Observation for the Impact of Nitroglycerin on Radial Artery Structure by Optical Coherence Tomography / 中国循环杂志

Objective: To observe the lumen structural changes of radial artery (RA) in patients with transradial coronary intervention and the impact of nitroglycerin on the structure by optical coherence tomography (OCT). Methods: A total of 20 patients with transradial coronary intervention were enrolled for OCT imaging to observe and compare the lumen structures of RA between the basic condition and nitroglycerin treated condition. Results: OCT imaging found that 15/20 patients had radial spasm and 1 had intimal tear. Compared to basic condition, with nitroglycerin treatment, the mean lumen diameter, lumen area and total vascular area were increased in the distal, middle and proximal portion of RA, all P<0.001; the intima-media thickness was decreased in the distal, middle and proximal portion of RA, all P<0.001; while the cross section area of tunica media, intimal thickness and extravascular membrane thickness were similar between the basic condition and nitroglycerin treated condition, all P>0.005. Conclusion: Vasodilatation drug may obviously enlarge RA lumen area and total vascular area in patients after transradial coronary intervention.

Influence of Puncture Site on Radial Artery Occlusion After Transradial Coronary Intervention / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The risk of radial artery occlusion (RAO) needs particular attention in transradial intervention (TRI). Therefore, reducing vascular occlusion has an important clinical significance. The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI.</p><p><b>METHODS</b>We prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI. Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention. Risk factors for RAO were evaluated using a multivariate model analysis.</p><p><b>RESULTS</b>Of the 606 patients, the RAO occurred in 56 patients. Compared with TRI at 2-5 cm away from the radius styloid process, the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P = 0.033) and 8.90 (P = 0.040), respectively. The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 (OR = 2.45, P = 0.004).</p><p><b>CONCLUSION</b>Distal puncture sites (0-1 cm away from the radius styloid process) can lead to a higher rate of RAO.</p><p><b>TRIAL REGISTRATION</b>ClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/NCT01979627?term = NCT01979627 and rank = 1.</p>

Effect of Intravenous Administration of Liposomal Prostaglandin E1 on Microcirculation in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Several studies have demonstrated that primary percutaneous coronary intervention (PCI) can result in reperfusion injury. This study aims to investigate the effectiveness of liposomal prostaglandin E1 (Lipo-PGE1, Alprostadil, Beijing Tide Pharmaceutical Co., Ltd.) for enhancing microcirculation in reperfusion injury. In addition, this study determined the optimal administration method for acute ST elevation myocardial infarction (STEMI) patients undergoing primary PCI.</p><p><b>METHODS</b>Totally, 68 patients with STEMI were randomly assigned to two groups: intravenous administration of Lipo-PGE1 (Group A), and no Lipo-PGE1 administration (Group B). The corrected thrombolysis in myocardial infarction (TIMI) frame count (cTFC) and myocardial blush grade (MBG) were calculated. Patients were followed up for 6 months. Major adverse cardiac events (MACE) were also measured.</p><p><b>RESULTS</b>There was no significant difference in the baseline characteristics between the two groups. The cTFC parameter in Group A was significantly lower than Group B (18.06 ± 2.06 vs. 25.31 ± 2.59, P < 0.01). The ratio of final MBG grade-3 was significantly higher (P < 0.05) in Group A (87.9%) relative to Group B (65.7%). There was no significant difference between the two groups in final TIMI-3 flow and no-reflow. Patients were followed up for 6 months, and the occurrence of MACE in Group A was significantly lower than that in Group B (6.1% vs. 25.9% respectively, P < 0.05).</p><p><b>CONCLUSIONS</b>Myocardial microcirculation of reperfusion injury in patients with STEMI, after primary PCI, can be improved by administering Lipo-PGE1.</p>

Prevalence and related factors of injury caused by agricultural machinery in the 3 provinces Shandong, Henan and Hebei of China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the prevalent characteristics and related factors of injuries caused by agricultural machinery in 3 provinces Shandong, Henan and Hebei in China.</p><p><b>METHODS</b>A total of 1621 agricultural machinery operators aged between 18 and 60 years old from Shandong, Henan and Hebei provinces were selected by purposive-cluster sampling method in 2009. Demographic characteristics, injury history caused by agricultural machinery in the last year and the related social and psychological factors were collected by self-designed questionnaire. We used statistical description to report the injury prevalence, and adopted the univariate and multivariate analysis to explore the risk factors.</p><p><b>RESULTS</b>The average incidence of injuries caused by agricultural machinery was 13.44% (213/1585) in the three provinces, of which 14.46% (202/1397) in males and 5.85% (11/188) in females (χ(2) = 10.56, P < 0.01). Most of injuries (155 cases, 72.77%) occurred between April and August. Being stuck by rolling starting handles (45 cases, 21.13%), being crushed by running or dropping machineries (32 cases, 15.02%), fall from machines (28 cases, 13.15%) ranked the top three causes of injuries. The main related machines were tractors and motor tricycles (133 cases, 62.44%). The leading types of injuries were scratch (115 cases, 53.99%), strain (68 cases, 31.92%) and fracture (37 cases, 17.37%).</p><p><b>RESULTS</b>of multivariate logistic regression analysis showed that being male (OR = 3.18, 95%CI:1.65-6.15), educational level above high school(OR = 1.69, 95%CI:1.21-2.34), annual family income <2000 yuan (OR = 1.94, 95%CI:1.13-3.32), operating experience ≤ 5 years (OR = 1.70, 95%CI:1.13-2.55), daytime sleepiness (OR = 2.89, 95%CI:1.66-5.01), smoking during machinery operation (OR = 1.43, 95%CI:1.05-1.96), bearing debts (OR = 1.88, 95%CI:1.35-2.63) and suffering from other diseases (OR = 1.42, 95%CI:1.02-1.98) were risk factors of agricultural machinery injuries.</p><p><b>CONCLUSION</b>The average incidence of injuries caused by agricultural machinery in the three provinces Shandong, Henan and Hebei, was rather high among agricultural machinery operators, especially in the males. Agricultural machinery injury has been an important issue endangering the health of rural labor force in recent years.</p>

