Evaluation of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome: a prospective multicenter single-arm interventional study / 老年心脏病学杂志（英文版）

OBJECTIVE@#To evaluate the feasibility and tolerability of metoprolol standard dosing pathway (MSDP) in Chinese patients with acute coronary syndrome (ACS).@*METHODS@#In this multicenter, prospective, open label, single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals. A total of 998 hospitalized patients aged ≥ 18 years and diagnosed with ACS were included. The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines. The primary endpoint was the percentage of patients achieving the target dose at discharge (V2). The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge (V4), and percentage of patients experiencing bradycardia (heart rate < 50 beats/min), hypotension (blood pressure < 90/60 mmHg) and transient cardiac dysfunction at V2 and V4.@*RESULTS@#Of the 998 patients, 29.46% of patients achieved the target dose (≥ 95 mg/d) at V2. The total population was divided into two groups: target group (patients achieving the target dose at V2) and non-target group (patients not achieving the target dose at V2). There was significant difference in the reduction of heart rate from baseline to discharge in the two groups (-4.97 ± 11.90 beats/min vs. -2.70 ± 9.47 beats/min, P = 0.034). There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2 (0 vs. 0, P = 1.000) and V4 (0.81% vs. 0.33%, P = 0.715). There was no significant difference in the proportion of hypotension between the two groups at V2 (0.004% vs. 0.004%, P = 1.000) and V4 (0 vs. 0.005%, P = 0.560). No transient cardiac dysfunction occurred in two groups during the study. A total of five adverse events (1.70%) and one serious adverse event (0.34%) were related to the pathway in target group.@*CONCLUSIONS@#In Chinese ACS patients, the feasibility and tolerability of the MSDP have been proved to be acceptable.

Protection of side-branch ostium by the jailed balloon technique validated by three-dimensional optical coherence tomography / 中华心血管病杂志

Objective: To evaluate the protective effect of jailed balloon technique on side branch (SB) ostium using three-dimensional optical coherence tomography(OCT). Methods: This is a retrospective study. Consecutive coronary disease patients with coronary artery bifurcation lesions who underwent percutaneous coronary intervention (PCI) and completed pre-and post-procedural OCT examinations at the Chinese People's Liberation Army General Hospital from September 2019 to March 2022 were enrolled. Patients were divided into the jailed balloon technique group and the unprotected group according to the options applied for the SB. The SB ostium area difference was calculated from OCT images (SB ostium area difference=post-PCI SB ostium area-pre-PCI SB ostium area). The SB ostium area differences were compared between the two groups and compared further in the subgroup of true bifurcation lesions and non-true bifurcation lesions. In the jailed balloon group, the SB ostium area difference was compared between the active jailed balloon technique and the conventional jailed balloon technique, between the jailed balloon>2.0 mm diameter and the jailed balloon≤2.0 mm diameter, and between the higher balloon pressure (>4 atm, 1 atm=101.325 kPa) and the lower balloon pressure (≤4 atm). Multivariate linear regression analysis was used to explore the correlation between the technical parameters of the jailed balloon technique and the SB protection effect. Results: A total of 176 patients with 236 bifurcation lesions were enrolled, aged (60.7±9.3) years, and there were 128 male patients (72.7%). There were 67 patients in the jailed balloon technique group with 71 bifurcation lesions and 123 patients in the unprotected group with 165 bifurcation lesions. Fourteen patients had 2 to 3 lesions, which were treated in different ways, so they appeared in the unprotected group and the jailed balloon technique group at the same time. The area difference in SB ostium was greater in the jailed balloon group than in the unprotected group (0.07 (-0.43, 1.05)mm2 vs.-0.33 (-0.83, 0.26)mm2, P<0.001), and the results were consistent in the true bifurcation lesion subgroup (0.29 (-0.35, 0.96)mm2 vs.-0.26 (-0.64, 0.29)mm2, P=0.004), while the difference between the two groups in the non-true bifurcation lesion subgroup was not statistically significant (P=0.136). In the jailed balloon technique group, the SB ostium area difference was greater in patients treated with the active jailed balloon technique than in those treated with the conventional jailed balloon technique ((0.43±1.36)mm2 vs. (-0.22±0.52)mm2, P=0.013). The difference in SB ostium area was greater in those using>2.0 mm diameter jailed balloons than in those using≤2.0 mm diameter jailed balloons (0.25 (-0.51, 1.31) mm2 vs.-0.01 (-0.45, 0.63) mm2, P=0.020), while SB ostium area difference was similar between those endowed with higher balloon pressure (>4 atm) compared to those with lower balloon pressure (≤4 atm) (P=0.731). Multivariate linear regression analysis showed that there was a positive correlation between jailed balloon diameter and SB ostium area difference (r=0.344, P=0.019). Conclusions: The jailed balloon technique significantly protects SB ostium, especially in patients with true bifurcation lesions. The active jailed balloon technique and larger diameter balloons may provide more protection to the SB.

