Effect of Clopidogrel on Antiplatelet Therapy in Patients With Coronary Artery Disease Combining Chronic Kidney Disease / 中国循环杂志

Objective: To investigate the effect of clopidogrel on antiplatelet therapy in patients with coronary artery disease (CAD) combining chronic kidney disease (CKD) in order to provide a medication reference in clinical practice. Methods: We retrospectively investigated 423 CAD patients with coronary angiography (CAG) conifrmed diagnosis in our hospital from 2014-01 to 2014-09. According to the value of eGFR, the patients were classiifed into 2 groups:CAD+ CKD- group,n=257 patients with eGFR ≥ 90 ml/(min?1.73 m2), including 182 male and 75 female at the mean age of (60.39 ± 11.09) years, and CAD+CKD+ group,n=166 patients with eGFR < 90 ml/(min?1.73 m2), including 107 male and 59 female at the mean age of (65.80 ± 10.84) years. The patients were treated either by aspirin 0.1 g/d with clopidogrel 75 mg/d for at least 7 days, or by PCI operation with the load of aspirin 0.3g and clopidogrel 300 mg. The thrombelastography was conducted to examine and compare the inhibitory rates of ADP receptor and arachidonic acid (AA) pathway in platelet between 2 groups. Results: The inhibitory rate of platelet ADP receptor in CAD+CKD- group (64.9 ± 27.2) % was higher than that in CAD+CKD+ group (56.6 ± 27.4) %,P=0.039. Based on clinical standard of platelet’s ADP and AA inhibitory rates, in CAD+CKD- group, there were 24/257 (9.4%) of patients only insensitive to clopidogrel, in comparison with 25 (9.7%) of patients only insensitive to aspirin,P=0.99. While in CAD+CKD+ group, there were 21/166 (12.7%) of patients only insensitive to clopidogrel, in comparison with 11 (6.6%) of patients only insensitive to aspirin,P= 0.045. Conclusion: Clopidogrel has decreased effect on anti-platelet therapy in CAD patients combining with CKD, such patients have reduced sensitivity to relevant medication.

Prognostic value of high-sensitivity cardiac troponin T in patients with en-domyocardial-biopsy proven cardiac amyloidosis / 老年心脏病学杂志（英文版）

Objective To investigate prognostic predictors of long-term survival of patients with cardiac amyloidosis (CA), and to determine predictive value of high-sensitivity cardiac troponin T (hs-cTnT) in CA patients. Methods We recruited 102 consecutive CA cases and followed these patients for 5 years. We described their clinical characteristics at presentation and used a new, high-sensitivity assay to determine the concentration of cTnT in plasma samples from these patients. Results The patients with poor prognosis showed older age (56 ±12 years vs. 50 ±15 years, P=0.022), higher incidences of heart failure (36.92%vs. 16.22%, P=0.041), pericardial effusion (60.00%vs. 35.14%, P=0.023), greater thickness of interventricular septum (IVS) (15 ±4 mm vs. 13 ±4 mm, P=0.034), higher level of hs-cTnT (0.186 ±0.249 ng/mL vs. 0.044 ±0.055 ng/mL, P=0.001) and higher NT-proBNP (N-terminal pro-B-type natriuretic pep-tide) levels (11,742 ± 10,464 pg/mL vs. 6,031 ± 7,458 pg/mL, P=0.006). At multivariate Cox regression analysis, heart failure (HR:1.78, 95%CI:1.09-2.92, P=0.021), greater wall thickness of IVS (HR:1.44, 95%CI:1.04-3.01, P=0.0375) and higher hs-cTnT level (HR:6.16, 95%CI:2.20-17.24, P=0.001) at enrollment emerged as independent predictors of all-cause mortality. Conclusions We showed that hs-cTnT is associated with a very ominous prognosis, and it is also the strongest predictor of all-cause mortality in multivariate analysis. Examination of hs-cTnT concentrations provides valuable prognostic information concerning long-term outcomes.