Safety and efficacy of anisodamine on prevention of contrast induced nephropathy in patients with acute coronary syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous studies have proved the renal protective effects of anisodamine in patients with septic shock. The aim of this study was to investigate anisodamine for the prevention of contrast induced nephropathy (CIN) in patients with acute coronary syndrome (ACS).</p><p><b>METHODS</b>Consecutive ACS patients undergoing elective percutaneous coronary intervention (PCI) were randomly assigned to one of two groups: patients in the anisodamine group (ANI group) were assigned to receive intravenous infusions of anisodamine by an adjusted-dose (0.1 - 0.2 µg × kg(-1)× min(-1)) from the PCI procedure to 24 hours after PCI, and the control group (CON group) received 0.9% isotonic saline of the same volume. All patients were hydrated for 6 to 12 hours before and 12 hours after PCI. Blood samples were taken on the day of PCI and at 24, 48 and 72 hours after PCI to measure the serum creatinine (SCr).</p><p><b>RESULTS</b>A total of 177 patients were involved in the study, 88 in the ANI group and 89 in the CON group. In both groups, the SCr concentrations significantly increased after PCI, with the peak value occurring at 48 hours. At 72 hours, the SCr concentration in the ANI group retuned to the baseline level (P > 0.05), but the SCr concentration in CON group was still higher than baseline level (P < 0.01). The SCr concentrations at 48 and 72 hours after PCI were much lower in the ANI group than those in the CON group (both P < 0.01). The estimated glomerular filtration rate (eGFR) significantly decreased after PCI, the lowest value occurred at 48 hours. In the ANI group, the eGFR at 72 hours was similar to the baseline level. In the CON group, the eGFR failed to return to baseline at 72 hours (P < 0.01). The eGFR at 24, 48 and 72 hours after PCI were higher in the ANI group (all P < 0.05). The incidence of CIN in the ANI group was lower than that in the CON group within 72 hours after PCI (P < 0.05). The results of multiple Logistic regression proved that both diabetes and left ventricular ejection fraction (LVEF) were independent predictors of CIN, and treatment with anisodamine was an independent preventive factor of CIN (OR 0.369 and 95%CI 0.171 to 0.794, P = 0.011). No serious side effects were found in the ANI group.</p><p><b>CONCLUSION</b>Intravenous infusion of anisodamine during and after elective PCI may safely prevent the occurrence of CIN in ACS patients.</p>

Preventive effects of anisodamine against contrast-induced nephropathy in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Anisodamine is widely used in therapy for treating acute glomerulonephritis and diabetic nephropathy because it can improve renal microcirculation. We performed a study to evaluate the preventive effects of anisodamine against contrast-induced nephropathy (CIN) in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty.</p><p><b>METHODS</b>A total of 260 patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) of 60 ml(-1)×min(-1)×1.73 m(-2) or less, who were undergoing coronary angiography or angioplasty, were randomly assigned to receive an infusion of either sodium chloride (control group, n = 128) or anisodamine (treatment group, n = 132). Patients in the treatment group received an infusion of anisodamine at a rate of 0.2 µg×kg(-1)×min(-1) from 12 hours before to 12 hours after coronary angiography or angioplasty, while patients in the control group received an infusion of sodium chloride with the same volume as the treatment group. All patients received intravenous sodium chloride hydration. CIN was defined as a 25% increase in serum creatinine from baseline or an absolute increase of > 0.5 mg/dl within three days after contrast exposure. The primary end point was the incidence of CIN. The secondary end point was a 25% or greater reduction in eGFR.</p><p><b>RESULTS</b>There were no significant differences between the two groups with regard to age, gender, risk factors, laboratory results, medications and interventions. The incidence of CIN was 9.8% (13/132) in the treatment group and 20.3% (26/128) in the control group (P < 0.05). The secondary end point was 6.0% (8/132) in the treatment group and 16.4% (21/128) in the control group (P < 0.05).</p><p><b>CONCLUSION</b>These results indicate the preventive effects of anisodamine against CIN in type 2 diabetics with renal insufficiency who are undergoing coronary angiography or angioplasty.</p>