Bax inhibitor 1 inhibits vascular calcification in mice by activating optic atrophy 1 expression / 南方医科大学学报

OBJECTIVE@#To investigate the effects of Bax inhibitor 1 (BI- 1) and optic atrophy protein 1 (OPA1) on vascular calcification (VC).@*METHODS@#Mouse models of VC were established in ApoE-deficient (ApoE-/-) diabetic mice by high-fat diet feeding for 12 weeks followed by intraperitoneal injections with Nε-carboxymethyl-lysine for 16 weeks. ApoE-/- mice (control group), ApoE-/- diabetic mice (VC group), ApoE-/- diabetic mice with BI-1 overexpression (VC + BI-1TG group), and ApoE-/- diabetic mice with BI-1 overexpression and OPA1 knockout (VC+BI-1TG+OPA1-/- group) were obtained for examination of the degree of aortic calcification using von Kossa staining. The changes in calcium content in the aorta were analyzed using ELISA. The expressions of Runt-related transcription factor 2 (RUNX2) and bone morphogenetic protein 2 (BMP-2) were detected using immunohistochemistry, and the expression of cleaved caspase-3 was determined using Western blotting. Cultured mouse aortic smooth muscle cells were treated with 10 mmol/L β-glycerophosphate for 14 days to induce calcification, and the changes in BI-1 and OPA1 protein expressions were examined using Western blotting and cell apoptosis was detected using TUNEL staining.@*RESULTS@#ApoE-/- mice with VC showed significantly decreased expressions of BI-1 and OPA1 proteins in the aorta (P=0.0044) with obviously increased calcium deposition and expressions of RUNX2, BMP-2 and cleaved caspase-3 (P= 0.0041). Overexpression of BI-1 significantly promoted OPA1 protein expression and reduced calcium deposition and expressions of RUNX2, BMP-2 and cleaved caspase-3 (P=0.0006). OPA1 knockdown significantly increased calcium deposition and expressions of RUNX2, BMP-2 and cleaved caspase-3 in the aorta (P=0.0007).@*CONCLUSION@#BI-1 inhibits VC possibly by promoting the expression of OPA1, reducing calcium deposition and inhibiting osteogenic differentiation and apoptosis of the vascular smooth muscle cells.

Resting heart rate control and prognosis in coronary artery disease patients with hypertension previously treated with bisoprolol: a sub-group analysis of the BISO-CAD study / 中华医学杂志(英文版)