An analysis of factors affecting the prognosis of patients with cardiac amyloidosis / 中华内科杂志

Objective To analyze the clinical characteristics,diagnosis,treatment and outcome of patients with cardiac amyloidosis (CA).Methods Clinical data from 18 patients diagnosed as CA by endomyocardial biopsy (EMB) from 1995 to 2005 were retrospectively analyzed.Results Among the 18 patients with CA,all patients had reduced diastolic dysfunction; 12 had mitral valve early diastolic blood flow peak velocity/late diastolic blood flow peak velocity (E/A) ＞ 2.0 and ventricular diastolic early filling deceleration time (DT) ＜ 150 ms; 12 had left ventricular ejection fraction (LVEF) ＜50％ ; and 13 had New York Heart Association (NYHA) classification Ⅲ or Ⅳ.The 1-year,3-year and 5-year survival rates of 18 patients with CA were 67％,44％ and 17％,respectively.Kaplan-Meier analysis showed,NYHA functional class ＞ Ⅱ,E/A ＞ 2.0 and DT ＜ 150 ms were associated with increased mortality (log-rank statistic P =0.026 and 0.001,respectively).CA patients with chemotherapy before heart failure were associated with decreased mortality and extend survival.Conclusions The mortality rate goes up and survival rate gradually descends as prolonged onset time.NYHA functional class ＞ Ⅱ and E/A ＞ 2.0 (DT ＜150 ms) are associated with mortality.

Renalase—the New Signal of Relations between Heart and Kidney(review) / 中国康复理论与实践

@#The latest reports showed that kidney secrets a new type protein:renalase,a novel flavin adenine dinucleotide-dependent(FAD-dependent)amine oxidase which is secreted into the blood by the kidney and regulates heart function and blood pressure by metabolizing catecholamines.Kidney disease is associated with cardiovascular disease,so people pay more and more attentions to renalase.This article will introduce the structure and mechanism of renalase,and propose its future.

Complications following paclitaxel-eluting stent implantation:6-month follow-up / 中国组织工程研究

BACKGROUND:The safety and efficacy of paclitaxel-eluting stents (Taxus DES) has been proved by international researchers in clinic investigations.Based on further inclusion criteria,the incidence of in-stent restenosis is still lower than that of bare-metal stent.OBJECTIVE:TO observe restenosis of Taxus DES and the effect on local vessels through applying the follow up of coronary angiography and to investigate the biocompatibility of stent and host.DESIGN:Following-up observation.SETTING:Department of Cardiology,General Hospital of Chinese PLA.PARTICIPANTS:A total of 297 patients who had undergone coronary Taxus DES implantation for coronary artery disease were selected from Cardiovascular Department of General Hospital of Chinese PLA from May 2003 to May 2005.There were 265 males and 32 females and their ages ranged from 36 to 76 years.All patients provided informed consent,and the experiment had got confirmed consent from local ethic committee.METHODS:All patients were implanted Taxus DES and received the follow up within 6 and 12 months.In addition,at 6 months after operation,coronary angiography was used to measure the reference vessel diameter (RVD) and the minimal lumen diameter(MLD),calculate diameter restenosis rate and observe late loss.MAIN OUTCOME MEASURES:Coronary angiography at 6 months after Taxus DES implantation and biocompatibility of stent and host.RESULTS:①Quantitative angiographic analysis(QCA):Angiographic follow-up showed that the late loss of in-stent was significantly higher than that of pro-in-lesion and dis-in-lesion(P＜0.05).②Coronary angiography in-stent restenosis:In 134 angiographic follow-up patients,a total of 14 patients experienced restenosis,and the incidence was 10.4%(14/134).The patterns of restenosis were diffuse in-stent in 7 patients and the rate of revascularization was 6.7%.③Stent aneurysm:Angiographic evidence of aneurysm was observed in one patient among follow-up cases,and the rate of which was 0.75% (1/134).④Clinic follow-up major adverse cardiac events(MACE):Among 297 patients,one patient was attracted sudden death 5 months after intervention (0.34%; 1/297),and one patient was suffered subacute thrombosis 5 days after stent implant (0.34%;1/297),and late thrombosis occurred in 2 patients.The general rate of MACE was 1.35%.CONCLUSION:①The late loss of Taxus DES mainly takes place in in-stent.The patterns of restenosis of Taxus DES are in majority of diffuse in-stent,and the incidence of MACE is low.②Taxus DES possibly results aneurysm in local vessels.The follow up indicates that Taxus DES has a good biocompatibility to patients.