Prediction of contrast-induced nephropathy in diabetics undergoing elective percutaneous coronary intervention: role of the ratio of contrast medium volume to estimated glomerular filtration rate / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Diabetic patients undergoing percutaneous coronary intervention (PCI) have a higher incidence of contrast-induced nephropathy (CIN) than nondiabetic patients, and no pharmacological approach has been demonstrated to offer consistent protection. Therefore, identifying individuals who are at increased risk becomes essential. This study was designed to assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate (CMV/eGFR) in diabetic patients undergoing elective PCI who developed CIN.</p><p><b>METHODS</b>We retrospectively investigated clinical factors associated with the development of CIN in 114 diabetic patients who had undergone elective PCI. The risk factors for CIN included age, gender, body mass index (BMI), left ventricular ejection fraction (LVEF), hemoglobin (Hb), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), volume of contrast medium, basic levels of serum creatinine (Scr), the number of treated vessels and the number of stents used. We conducted a stepwise regression analysis to evaluate the predictive role of these risk factors in the incidence of CIN.</p><p><b>RESULTS</b>The incidence of CIN was 18.4% (21/114). There were no significant differences in age, gender, BMI, LVEF, Hb, FPG, HbA1c, and incidence of hypertension and number of acute myocardial infarction (AMI) in patients between the CIN (n = 21) and the non-CIN (n = 93) groups. However, the eGFR was significantly lower ((72.0 ± 12.5) ml·min(-1)·1.73 m(-2) vs. (82.0 ± 16.5) ml·min(-1)·1.7 m(-2), P = 0.010), and the basic serum creatinine level ((1.07 ± 0.12) mg/dl vs. (0.97 ± 0.19) mg/dl P = 0.014) was significantly higher in the CIN group. In addition, the volume of contrast medium was significantly larger ((253 ± 75) ml vs. (211 ± 71) ml, P = 0.017) and the CMV/eGFR ratio was significantly greater (3.64 ± 1.26 vs. 2.70 ± 1.11, P = 0.001) in the CIN group. Stepwise regression analysis showed that the CMV/eGFR ratio was a significant independent predictor for the development of CIN (P = 0.001). At a cut-off point of > 3.1, the CMV/eGFR ratio exhibited 71% sensitivity and 70% specificity for detecting CIN.</p><p><b>CONCLUSION</b>The CMV/eGFR ratio could be a valuable predictor of CIN for diabetic patients after elective PCI. At a cut-off point of > 3.1, the CMV/eGFR ratio was an optimal predictor for the incidence of CIN.</p>

The effect of Valsartan and Captopril for the improvement of left ventricular systolic function after acute anterior myocardial infarction / 中华核医学杂志

Objective To compare the therapeutic effect of angiotensin Ⅱ antagonist (Valsartan)and angiotension-converting enzyme inhibitor (Captopril) for the improvement of left ventricular systolic function(LVSF) after acute myocardial infarction (AMI) at anterior wall. Methods A total of 75 patients with initial AMI at anterior wall were enlisted in the study. Patients were divided randomly into three groups: control group (n = 15), Captopril treated (n =30), and Valsartan treated (n =30). At 1 week and 28 weeks post AMI, the LVSF and left ventricular regional ejection fraction (LrEF) were measured by equilibrium radionuclide angiography (ERNA). The t-test was used to compare the dada. Results ( 1 ) At 28 weeks, left ventricular ejection fraction (LVEF) and left ventricular peak ejection rate (LPER) in Valsartan treated group were significantly increased as compared with those of control: ( 59.4 ± 8.6 ) % vs (44.9 ± 8.4)%, t = 3.87, P ＜ 0.01 for LVEF; (3.89 ± 1.01 ) end-diastolic volume (EDV)/s vs (2.84 ±1.05) EDV/s, t= 4.16, P ＜ 0.01 for LPER). The left ventricular time to peak ejection rate (LTPER) in Valsartan treated group was significantly decreased ( ( 116 ± 16 )ms vs ( 137 ±20) ms, t =2.16, P ＜ 0.05 ) as compared with control. (2)Compared with 1-week, 28-week Valsartan treated group had a significant increase inLrEF2, LrEF4, LrEF5, LrEF6: (71.6±18.8)% vs (57.0±11.4)%, t=2.11, P＜0.05;(78.1 ±16.8)% vs (68.9±21.0)%, t =2.06, P＜0.05; (70.5±16.9)% vs (59.9 ±23.4)%, t=1.99, P ＜ 0.05; and (58.1 ± 9.0) % vs (46.0 ± 18.9) %, t = 2.43, P ＜ 0.05, respectively. Conclusions Valsartan and Captopril are effective for the improvement of LVEF after AMI at anterior wall. The effects of the two drugs are similar.

