control group: the neointimal thickness was (0.22 +/- 0.10) mm and (0.47 +/- 0.05) mm, the neointimal area was (1.85 +/- 0.78) mm2 and (3.43 +/- 0.25) mm2, the lumen area was (3.15 +/- 0.43) mm2 and (1.85 +/- 0.55) mm2, the extent of stenosis was (36.00 +/- 10.97)% and (65.40 +/- 8.23)%, and all the variances above were also significantly different between the two groups (P < 0.05). The stents of both the groups were fully endothelialized. No thrombus or aneurysm was found in stents.</p><p><b>CONCLUSION</b>Local delivery of paclitaxel with the double-balloon perfusion catheter to prevent restenosis in coronary stents is safe and efficient.</p>

Ex vivo assessment of coronary lesions by optical coherence tomography and intravascular ultrasound in comparison with histology results / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the diagnostic accuracy of optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in the detection of ex vivo coronary plaques with different compositions compared with histology results.</p><p><b>METHODS</b>OCT and IVUS were performed in 15 autopsied heart specimens and the isolated coronary artery was assessed by routine histological processing thereafter. Coronary plaques were classified into 3 types (lipid-rich plaque, calcified plaque and fibrous plaque) according to standard criteria respectively. Sensitivity and specificity for detection of different types of plaque by OCT and IVUS were calculated according histology results.</p><p><b>RESULTS</b>Seventy seven coronary plaques were analyzed. OCT demonstrated a sensitivity and specificity of 69% and 88% for lipid-rich plaque, 93% and 92% for calcified plaque, 88% and 98% for fibrous plaque. IVUS demonstrated a sensitivity and specificity of 61% and 92%, 98% and 97%, 68% and 90% respectively. The agreement between OCT and IVUS in assessment of coronary plaque was 0.831 (Kappa = 0.72, P < 0.01).</p><p><b>CONCLUSIONS</b>Both OCT and IVUS correctly detected ex vivo coronary plaques and there was a good agreement in assessment of coronary plaques between OCT and IVUS. OCT is superior to IVUS in assessment of fibrous plaque and is similar as IVUS in assessment of calcified plaque.</p>

Effects of matrix metalloproteinase-9 inhibitor in Lewis rats with experimental autoimmune myocarditis / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the effects of matrix metalloproteinase-9 (MMP-9) inhibitor minocyclin hydrochloride in Lewis rats with experimental autoimmune myocarditis (EAM).</p><p><b>METHODS</b>EAM was induced by injection of cardiac C protein emulsified in completed Freund adjuvant in double footpad and intraperitoneal injection of pertussis toxin on 6- to 8-week old Lewis rats. Sixty EAM Lewis rats were divided into 3 groups (early, middle and late intervention groups, n = 20 each: 10 minocyclin treated and 10 control rats). In early intervention group, rats in treatment group received intraperitoneal injection of minocyclin hydrochloride from 1(st) to 21(st) day after immunization; in middle intervention group, rats were treated from 8(th) to 28(th) day after immunization and in late intervention group, rats were treated from 15(th) to 35(th) day after immunization (50 mg/kg body weight, once daily). Control rats received intraperitoneal injection of same volumetric physiological saline at corresponding time periods. At the end of intervention, rats were euthanatized and hearts were harvested. Paraffin sections were used for hematoxylin and eosin stain to determine the inflammatory score, for picrosirius stain to determine fibrosis score and collagen content, and for immunohistological stain to determine macrophages and T lymphocytes. Real time PCR was used to detect mRNA expression of myocardial MMP-2 and MMP-9. Cryostat sections were used for in situ zymography to detect protein activity of gelatinase.</p><p><b>RESULTS</b>Inflammatory score in cardiac paraffin slides, number of cardiac macrophages and T lymphocytes, cardiac interstitial fibrosis score and content, expression of MMP-2, 9 mRNA and activity of gelatinase in treatment group were all significantly lower than in control group for early and middle intervention groups (inflammatory score: early control group vs. treatment group: 3.03 ± 1.35 vs.1.51 ± 0.36, P < 0.05, middle control group vs. treatment group: 3.75 ± 0.29 vs. 2.11 ± 0.82, P < 0.01; cardiac interstitial fibrosis score, early control group vs. treatment group: 2.75 ± 0.29 vs.1.51 ± 0.35, P < 0.01, middle control group vs. treatment group: 2.50 ± 0.41 vs. 1.61 ± 0.42, P < 0.05; gelatinase, early control group vs. treatment group: 162 367 ± 5095 vs. 62 366 ± 2131, P < 0.01, middle control group vs. treatment group: 184 256 ± 5427 vs. 113 197 ± 4809, P < 0.01) while these parameters were similar between minocyclin-treated and control rats in late intervention group (all P > 0.05).</p><p><b>CONCLUSIONS</b>MMP-9 plays an important role in the pathogenesis of autoimmune myocarditis. Inhibition of MMP-9 in early and middle stage could significantly attenuate inflammatory responses and myocardial fibrosis in this experimental EAM model.</p>