BACKGROUND@#Resting heart rate (RHR) is considered as a strong predictor of total mortality and hospitalization due to heart failure in hypertension patients. Bisoprolol fumarate, a second-generation beta-adrenoreceptor blockers (β-blocker) is commonly prescribed drug to manage hypertension. The present study was to retrospectively evaluate changes in the average RHR and its association with cardiovascular outcomes in bisoprolol-treated coronary artery disease (CAD) patients from the CAD treated with bisoprolol (BISO-CAD) study who had comorbid hypertension.@*METHODS@#We performed ad-hoc analysis for hypertension sub-group of the BISO-CAD study (n = 866), which was a phase IV, multination, multi-center, single-arm, observational study carried out from October 2011 to July 2015 across China, South Korea, and Vietnam. Multivariate regression analysis was used to identify factors associated with incidence of composite cardiac clinical outcome (CCCO), the results were presented as adjusted odds ratio (OR) along with 95% confidence interval (CI) and adjusted P value.@*RESULTS@#A total of 681 patients (mean age: 64.77 ± 10.33 years) with hypertension from BISO-CAD study were included in the analysis. Bisoprolol improved CCCOs in CAD patients with comorbid hypertension, with RHR <65 and <70 beats/min compared with RHR ≥65 and ≥75 beats/min, respectively, in the efficacy analysis (EA) set. In addition, it lowered RHR in both intent-to-treat (ITT) and EA groups after 6, 12, and 18 months of treatment. Further, RHR 70 to 74 beats/min resulted in significantly higher risk of CCCOs EA set of patients (adjusted OR: 4.34; 95% CI: 1.19-15.89; P = 0.03). Also, events of hospitalization due to acute coronary syndrome were higher when RHR 69 to 74 beats/min compared to RHR <69 beats/min in ITT patients.@*CONCLUSION@#Bisoprolol can effectively reduce RHR in Asian CAD patients with comorbid hypertension and hence, improve CCCO without affecting their blood pressure.

Correlation Factor Analysis for Cardiac Morphology and Valvular Regurgitation in Normal Tibetan Population at High Altitude Area / 中国循环杂志

Objective: To explore the correlation factors for cardiac morphology and valvular regurgitation in normal Tibetan population at high altitude area. Methods: Based onTibetan permanent resident population, a 4-stage cluster random sampling was conducted to drawn normal Tibetan subjects. Personal information and medical history were collected; physical parameters including blood and urine tests, ECG, chest X-ray and echocardiography were examined; cardiac morphology and valvular stenosis and regurgitation were detected. Canonical correlation study and Logistic regression analysis were performed to investigate the correlation factors for cardiac structure and function. Results: A population of 4 688 in Tibetan area were involved and 1 820 normal subjects were studied including 694 from Lhasa, 575 from Naqu, 286 from Nyingchi and 265 from Shigatse area. Canonical correlation analysis revealed that in normal Tibetan population, the major relevant physiological parameters for measuring right ventricle were age, blood oxygen saturation and body weight; for left ventricle were body weight, age and height; gender had no real differences. Logistic regression analysis presented that body weight, pulse and blood oxygen saturation were negatively related to mild tricuspid regurgitation; age was positively related to mild mitral and aortic regurgitations, all P<0.01. Conclusion: Age and body weight were the correlation factors for cardiac morphology and mild valvular regurgitation in normal Tibetan population at high altitude area, which should be alert in heart disease investigation.

Current Status of Antithrombotic Strategy for Elderly Patients With Atrial Fibrillation and Acute Coronary Syndrome After Stent Implantation in Beijing Area / 中国循环杂志

Objective: To investigate the current status of antithrombotic strategy for elderly patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) after stent implantation in Beijing area and to study the safety and efficacy of different therapeutic strategy. Methods: A total of 467 relevant patients were enrolled by re-travelling electronic medical records from 12 hospitals in Beijing area. The patients' mean age was (78.70±3.32) years and they were divided into 2 groups by antithrombotic therapy condition: Triple therapy group, n=17 (3.64％), Double therapy group, n=450 (96.36％). The incidence of major adverse cardiac and cerebral events (MACCE) including all-caused death, non-fatal myocardial infarction, stent thrombosis, target vessel revascularization (TVR), stoke and bleeding was compared between Triple therapy group and Double therapy group.Results: The medication in Double therapy group included aspirin+ticagrelor, aspirin+clopidogrel, clopidogrel+warfarin and cilostazol+clopidogrel; in Triple therapy group was aspirin+clopidogrel+warfarin. Patient with HAS-BLED score≥3 was defined as high risk of bleeding and they were all treated by double therapy; HAS-BLED<3 was defined as low risk of bleeding, only 5.03％ patients were treated by triple therapy. 3 patients in Triple therapy group and 33 in Double therapy group suffered from gastrointestinal bleeding, P=0.338; 6 patients in Triple therapy group and 128 in Double therapy group had MACCE, P=0.589; 3 and 80 patients died in Triple therapy group and Double therapy group, P=0.766. Conclusion: Triple therapy was rarely used in elderly AF and ACS patients after stent implantation, double therapy was the main strategy; the incidence of MACCE and mortality were similar between triple and double therapies; patients with triple therapy had the higher incidence of gastrointestinal bleeding.