Subjective sleepiness in heart failure patients with sleep-related breathing disorder / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous studies show that sleep-related breathing disorder (SRBD) is common in patients with heart failure (HF) and is associated with increased mortality. This study aimed to determine whether there was significant difference of subjective daytime sleepiness between HF patients with and without SRBD.</p><p><b>METHODS</b>We enrolled, prospectively, 195 consecutive HF patients with left ventricular ejection fractions (LVEF) < or = 45% and all subjects underwent polysomnography to measure the sleep structure between 2005 and 2008. Patients were then assigned to those with SRBD including obstructive and central sleep apnea (apnea-hypopnea index (AHI) > or = 5/hour of sleep) and those without SRBD (AHI < 5/hour) according to the sleep study. The subjective sleepiness was assessed with Epworth sleepiness scale (ESS).</p><p><b>RESULTS</b>Among 195 HF patients, the prevalence of obstructive sleep apnea (OSA) was 53% and of central sleep apnea (CSA) was 27%. There was no significant difference of ESS scores between patients without SRBD (NSA) and with SRBD (NSA vs OSA: 6.7 +/- 0.6 vs 7.6 +/- 0.4, P = 0.105 and NSA vs CSA: 6.7 +/- 0.6 vs 7.4 +/- 0.5, P = 0.235, respectively), indicating that SRBD patients had no more subjective daytime sleepiness. Compared with NSA, patients with SRBD had increased arousal index (ArI) (NSA vs OSA: 14.1 +/- 1.4 vs 26.3 +/- 1.5, P < 0.001 and NSA vs CSA: 14.1 +/- 1.4 vs 31.3 +/- 3.5, P < 0.001, respectively), more awake number after sleep onset (NSA vs OSA: 19.2 +/- 1.5 vs 26.2 +/- 1.4, P = 0.01 and NSA vs CSA: 19.2 +/- 1.5 vs 36.9 +/- 4.4, P < 0.001, respectively), and reduced proportion of slow-wave sleep (SWS) (NSA vs OSA: 13.8 +/- 1.7 vs 9.3 +/- 0.7, P = 0.024 and NSA vs CSA: 13.8 +/- 1.7 vs 8.9 +/- 0.9, P = 0.024, respectively).</p><p><b>CONCLUSIONS</b>OSA and CSA remain common in patients with HF on optimal contemporary therapy. Patients with both HF and SRBD have no significant subjective daytime sleepiness compared with patients without SRBD, despite of significantly increased awake number, arousal and decreased proportion of deep sleep stages. It is not a credible way and means to exclude SRBD in patients with HF according to the absence of subjective daytime sleepiness.</p>

Intensive cholesterol lowering with statin improves the outcomes of percutaneous coronary intervention in patients with acute coronary syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The incidence of no reflow phenomenon limits the clinical outcomes of percutaneous coronary intervention (PCI). This randomized controlled study was designed to evaluate the immediate protective effects of intensive statin pretreatment on myocardial perfusion and myocardial ischemic injury during PCI.</p><p><b>METHODS</b>Altogether 228 patients with acute coronary syndrome (ACS) were randomly assigned to standard statin group (SS group, n = 115) and intensive statin group (IS group, n = 113). Patients in the SS group received 20 mg simvastatin and patients in the IS group received 80 mg simvastatin for 7 days before PCI. Thrombolysis in myocardial infarction (TIMI) flow grade (TFG), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the intervened vessel were recorded before and after stent deployment. Creatine kinase (CK) isoenzyme MB, troponin I and plasma level of high sensitive-C reactive protein (hs-CRP), P-selectin and intercellular adhesion molecule (ICAM) were measured before and 24 hours after the procedure.</p><p><b>RESULTS</b>The TFG after stent deployment was significantly improved with less TIMI 0-1 and more TIMI 3 blood flow in the IS group than in the SS group (all P < 0.05). Patients with no reflow phenomenon were less in the IS group (P < 0.001). The CTFC was lower in the IS group than in the SS group (P < 0.001). TMPG was also improved in the IS group than in the SS group (P = 0.001). Although PCI caused a significant increase in CK-MB 24 hours after the procedure, the elevated CK-MB value was lower in the IS group than in the SS group (18.74 +/- 8.41 vs 21.78 +/- 10.64, P = 0.018). Similar changes were also found in troponin I (0.99 +/- 1.07 in the IS group vs 1.47 +/- 1.54 in the SS group, P = 0.006). CK-MB elevation occurred in 27.8% (32/115) of the patients in the SS group vs 15.9% (18/113) in the IS group (P = 0.030). Myocardial necrosis was detected in 4.4% (5/115) of the patients in the SS group, whereas 0.9% (1/113) in the IS group (P = 0.341). But no myocardial infarction was found. Similarly, the patients with increased level of troponin I were much more in the SS group (36.5%, 42/115) than in the IS group (19.5%, 22/113) (P = 0.04). Among them, myocardial necrosis was detected in 13.0% (15/115) of the patients in the SS group, while 4.4% (5/113) in the IS group (P = 0.021). Myocardial infarction was found in 4.4% (5/115) of the patients in the SS group and 0.9% (1/113) in the IS group (P = 0.213).</p><p><b>CONCLUSIONS</b>Intensive statin pretreatment for 7 days before PCI can further improve myocardial blood perfusion, protect the myocardium from ischemic injury. These effects are associated with the lowered levels of hs-CRP, P-selectin and ICAM.</p>