Relative Risk Factors of Patients with Renal Artery Stenosis / 中国康复理论与实践

@#Objective To study the risk factors of patients with atherosclerotic renal artery stenosis (ARAS) and the relation with renal function.Methods The renal function of 64 ARAS patients was measured and compared with 36 healthy controls.Results Compared with the healthy controls, the incidence rates of morbilities of coronary artery disease, more than single-vessel, peripheral vascular disease, renal inadequacy increased significantly ( P<0.05), and the age, pulse pressure, levels of blood urea nitrogen (BUN), serum creatinine (SCr) were significantly higher ( P<0.01) in ARAS patients.Conclusion The elder, coronary artery disease, more than single-vessel, large pulse pressure, peripheral vascular disease and renal inadequacy are risk factors for ARAS. Severe renal artery stenosis may lead to renal inadequacy.

Effet of the Renal Artery Angioplasty on Level of Renin and Angiotensin in Renal Vein / 中国康复理论与实践

@#Objective To explore the mechanism of the renal artery angioplasty applied in hypertension with renal atherosclerosis. Methods Acording to the result of the renal artery angiography, 98 patients were divided to 3 groups. The renin activity and the angiotensin in the therapy groups were measured before and after the angioplasty and the datas were compared among 3 groups. Results After the angioplasty, the renin activity and the angiotensin significantly decreased in the therapy groups (P<0.01). The blood pressure and the creatinine decresed a month later. Conclusion The renal angioplasty can decrease the blood pressure and instantly decrease the renin activity and the angiotensin of the renal vein in hypertension with renal atherosclerosis.

The study of left ventricular diastolic function with echocardiography and coronary angiography / 中华超声影像学杂志

Objective　To examine the left ventricular diastolic function of patients with coronary artery diseases by noninvasive echocardiography and invasive coronary angiography.Methods　Mitral and pulmonary venous Doppler signals were recorded by the continuous wave Doppler technique in 62 patients, both coronary angiography and left ventricle pressure were measured. Patients were divided into normal and abnormal groups based on coronary angiography.Results　Left ventricular end diastolic pressure (LVEDP) (17.6 mm Hg vs 13.2 mm Hg,P<0.05),the left ventricular negative Δp/Δt before atria contraction ［-(224.63±52.18),-(87.81±24.41),P<0.05］,and the elevated value of left ventricular pressure derived from atria contraction ［(6.66±0.92)mm Hg vs (0.96±1.87)mm Hg,P=0.0094］ in abnormal group were more than those in the normal. The ratio of slope in pulmonary vein and mitral A wave peak was less in normal group than that in the abnormal (5.10±0.31 vs 4.12±0.20,P＝0.0106). But the isovolume relaxation parameters had no differences between the two groups.Conclusions　Coronary arter ischemia is an important cause of left ventricular impaired relaxation aggravation and stiffness, the diastolic abnormalities existed in the whole diastolic duration. Except ischemia, other factors also could cause relaxation disfuction and even elevate the LVEDP.

Effects on platelet and clinical application of prostaglandin E_1 / 中国药理学通报

Prostaglandin E1 ( PGE1) , derived from D-HLA and controlled by phospholipidase A2, is a kind of strong endogeneous vasodilator and platelet inhibitor. Its effects on vasculars and platelets are just inferior to prostacyclin only, which is the strongest physiological vasodilator and platelet inhibitor, and the common receptors exits.Now it is found that exogeneous PGE1 can central some kinds of paletet supra-activation in illnesses such as cardiovascular disease, renal disease and diabetes mellitus. So PGE1 may be benificial to those patients.