Evaluation of neointimal proliferation in stented canine coronary artery with optical coherence tomography / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the accuracy of optical coherence tomography (OCT) in evaluating neointimal proliferation in canine coronary artery following stenting.</p><p><b>METHODS</b>In 15 domestic dogs, a single bare-metal stent was implanted in the anterior descending or the circumflex branch of the left coronary artery. Ninety days after stenting, the dogs underwent coronary angiography and OCT, followed by quantitative histological assessment of neointimal proliferation in the target arterial segments. The parameters of OCT and the histological findings were analyzed comparatively.</p><p><b>RESULTS</b>A total of 15 OCT-histology matched frames acquired at the point with the most severe stenosis in every stent, and 60 pathological sections from all the stents were analyzed. The difference of the stent area assessed by OCT was comparable to that defined histologically (5.01∓0.79 mm(2) vs 4.99∓0.81 mm(2), P>0.05). Neointimal thickness and area were smaller with OCT assessment than with histological assessment (0.19∓0.08 mm vs 0.22∓0.10 mm, and 1.52∓0.49 mm(2) vs 1.85∓0.78 mm(2), respectively, P<0.05). The lumen area was larger by OCT assessment than by histological assessment (3.50∓0.66 mm(2) vs 3.15 ∓ 0.43 mm(2), P<0.05). Close correlations were found between OCT and histological evaluations of the neointimal thickness (R(2)=0.5280.767), neointimal area (R(2)=0.5280.537) and stent area (R(2)=0.528), but the correlation was poor for lumen area (R(2)=0.5280.307). All the stents showed full endothelialization without thrombus or aneurysm in the stents.</p><p><b>CONCLUSION</b>OCT allows precise and reproducible assessment of neointimal proliferation in the coronary artery following stenting, but for measurement of the lumen area, OCT shows a poor correlation to histological evaluation.</p>

Experimental study of MMP-2 inhibitor treatment of experimental autoimmune myocarditis in Lewis rats / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To investigate the inhibitor of matrix metalloproteinase-2 (MMP-2) (2R)-2-[5-[4-[ ethyl-methylamino] phenyl [thiophene-2-sulfonylamino]-3-methylbutyric acid (TISAM) therapeutic effect on experimental autoimmune myocarditis (EAM) in Lewis rats.</p><p><b>METHODS</b>Treatment protocol of oral administration of 5 mg/kg TISAM once a day for 14 days was performed on EAM Lewis rats. EAM Lewis rats were divided into 3 groups: treatment in early, middle and later stage respectively (n = 20). After experiment at the designate time point, the rats were euthanatized and hearts were harvested. Cardiac inflammatory score, fibrosis score and content, and infiltration of macrophages and T lyminflammatory score, fibrosis score and content, and infiltration of macrophages and T lymphocytes, message RNA (mRNA) expression of matrix metalloproteinase (MMP)-2 and MMP-9 and protein activity of gelatinase were determined.</p><p><b>RESULTS</b>TISAM treatment in early phase was invalid (treatment started from the creation of the model), treatment in middle and later phase was effective (treatment started from 7 and 14 day after the creation of the model).</p><p><b>CONCLUSION</b>Inhibitor of MMP-2 can block ventricular remodeling in middle stage in EAM Lewis rats. The mechanism maybe alleviate the inflammatory cell cardiac infiltration, decrease the mRNA expression of MMP-2 at transcript level and downregulate gelatinase activity at protein level.</p>