Application of high-pitch dual-source CT with prospective ECG gated double scan mode in postoperative follow-up of coronary artery bypass grafting / 解放军医学杂志

Objective To evaluate the application of high-pitch dual-source CT with prospective ECG gated double scan mode (Double Flash) in postoperative follow-up of coronary artery bypass grafting (CABG).Methods Sixty-one patients undergone CABG and received coronary CT angiography (CCTA) from Apr.2012 to Dec.2014 were enrolled in present study.The patients were randomly divided into two groups according to scanning mode:group A (Double Flash mode,30 cases) and group B (retrospective ECG gated spiral mode,31cases).Evaluation parameters included volumetric CT dose index (CTDIvol) and effective radiation dose (ED).All the coronary segments were evaluated with double blind method by two independent observers according to the image quality (IQ) on 4-point scale (1:excellent to 4:non-diagnostic).Results There were 139 coronary artery bypass grafts in 2 groups.Group A had 69 grafts,including 25 artery grafts and 44 venous grafts.Group B had 70 grafts,including 29 grafts and 41 venous grafts.No significant difference was found in IQ.between the two groups for all coronary segments (1.22 ± 0.57 vs.1.21 ± 0.61,P=0.975).ED (4.34 ± 1.88 vs.17.07 ± 2.13mSv,P＜0.001) and CTDIvol (5.70 ± 2.36 vs.40.95 ± 3.12mGy,P＜0.001) were significantly lower in group A than in group B.Conclusion Double Flash spiral protocol of dual-source CCTA can acquire good image quality with reduced radiation dose during assessment of CABG patency,and might have potential value in the follow-up of CABG patency.

Retrospective study on the diagnostic performance of noninvasive fractional flow reserve derived from coronary CT angiography for myocardial ischemia / 解放军医学杂志

Objective To evaluate the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomographic angiography (CTA) (FFRCT) for functional myocardial ischemia.Methods Thirty-nine patients undergone coronary CTA and FFR examination from Aug.2012 to Jul.2015 in PLA General Hospital were retrospectively included in present study.Measurements of invasive FFR value was used as reference standard,and FFRCT based on coronary CTA image was performed in either per-patient or per-vessel level to assess the accuracy,specificity,sensitivity,the positive predictive value and negative predictive value for functional myocardial ischemia.Results In per-patient level,the accuracy of FFRCT was 82.05％,sensitivity was 83.33％,specificity was 80.95％,positive predictive value was 78.95％ and negative predictive value was 85.00％.In per-vessel level,the accuracy of FFRCT was 76.79％,sensitivity was 69.57％,specificity was 81.82％,positive predictive value was 72.73％ and negative predictive value was 79.41％.The area under ROC was 0.826 in per-patient level,and 0.786 in per-vessel level.For per-vessel,FFRCT was positively correlated with FFR value significantly (r=0.644;95％CI:0.458-0.775).Conclusion With FFR as reference standard,domestic noninvasive FFRCT can be used for the diagnosis of functional myocardial ischemia with high diagnostic performance and clinical application prospect.