Effect of intra-coronary injection of anisodamine on the slow-reflow phenomenon in patients with acute myocardial infarction after percutaneous coronary intervention / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To assess the effect and safety of intra-coronary administration of anisodamine on "slow-reflow" phenomenon of infarct related artery (IRA) following primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).</p><p><b>METHODS</b>Twenty-five patients with slow-reflow phenomenon screened out from 153 AMI patient with post-PCI reflow IRA were enrolled. They were 17 males and 8 females; aged (62.3 +/- 9.3) years; 10 with focal artery at left anterior descendens, 5 in circumflux and 10 in right coronary artery; PCI was successfully performed on them about 7.11 +/- 2.31 h after the onset of angina pectoris and the post-operation mean TIMI flow was 1.75 +/- 0.42 grade. Nitroglycerin (200 microg) was injected into coronary previously for confirming the slow-reflow phenomenon as control, then the injection of anisodamine 500 microg 10 min later. Coronary arteriography (CAG) was performed at the 1 st, 3 rd and 10 th min after the medication. Gibson's TIMI frame count method and quantitative computer angiography (QCA) system was used to quantitatively detect the frames of blood flow and the diameter of arterial lumen at different time points after nitroglycerin or anisodamine administration. Hemodynamics and changes of electrocardiogram were determined.</p><p><b>RESULTS</b>(1) No significant change in frames of blood flow was found between before and 1 min after intra-coronary administration of nitroglycerin (82.79 +/- 9.30 frames vs 78.43 +/- 9.37 frames, P >0. 05) after operation; but 1, 3 and 10 min after injection of anisodamine, it was decreased 46.25 +/- 4.55, 44.52 +/- 4.52 and 43.09 +/- 4.18, respectively, all P <0. 01, and the average coronary blood flow increased from TIMI grade 1.75 +/- 0.42 to grade 2.70 +/- 0.45 (t = 0. 34, P < 0.05). (2) The diameter of middle segment of reopened coronary artery slightly increased from 3.2 +/- 0.3 mm to 3.3 +/- 0.4 mm 3 min after anisodamine injection, but without statistical significance (P >0. 05). (3) Successive monitoring at 10 min after anisodamine injection showed that all the parameters, including intra-coronary pressure, peripheral blood pressure, P-R interval, Q-T interval and QRS duration were not changed significantly (P > 0.05), only the heart rate increased for 15-19 beats/min, but did not induce tachycardia or other malignant arrhythmia.</p><p><b>CONCLUSION</b>Intra-coronary administration of anisodamine 500 microg could improve the post-PCI slow-reflow phenomenon, it is safe and convenient, and may be taken as an effective approach for treatment of the illness.</p>

Effect of tirofiban plus clopidogrel and aspirin on primary percutaneous coronary intervention via transradial approach in patients with acute myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Aspirin and clopidogrel can improve myocardial reperfusion and alleviate myocardial injury during percutaneous coronary intervention (PCI). Whether the addition of intravenous tirofiban during this procedure produces further benefit has not been clarified in ST segment elevation myocardial infarction (STEMI) patients. We evaluated this on STEMI patients who underwent primary PCI (p-PCI) via transradial artery approach.</p><p><b>METHODS</b>Consecutive patients were randomized into tirofiban group (n=72) or placebo group (n=78). Angiographic analysis included initial and final thrombolysis in myocardial infarction (TIMI) flow grade (TFG), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the thrombotic vessel. Platelet aggregation rate (PAR), creatine phosphokinase (CPK), CPK isoenzyme MB (CPK-MB) and troponin I levels were measured and TIMI definitions were used to assess bleeding complications. Left ventricular performance parameters were investigated with equilibrium radionuclide ventriculography. Major adverse cardiac events (MACE) were followed up for 6 months.</p><p><b>RESULTS</b>The cases of TFG 0 and 1 before PCI, TFG 0 when first crossing of guide wire were less, and the cases of TFG 3 after PCI was more in tirofiban group than those in placebo group. The final CTFC was fewer and the incidence of no reflow phenomenon was lower, as well the percentage of final TFG 3 was higher in tirofiban group than those in placebo group (all P<0.05). Mean peak CPK-MB was significantly lower, while the left ventricular performance parameters 1 week after PCI were much more improved in tirofiban group than those in the placebo group. PAR was significantly decreased shortly after tirofiban infusion. The incidence of 6-month MACE in tirofiban group was obviously lower than that in the placebo group. No statistical difference was noted between the two groups with regard to bleeding complications.</p><p><b>CONCLUSIONS</b>Intravenous tirofiban infusion, in addition to aspirin and clopidogrel in STEMI patients with p-PCI via transradial artery access, can quickly inhibit platelet aggregation, loosen occlusive thrombus, improve myocardial reperfusion and reduce incidence of MACE with few complications of vessel access and bleeding.</p>