Lymphocyte GRK2 expression of the very elderly with chronic heart failure / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To explore the correlation of lymphocyte G protein-coupled receptor kinases 2 (GRK2) expression of the very elderly with chronic heart failure (HF) and heart ejection fraction (EF).</p><p><b>METHODS</b>16 elderly patients with chronic heart failure were divided into 2 groups as following: EF < 45% (n=7), EF > or = 45% (n=9); and health elderly as control (n=8). Lymphocytes were obtained from blood, reverse transcription polymerase chain reaction were used to measure GRK2 mRNA levels.</p><p><b>RESULTS</b>Lymphocyte GRK2 mRNA levels of EF < 45% group were higher than that of EF > 45% group, which were greater than that of control.</p><p><b>CONCLUSION</b>Elevation of lymphocyte GRK2 levels in HF is associated with heart EF, lymphocytes may provide a surrogate for monitoring cardiac GRK2 in human HF.</p>

Effect of metoprolol on the expression of GRK2 in lymphocyte of advanced elderly patients with chronic heart failure / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of metoprolol on the expression of G protein-coupled receptor kinases 2 (GRK2) in lymphocyte of advanced elderly patients with chronic heart failure.</p><p><b>METHODS</b>32 elderly patients with chronic heart failure were divided into control group and metoprolol group, 16 each. Conventional therapy was used in the control group, conventional therapy plua metoprolol was used in metoprolol group. The treatment courses were 8 weeks in both groups.</p><p><b>RESULTS</b>Left ventricular end-diastolic diameter and left ventricular ejection fraction were not different between the two groups. Lymphocyte GRK2 mRNA level in metoprolol group was lower than that in control group.</p><p><b>CONCLUSION</b>Metoprolol can inhibit the expression of GRK2 in lymphocyte of advanced elderly patients with chronic heart failure.</p>

Evaluation of the late stent malposition after drug-eluting stent implantation by optical coherence tomography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the characteristic of late stent malposition after drug-eluting stent implantation by optical coherence tomography (OCT).</p><p><b>METHODS</b>The study comprised of 32 patients (target vessels: 51, total stents: 71) underwent drug eluting stent implantation one year ago [average (14.8 +/- 5.2) months]. OCT images of the stent were analyzed at interval of 0.5 mm. The stent malposition was detected, the thickness of intima and gap between the stent strut and vessel wall were measured.</p><p><b>RESULTS</b>Stent malposition was detected in 7 patients without clinical cardiac events, including positive remodeling (n = 4), overlapping stents (n = 1) and stent struts covered with thrombus (n = 2). Stent strut apposition with complete intima coverage was about 97.6%, stent struts malposition was 2.4% including half of struts located at the ostium of side branch. The intima coverage of stent struts is similar between the struts at the side branch and others [(0.06 +/- 0.05) mm vs. (0.05 +/- 0.03) mm, P > 0.05].</p><p><b>CONCLUSION</b>The causes of late stent malposition include the primary malposition after stent implantation, positive remodeling, overlapping stents and stent struts located at the ostium of side branch. Thinner intima coverage was also observed on the stent struts with malposition.</p>

Association between stent fracture and restenosis after drug-eluting stent implantation / 中华心血管病杂志

<p><b>OBJECTIVE</b>This study was performed to evaluate the relationship between the stent fracture and restenosis after drug-eluting stent implantation.</p><p><b>METHODS</b>The study enrolled 536 patients with angiographies during stenting procedure and follow-up, the patients were divided into DES group (n=397) and BMS group (n=139). The coronary angiography images were analyzed to detect restenosis and stent fracture.</p><p><b>RESULTS</b>Restenosis rate was significantly lower in DES group (31/397, 7.8%) compared that in BMS group (30/139, 21.6%, P<0.05). Stent fracture (n=5) was found only in DES group and not in BMS group (P<0.05). Restenosis were found in all stent fracture segments. The stent fracture developed at the angulated tortuosity lesions.</p><p><b>CONCLUSION</b>Stent fracture is one of the causes of restenosis after drug-eluting stents implantation and related to implantation of long DES stent at the location of angulated tortuosity lesions.</p>

Debates on Plasticity of Stem Ccells (review) / 中国康复理论与实践

@#Traditionally, stem cells in adult tissues were believed to be restricted in their differentiation potential and limited to generate the types of cell present in the tissue in which the stem cell resides. Recently, however, many studies indicate that stem cells may display a broader differentiation potential, termed plasticity or transdifferentiation, than what was previously thought. But the validity of this understanding has been challenged by some investigators. In this review, the authors present some standpoints on stem cell plasticity and discuss some phenomena of stem cell plasticity observed on animal models those have been generally accepted currently.