Clinical, Laboratory and Imaging Features of High Altitude Pulmonary Edema in Tibetan Plateau / 中国医学科学杂志(英文版)

Objective To analyze characteristics of high altitude pulmonary edema (HAPE) in Chinese patients.Methods We performed a retrospective study of 98 patients with HAPE. We reviewed the medical records and summarized the clinical, laboratory and imaging characteristics of these cases, and compared the results on admission with those determined before discharge.Results Forty-eight (49.0%) patients developed HAPE at the altitude of 2800 m to 3000 m. Ninty-five (96.9%) patients were man. Moist rales were audible from the both lungs, and moist rales over the right lung were clearer than those over the left lung in fourteen patients. The white blood cells [(12.83±5.55) versus (8.95±3.23) ×10 /L, P=0.001)] as well as neutrophil counts [(11.34±3.81) versus (7.49±2.83)×10 /L, P=0.001)] were higher, whereas the counts of other subsets of white blood cells were lower on admission than those after recovery (all P<0.05). Serum levels of alkaline phosphatase (115.8±37.6 versus 85.7±32.4 mmol/L, P=0.020), cholinesterase (7226.2±1631.8 versus 6285.3±1693.3 mmol/L, P=0.040), creatinine (85.2±17.1 versus75.1±12.8 mmol/L, P=0.021), uric acid (401.9±114.2 versus 326.0±154.3 mmol/L, P=0.041), and uric glucose (7.20±1.10 versus 5.51±1.11 mmol/L, P=0.001) were higher, but carbondioxide combining power (COCP, 26.7±4.4 versus 28.9±4.5 mmol/L, P=0.042) and serous calcium (2.32±0.13 versus 2.41±0.10 mmol/L, P=0.006) were lower on admission. Arterial blood gas results showed hypoxemia and respiratory alkalosis on admission. Conclusions In the present research, men were more susceptible to HAPE than women, and in the process of HAPE, the lesions of the right lung were more serious than those of the left lung. Some indicators of routine blood test and blood biochemistry of HAPE patients changed.

Eff ect of interventional therapy on chronic total occlusion by doubutamine stress echocardiography evaluation / 中国介入心脏病学杂志

Objective To evaluate the effect of percutaneous coronary intervention (PCI) on chronic total occlusion (OCT) by doubutamine stress echocardiography. Methods Forth-six CTO patients were categorized into the reopening group and failed-reopening group based on the results of PCI. All patients had undergoing low dose doubutamine stress echocardiography before PCI and at 6-month follow-up, measuring rest and stress wall motion score index (WMSI) with semi-quantitative method. Cardiac volumes and ejection fraction were measured with 3D full volume echocardiographic. Results The two groups showed no differences in general clinical data and all baseline echocardiography data before PCI. During follow-up, the reopening group was observed to have improvement in ejection fraction[(60.00±3.22)% vs.(62.65±3.58)%,P=0.017)],and WMSI in stress status[(1.42±0.37)vs.(1.32±0.36),P<0.001], compared with pre-PCI results. The reopening group showed improvement in ejection fraction[(62.65±3.58)% vs.(57.7±5.61)%,P=0.001)]and WMSI in stress status[(1.32±0.36)vs.(1.62±0.47),P<0.001)],when compared with the failed-reopening group. Conclusions Low dose doubutamine stress echocardiography can be nsed for evaluation of the eff ect of revascularization of CTO. The cardiac volumes and contractile function representing by wall motion in stress status were improved after recanalization of CTO.