Cardioprotective effects of simvastatin on reversing electrical remodeling induced by myocardial ischemia-reperfusion in normocholesterolemic rabbits / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recent studies have revealed that pretreatment with statin is effective in preventing arrhythmia, but its electrophysiological mechanism is unclear. This study was conducted to investigate the cardioprotective effects of simvastatin on reversing electrical remodeling in left ventricular myocytes of rabbit heart undergoing ischemia-reperfusion, so as to explore the ionic mechanism responsible for the anti-arrhythmic effect of statin.</p><p><b>METHODS</b>Forty-five rabbits were randomly divided into three groups: ischemic-reperfusion group (I-R), simvastatin intervention group (Statin) and sham-operated control group (CON). Anesthetized rabbits were subjected to 30-minute ischemia by ligation of the left anterior descending coronary artery and a 60-minute reperfusion after a 3-day administration of oral simvastatin of 5 mg x kg(-1) x d(-1) in the Statin group or a placebo in the I-R group. Single ventricular myocytes were isolated enzymatically from the epicardial zone of the infracted region derived from the hearts in the I-R and Statin group and the same anatomical region in the CON animals. The whole cell patch-clamp technique was used to record membrane ionic currents, including sodium current (I(Na)), L-type calcium current (I(Ca-L)) and transient outward potassium current (I(to)). Simultaneously, the level of serum cholesterol was examined.</p><p><b>RESULTS</b>There was no significant difference in the serum cholesterol concentration among the three groups. The peak I(Na) current density (at -30 mV) was significantly decreased in I-R ((-22.46+/-5.32) pA/pF, n=12) compared with CON ((-42.78+/-5.48) pA/pF, n=16, P<0.01) and Statin ((-40.66+/-5.89) pA/pF, n=15, P<0.01), while the peak I(Na) current density in the Statin group was not different from CON (P>0.05). The peak I(Ca-L) current density (at 0 mV) was significantly increased in I-R ((-4.34+/-0.92) pA/pF, n=15) compared with CON ((-3.13+/-1.22) pA/pF, n=13, P<0.05) and Statin ((-3.46+/-0.85) pA/pF, n=16, P<0.05), while the Peak I(Ca-L) current density in Statin was not different from CON (P>0.05). The I(to) current density (at +60 mV) was significantly decreased in I-R ((9.49+/-1.91) pA/pF, n=11) compared with CON ((17.41+/-3.13) pA/pF, n=15, P<0.01) and Statin ((14.54+/-2.41) pA/pF, n=11, P<0.01), although there was a slight reduction in the Statin group compared with CON (P<0.05).</p><p><b>CONCLUSIONS</b>It is implied that ischemia-reperfusion induces significant down-regulation of I(Na) and I(to) and up-regulation of I(Ca-L), which may underlie the altered electrical activity and long abnormal transmembrane action potential duration of the surviving ventricular myocytes, thus contributing to ventricular arrhythmias during acute ischemia-reperfusion period. Pretreatment with simvastatin could attenuate these changes and reverse this electrical remodeling without lowering the serum cholesterol level, contributing to the ionic mechanism of statin in treatment of arrhythmia independent of a decrease in cholesterol.</p>

Influence of intracoronary administration of anisodamine on no-reflow, ventricular function and systolic synchrony in acute myocardial infarction patients undergoing percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the influence of intracoronary administration of anisodamine on myocardial blush grade (MBG) and left ventricular regional and global systolic function and synchrony in the acute myocardial infarction (AMI) patients with no-reflow phenomenon post percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>Forty-seven AMI patients who underwent PCI within 12 hours of onset and MBG was 0 - 1 were randomized to receive standard therapy [group B, n = 23, 18 males, mean age (62.72 +/- 11.48) years] or standard therapy plus intracoronary administration of anisodamine [200 microg/ml, group A, n = 24, 18 males, mean age (64.23 +/- 12.27) years]. The left ventriculography (LVG) was performed immediately and 6 months after PCI to measure the ventricular volume, LVEDP and wall motion score (WMS). Equilibrium radionuclide angiography (ERNA) was performed 1 week and 6 months after PCI to determine the parameters of left ventricular regional, global systolic function and systolic synchrony. Incidence of major adverse cardiac events (MACE) during the follow-up was analyzed.</p><p><b>RESULTS</b>Anisodamine [(2530 +/- 340) microg/person)] was well tolerated by patients. The MBG remained unchanged in group B and significantly increased from grade 0.74 +/- 0.32 to grade 2.33 +/- 0.28 10 min after anisodamine injection in group B. Six months post PCI, LVESVI [(40.53 +/- 8.12) ml/m(2) vs. (50.32 +/- 8.26) ml/m(2)], LVEDVI [(80.13 +/- 9.74) ml/m(2) vs. (87.17 +/- 10.25) ml/m(2)], WMS [(8.24 +/- 1.31) vs. (10.23 +/- 1.82)] and LVEDP [(13.36 +/- 4.21) vs. (16.38 +/- 3.21) mm Hg, 1 mm Hg = 0.133 kPa] were significantly lower in group A compared with that in group B (all P < 0.05) while LVEF [(44.02 +/- 5.86)% vs. (38.52 +/- 5.18)%], PER [(1.86 +/- 0.09) EDV/s vs. (1.61 +/- 0.09) EDV/s] and PFR [(2.19 +/- 0.32) EDV/s vs. (1.78 +/- 0.17) EDV/s] measured by ERNA were significantly increased in group A compared with that in group B (all P < 0.05). (2) LrEF(2)-LrEF(8) in group A were higher by 13.96%, 25.02%, 30.36%, 22.86%, 27.67%, 22.07% and 18.71% respectively compared with that in group B. (3) Phase analysis showed that the left ventricular systolic synchrony parameters PS [(46.04 +/- 8.93) degrees vs. (53.19 +/- 162) degrees ], FWHM [(23.02 +/- 6.27) degrees vs. (25.02 +/- 5.31) degrees ] and PSD [(7.92 +/- 4.12) degrees vs. (11.76 +/- 4.11) degrees ] were also significantly lower in group A than that in group B (all P < 0.05). (4) During the 6 months of follow-up, the incidence of MACE in group A was significantly lower than that in group B (P < 0.05).</p><p><b>CONCLUSION</b>Intracoronary administration of anisodamine is safe and could partly attenuate the no-reflow phenomenon, improve the left ventricular systolic function and synchrony and reduce the incidence of MACE in patients with no-reflow phenomenon post AMI-PCI.</p>