Advances of Hepatocyte Growth Factor in Cardiology(review) / 中国康复理论与实践

@#Hepatocyte growth factor(HGF) is a mesenchyme-derived pleiotropic factor which regulates cell growth,cell motility,and morphogenesis of various types of cells,and is thus considered a humoral mediator of epithelial-mesenchymal interactions responsible for angiogenesis,apoptosis and oxidative stress,etc.This article reviewed the relationships between HGF and cardiovascular diseases.

Chronic effects of spironolactone in conjunction with an angiotensin-converting enzyme inhibitor enalapril on circulating procollagen marker P III NP and vascular resistance in patients with essential hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>Disturbances of the synthesis and breakdown of the extracellular matrix of arterial walls have emerged as key features of the atherosclerotic process. We observed the changes of circulating procollagen marker for type III collagen turnover rate, the N-terminal propeptide P III NP and vascular resistance in hypertensive patients treated with various antihypertensive regimens.</p><p><b>METHOD</b>A total of 130 light to moderate hypertensive patients were randomly assigned to receive enalapril (group B, n = 43), enalapril + spirolactone (20 mg/d, group A, n = 44) and anti-hypertensive drugs not directly affecting RAAS (calcium antagonist, beta-blocker, group C, n = 43) for 1 year. Target blood pressure is < 130/80 mm Hg.</p><p><b>RESULTS</b>Target blood pressure was reached in all treated patients and was similar among various groups. Under the same blood pressure controlling precondition, serum P III NP were similar at baseline among various groups and remained unchanged in group B [(3.4 +/- 0.3) microg/L vs. (3.7 +/- 0.3) microg/L, P > 0.05] and significantly decreased in group A [(2.3 +/- 0.2) microg/L vs. (3.8 +/- 0.2) microg/L, P < 0.05] while significantly increased in group C [(3.9 +/- 2.0) microg/L vs. (3.2 +/- 1.5) microg/L, P < 0.05]. Vascular resistance was similar among groups before therapy and all significantly decreased after 1 year antihypertensive therapy and the decrease was more significant in group A [(1064.3 +/- 158.6) dyn.s(-1).cm(-5)] than that in group B [(1200.8 +/- 298.7) dyn.s(-1).cm(-5)] and group C [(1205.1 +/- 206.4) dyn.s(-1).cm(-5)].</p><p><b>CONCLUSION</b>Spironolactone in conjunction with enalapril is a more favorable antihypertensive regimen in decreasing P III NP and improving vascular resistance than enalapril alone or antihypertensive drug regimens not directly affecting RAAS.</p>

The influence of coronary main vessel stenting on side branches / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the influence of stenting main vessel on side branches and to compare the different effects on side branches between BMS and DES (Taxus and Cypher).</p><p><b>METHODS</b>We reviewed the angiograms and the medical records of 183 patients who had received stent implantation in coronary main vessels and had follow-up angiograms. Any side branch was jailed by stent was evaluated.</p><p><b>RESULTS</b>Side branch occlusion occurred in 8.9% in all branches (10.5% in Cypher DES group, 11.1% in Taxus DES group and 7.8% in BMS group). Spontaneous recanalization of side branches was observed in 72% (90.9% in Cypher DES, 66.7% in Taxus stent group and 66.7% in BMS). The ostial side branch stenosis before stenting and the involvement of the side branch origin within the lesion of the parent vessel are the major independent predictors for side branch occlusion.</p><p><b>CONCLUSIONS</b>The influence of different DES implantations in coronary main vessels on side branches were similar and there was no difference between DES and BMS. Side branch occlusion had relatively benign clinical course. Most occluded side branches had late spontaneous reperfusion.</p>