Factors Related to Ventricular Size and Valvular Regurgitation in Healthy Tibetans in Lhasa / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Lhasa is the main residence of Tibetans and one of the highest cities in the world. Its unique geography and ethnic population provide the chance to investigate the interactions among high altitude, ethnicity, and cardiac adaptation. Meanwhile, echocardiographic data about healthy Tibetans on a large scale are not available. This study aimed to analyze physiological factors related to ventricular size and valvular function in healthy Tibetans in Lhasa.</p><p><b>METHODS</b>A representative sample of residents in Tibet was recruited using a multistage cluster random sampling method. Two-dimensional echocardiographic measurements and Doppler evaluation for valvular function were performed. Healthy Tibetans in Lhasa constituted the study population. Associations between physiological parameters and ventricular dimensions in healthy Tibetans were analyzed by canonical correlation analysis. Factors related to valvular regurgitations were determined by logistic regression analysis.</p><p><b>RESULTS</b>The 454 healthy Tibetans (340 females and 114 male) in Lhasa were included in the final analysis. Canonical correlation analysis revealed that weight was positively correlated with the proximal right ventricular outflow diameter and the basal left ventricular linear dimension in both genders. Weight and pulse were negatively related to mild tricuspid regurgitation. Age was a positive factor for pulmonary and aortic regurgitations. The same was found between systolic blood pressure and mitral regurgitation.</p><p><b>CONCLUSIONS</b>Weight is associated with ventricular size and valvular regurgitation in healthy Tibetans. It should be of more concern in research of high altitude population.</p>

Correlating transmural extent of acute myocardial infarction to left ventricular stain by mrifeature tracking / 中国介入心脏病学杂志

Objective The left ventricular myocardial strain of acute myocardial infarction on cardiac magnetic resonance cine imaging was measured by feature tracking technique. The relationship between left ventricular myocardial strain and the transmural extent of Myocardial Infarction was evaluated. Methods 74 patients with acute ST segment elevation myocardial infarction were included. All theses patients received primary PCI within 12 hours. After 2 to 5 days. ECG gated steady-state free precession sequences were collected. Gadolinium contrast enhanced imaging was performed on short axis. 20 patients repeated same scan after 3 to 5 months. TomTec 2D CPA and Segment software were used to analyze the images. The peak values of the regional myocardial strain indexes. The transmural extent of myocardial infarction of segment in left ventricular was measured. Results There was no significant difference of longitudinal strain in non-infarction,non-transmural infarction and transmural infarction segments at the basal and middle segments. The circumferential strain peak and the radial strain peak of non-transmural infarction segments were lower than those of the non-infarction segments. The circumferential strain of transmural infarction segments were the lowest(basal level:-14.24％±9.05％,P<0.05;middle level:-12.71％±8.92％,P<0.05;apical level:-13.81％±11.13％, P<0.05). GLS was improved while LVDd was increased when compared the acute phase of myocardial infarction to that of 3-5 months after primary PCI. The circumferential strain and longitudinal strain of the non-transmural infarction segments was improved. The circumferential strain and radial strain of the transmural infarction segments 3-5 months later was improved as compared to the acute phase. Conclusions There was differences in myocardial strain in non-infarction,non-transmural infarction and transmural infarction segments from patients with acute ST segment elevation myocardial infarction who had accepted primary PCI. The circumferential strain and longitudinal strain of the non-transmural infarction segments were improved after 3-5 months. The circumferential strain and radial strain of the transmural infarction segments after 3-5 months was improved as compared to the acute phase. Cardiac Magnetic resonance could combine feature tracking technique with gadolinium contrast delayed enhancement technique,giving both function and tissue characteristic evaluation to the myocardial damages after acute myocardial infarction.

Different approaches to revascularization for complex coronary artery disease and left ventricular dysfunction: analysis of perioperative outcomes / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the perioperative outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of complex coronary artery disease and left ventricular dysfunction.</p><p><b>METHDOS</b>The clinical data of 966 patients admitted to our hospital from January 2003 to December 2013 with coronary artery disease and left ventricular dysfunction (ejection fraction ≤50%) were retrospectively reviewed. Among the patients, 386 underwent CABG and 580 received PCI. After matching for EuroSCORE risk factors and preoperative echocardiographic parameters, 135 patients with CABG and 135 with PCI were enrolled in this study. With hospital mortality and perioperative major complications as the endpoints, the early outcomes of the procedures were evaluated. Perioperative echocardiography was performed to evaluate the change of left ventricular geometry and function.</p><p><b>RESULTS</b>Compared with CABG group, PCI group had significantly higher incidences of chronic lung disease (8.1% vs 0.7%, P=0.003) and recent myocardial infarction (64.4% vs 31.9%, P=0.000) but significantly lower left-main disease (12.6% vs 23.7%, P=0.018); the other baseline characteristics were comparable between the two groups. Patients with CABG had a greater number of treated target vessels than those with PCI (2.90±0.81 vs 1.67±0.73, P=0.000), and complete revascularization was more common in CABG group (94.8% vs 51.8%, P=0.000). No significant difference was found in perioperative variations of LVEF between the two groups, but patients with CABG had a greater variation in LVEDD than those with PCI. The hospital mortality and other major complications were similar between the two groups.</p><p><b>CONCLUSION</b>Both CABG and PCI are safe and reliable revascularization strategies for complex coronary artery disease and left ventricular dysfunction, but CABG can achieve a higher rate of complete revascularization and better improves the left ventricular function.</p>