Effect of intracoronary administration of anisodamine on slow reflow phenomenon following primary percutaneous coronary intervention in patients with acute myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Many basic and clinical studies have proved that anisodamine can produce significant effect on relieving microvascular spasm, improving and dredging the coronary microcirculation. It may be beneficial to the improvement of slow-reflow phenomenon (SRP) following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). So we investigated the effect of intracoronary administration of anisodamine on SRP of infarct related artery (IRA) following primary PCI in patients with ST segment elevated acute myocardial infarction (STEAMI).</p><p><b>METHODS</b>Twenty-one patients with SRP from a total of 148 STEAMI patients accepted primary PCI were enrolled into this study from September 2004 to December 2005. When SRP happened, nitroglycerin (200 microg) was "bolus" injected firstly into IRA to exclude the spasm of epicardial artery and identify SRP as well as a baseline and self-control agent following PCI. Ten minutes later, 1000 microg of anisodamine was injected into IRA with SRP at 200 microg/s, while the coronary angiography (CAG) was taken before and at 1st, 3rd and 10th minute after administration of nitroglycerin or anisodamine, respectively. The corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG) and the diameter of IRA were calculated and analyzed by Gibson's TIMI frame count method using quantitative computer angiography (QCA) system to evaluate the influence of anisodamine on coronary flow and vessel lumen. In the meantime the invasive hemodynamic parameters of intracoronary and systemic artery (systolic, diastolic and mean pressure) and electrocardiogram (ECG) were measured and monitored. The changes of ventricular performance parameters and the adverse reaction were evaluated and followed-up at 1 month post-PCI.</p><p><b>RESULTS</b>No significant changes in cTFCs and TMPGs were found at 1st, 3rd and 10th minute after intracoronary administration of nitroglycerin as compared with the baseline control (P > 0.05). cTFCs were decreased by 58.3%, 56.2%, and 54.6%, respectively (P < 0.001), and TMPGs were increased from 1.13 +/- 0.21 grade to 2.03 +/- 0.32, 2.65 +/- 0.45 and 2.51 +/- 0.57 grades (P < 0.05) at 1st, 3rd and 10th minute after intracoronary administration of anisodamine as compared with those after intracoronary administration of nitroglycerine, respectively. The average coronary blood flow of TIMI grade was improved from 1.76 +/- 0.43 to 2.71 +/- 0.46 (P < 0.05) while the diameter of middle segment in re-patented coronary artery was slightly increased from (3.20 +/- 0.40) mm to (3.40 +/- 0.50) mm at the 3rd minute after intracoronary administration of anisodamine (P > 0.05) as compared with those of nitroglycerine control. The systolic, diastolic and mean pressures of intracoronary artery after intracoronary administration of anisodamine increased from 115 to 123, 75 to 84, 88 to 95 mmHg (P < 0.05), respectively, along with the rise of heart rate from 68 to 84 beats per minute (P < 0.05). There were no significant changes in intervals of PR, QT and QRS (P > 0.05) and no any severe fast arrhythmia after intracoronary administration of anisodamine. The ventricular performance parameters were significantly improved and no major adverse cardiovascular events (MACE) were found during follow-up at 1 month post-PCI.</p><p><b>CONCLUSIONS</b>Intracoronary administration of 1000 microg anisodamine is effictive in reversing SRP following PCI in STEAMI patients, especially it is suitable for SRP patients with bradycardia or hypotension.</p>

Acute hemodynamic effects of intravenous recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicated with heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the acute hemodynamic effects and safety of intravenous injection of recombinant human brain natriuretic peptide (rhBNP) versus intravenous nitroglycerin (NIT) in acute myocardial infarction (AMI) patients with heart failure.</p><p><b>METHODS</b>On top of standard therapy, 42 consecutive patients who suffered from anterior wall AMI with heart failure [pulmonary capillary wedge pressure (PCWP) > 16 mm Hg] within 12 to 24 hours from the onset of chest pain were randomized into rhBNP group (n = 21, 1.5 microg/kg bolus intravenous injection followed by 0.0075 microg.kg(-1).mn(-1) for the first 3 hours and 0.015-0.03 microg.kg(-1).mn(-1) infusion for following 21 hours) and NIT group (n = 21, 10 to 100 microg/mn intravenous infusion for 24 hours). The hemodynamic parameters were monitored by Swan-Ganz catheter at baseline, during drug infusion and 6 hours post infusion withdraw; total urine output was also obtained. The major adverse cardiac events (MACE) were observed up to 1 week after drug infusions.</p><p><b>RESULTS</b>Central venous pressure and systolic blood pressure remained unchanged after rhBNP or NIT infusion. Compared to baseline level, PCWP was significantly reduced by 48.9% (P < 0.01) at 30 minutes after rhBNP infusion and this effect remained up to 6 hours post infusion withdraw; PCWP reduced by 28.7% (P < 0.05) at 2 hours after NIT infusion and this effect remained to 6 hours before infusion withdraw. Cardiac index (CI) was increased by 27.1% (P < 0.05) at 1 hour after rhBNP infusion and remained till 6 hours post infusion withdraw; CI was significantly increased at 3 hour after NIT infusion and this effect disappeared after infusion withdraw. The PCWP and CI values were significantly higher in rhBNP group than that of NIT group at 30 minutes and 2 hours (P < 0.05). Heart rate was significantly reduced at 30 minutes (95.3 +/- 7.4 vs. 118.0 +/- 8.2 bpm, P < 0.05) and at 2 hour (92.8 +/- 6.8 vs. 109.2 +/- 7.6 bpm, P < 0.05) in rhBNP and NIT group, respectively and heart rate remained reduced during the whole infusion period in both groups. The total urine output for 30 hours in rhBNP group (1870 +/- 535 ml) tended to be higher than that in NIT group (1538 +/- 620 ml, P > 0.05). There was no symptomatic hypotension or other adverse events during drug infusion in both groups and MACE up to 1 week post drug infusion was also similar between the two groups.</p><p><b>CONCLUSION</b>Intravenous injection of rhBNP results in more rapid and long-lasting hemodynamic improvements than that of NIT in AMI patients with heart failure and it is also feasible and safe for clinic use in AMI patients with heart failure.</p>