Effects of treadmill exercise on central hemodynamics in patients below 60 years of age with coronary artery disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of treadmill exercise on central hemodynamics in patients with coronary artery disease.</p><p><b>METHODS</b>Sixty-eight consecutive patients below 60 years of age with the diagnosis of coronary artery disease (CAD) between July, 2013 and April, 2014 underwent treadmill exercise test following the standard Bruce protocol. Ninety-seven individuals without CAD served as the control group. Central hemodynamics of the subjects, including the central aortic blood pressure (cSBP), augmentation index (AI) and augmentation pressure (AP), were examined before and after the exercise.</p><p><b>RESULTS</b>cSBP increased significantly after acute exercise in both groups (P<0.001). Immediately after treadmill exercise, AI showed no significant changes in CAD patients (P=0.561) but decreased significantly in the control subjects (P<0.001). AI before exercise and cSBP after exercise were significantly higher in CAD group than in the control group (P=0.009 and 0.009, respectively). Stepwise regression analysis showed that the maximal heart rate after exercise was the main factor that affected cSBP increment in CAD group (P=0.012), and the occurrence of ischemia after exercise was associated with a lower cSBP increment (P=0.048).</p><p><b>CONCLUSION</b>AI does not decrease significantly after acute exercise in patients with CAD, suggesting that AI is closely associated with coronary artery blood perfusion after exercise and may serve as a potential target for improving ischemic threshold during rehabilitation of the patients.</p>

Exenatide promotes chemotactic migration of adipose-derived stem cells through SDF-1/CXCR-4/Rho GTPase pathway / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of exenatide on chemotactic migration of adipose-derived stem cells (ADSCs) and confirm that Rho GTPase is the downstream effector protein of SDF-1/CXCR-4 migration pathway.</p><p><b>METHODS</b>ADSCs were isolated, cultured, identified by flow cytometry, and induced to differentiate in vitro. RTCA xCELLigence system was used to analyze the effect of exenatide on ADSC proliferation. The effects of exenatide at different concentrations, AMD3100 (CXCR-4 antagonist), and CCG-1423 (Rho GTPase antagonist) on chemotactic migration of ADSCs were tested using Transwell assay. The expression of CXCR-4 in exenatide-treated ADSCs was measured by flow cytometry and Western blotting. Active Rho pull-down detection kit was used to detect the expression of Rho GTPase. Laser confocal microscopy was used to observe the formation of stress fibers in ADSCs with different treatments.</p><p><b>RESULTS</b>Exenatide treatment for 24 h had no significant effect on ADSC proliferation. Exenatide obviously promoted chemotactic migration of ADSCs in a concentration-dependent manner, and this effect was blocked by either AMD3100 or CCG-1423. Both flow cytometry and Western blotting showed that exenatide dose-dependently up-regulated CXCR-4 expression in ADSCs. Western blotting showed that the expression of Rho GTPase was related to SDF-1/CXCR-4 pathway, and laser confocal microscopy revealed that the formation of stress fibers in ADSCs was related to SDF-1/CXCR-4/ Rho GTPase pathway.</p><p><b>CONCLUSION</b>Exenatide promotes chemotactic migration of ADSCs, and Rho GTPase is the downstream effector protein of SDF-1/CXCR-4 pathway.</p>