The effects of cardiac pacing with multisite combination on myocardial mechanics and cardiac work in dogs / 中国应用生理学杂志

<p><b>AIM</b>To approach the effects of multi-site synchronous ventricular pacing on myocardial mechanics and cardiac work.</p><p><b>METHODS</b>Five modes of multi-site synchronous ventricular pacing were randomly performed in 12 dogs with anesthetized, opened chest and artificial-ventilation. Some parameters were measured simultaneously including: the peak of left ventricular pressure rise and fall (+/- dp/ dt(max)), the time constant of left ventricular relaxation(tau), the muscle tensile force in left/right ventricular wall (V-tensile force, V-TF), SV, LVSW and RVSW.</p><p><b>RESULTS</b>The myocardial systolic mechanical parameters: +dp/dt(max) and LV-TF of cHisB-LVPL and RVA-LVPL pacing by biventricular pacing modes were increased than that of cHisB-RVA pacing in right ventricular bifocal pacing mode. +dp/dt(max) in above two groups of biventricular pacing was increased than that in cHisB-RVA pacing. Tau value of cHisB-LVPL and RVA-LVPL pacing modes were shorted than that of cHisB-RVA pacing. The above parameters of cHisB-RVA-LVPL and cHisB-RVA-LVA biventricular trifocal pacing were superior to that of cHisB-LVPL and RVA-LVPL biventricular pacing. The +dp/dt(max), LV-TF and RV-TF of cHisB-RVA-LVPL pacing were increased as compared with that of cHisB-RVA-LVA pacing (P > 0.05). The -dp/dt(max) in cHisB-RVA-LVPL pacing were increased by 6.0% and tau value was shorted by 3.7% compared with those in cHisB-RVA-LVA pacing (P > 0.05). SV, LVSW and RVSW of cHisB-LVPL and RVA-LVPL biventricular pacing were increased than those of cHisB-RVA bifocal pacing. The above parameters of cHisB-RVA-LVPL pacing were increased than that of cHisB-RVA-LVA and cHisB-LVPL pacing.</p><p><b>CONCLUSION</b>It was explained that the cHisB-RVA-LVPL biventricular trifocal sites synchronous pacing mode would increase the velocity of ejection and filling during myocardial contraction and relaxation and enhance cardiac work by maintaining normal VSS.</p>

Study of atria-His bundle sequential pacing on cardiac electrophysiology and heamodynamics in dogs / 中国应用生理学杂志

<p><b>AIM</b>To evaluate the effects of atria-His bundle sequential pacing on cardiac electrophysiology and heamodynamics in dogs.</p><p><b>METHODS</b>In 20 opening chest anesthetized dogs, platinum electrodes were fixed at the epicardium of right atria (RA) and the right ventricular apex (RVA) respectively, pacing right atria and the right ventricle. A special lead was located at His bundle (based on a optical "H" wave and narrow duration of the QRS complexes recorded in ECG), pacing His bundle. Cardiac electrophysiology and hemodynamics parameters were compared in the different pacing models RA(AAI, RVA-(VVI), HisB-(VVI) single chamber pacing and RA-RVA(DDI), RA-HisB(DDI) dual chamber pacing.</p><p><b>RESULTS</b>The threshold of His B pacing is similar to that of RVA pacing. Cardiac output (CO) is increased in pacing of RA(AAI), His B-(VVI) and RA-His B(DDI). It is increased by 29.64% in pacing of RA-His B(DDI) (P < 0.01) and by 0.25% (P > 0.05) in pacing of RA-RVA(DD1) While CO is decreased by 5.41% in RVA-VVI) pacing (P > 0.05). SV, LVSW and RVSW of RA-HisB(DDI) pacing are superior to those in RVA-VVI) and RA-RVA(DDI) pacing.</p><p><b>CONCLUSION</b>Right atria-His bundle sequence pacing significantly improves cardiac function compared with the other model pacing because it maintains normal physiological electronic activity sequence and systolic synchrony. It will be adapted to clinical application.</p>