Impact of Clinical Guideline Recommendations on the Application of Coronary Computed Tomographic Angiography in Patients with Suspected Stable Coronary Artery Disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Coronary computed tomographic angiography (CCTA) has been widely used in patients who are at intermediate risk for having stable coronary artery disease (SCAD), and 2013 European Society of Cardiology Guidelines on the Management of SCAD (2013G) recommended the appropriate application of CCTA. However, 2013G has not been subjected to systematic analyses for subsequent impact on clinical practice.</p><p><b>METHODS</b>A total of 5320 patients suspected with SCAD were enrolled and scheduled for CCTA from March 2013 to September 2014. For each patient, pretest probability of SCAD was calculated according to updated Diamond-Forrester model (UDFM). Appropriate CCTA or appropriate stress test was determined as described in the 2013G. A generalized estimating equation model was used to determine the trends in the half-monthly rate of appropriate CCTA.</p><p><b>RESULTS</b>Overall, only 61.37% of patients received appropriate CCTA, and there was insignificant change over time (P = 0.8701). The application of CCTA in patients who should have had a stress test accounted for most of the inappropriate CCTA before (22.29%) or after (19.98%) the publication of the 2013G. In all patients or any subgroup, no significant change in the adjusted half-monthly rate of appropriate CCTA was found after the publication of the 2013G (odds ratio, 1.002; 95% confidence interval, 0.982-1.021; P = 0.8678).</p><p><b>CONCLUSIONS</b>These findings suggest that the 2013G have not, to date, been fully incorporated into clinical practice, and the clinical utilization of CCTA remains unreasonable to some extent.</p>

Short-term rosuvastatin treatment for the prevention of contrast-induced acute kidney injury in patients receiving moderate or high volumes of contrast media: a sub-analysis of the TRACK-D study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Current randomized trials have demonstrated the effects of short-term rosuvastatin therapy in preventing contrast-induced acute kidney injury (CIAKI). However, the consistency of these effects on patients administered different volumes of contrast media is unknown.</p><p><b>METHODS</b>In the TRACK-D trial, 2998 patients with type 2 diabetes and concomitant chronic kidney disease (CKD) who underwent coronary/peripheral arterial angiography with or without percutaneous intervention were randomized to short-term (2 days before and 3 days after procedure) rosuvastatin therapy or standard-of-care. This prespecified analysis compared the effects of rosuvastatin versus standard therapy in patients exposed to (moderate contrast volume [MCV], 200-300 ml, n = 712) or (high contrast volume [HCV], ≥ 300 ml, n = 220). The primary outcome was the incidence of CIAKI. The secondary outcome was a composite of death, dialysis/hemofiltration or worsened heart failure at 30 days.</p><p><b>RESULTS</b>Rosuvastatin treatment was associated with a significant reduction in CIAKI compared with the controls (2.1% vs. 4.4%, P = 0.050) in the overall cohort and in patients with MCV (1.7% vs. 4.5%, P = 0.029), whereas no benefit was observed in patients with HCV (3.4% vs. 3.9%, P = 0.834). The incidence of secondary outcomes was significantly lower in the rosuvastatin group compared with control group (2.7% vs. 5.3%, P = 0.049) in the overall cohort, but it was similar between the patients with MCV (2.0% vs. 4.2%, P = 0.081) or HCV (5.1% vs. 8.8%, P = 0.273).</p><p><b>CONCLUSIONS</b>Periprocedural short-term rosuvastatin treatment is effective in reducing CIAKI and adverse clinical events for patients with diabetes and CKD after their exposure to a moderate volume of contrast medium.</p>

Long-term outcome of patients undergoing recanalization procedures for chronic total coronary occlusion / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the long-term outcomes of patients receiving percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy for treatment of chronic total coronary occlusion (CTO).</p><p><b>METHODS</b>The patients with CTO were selected from a consecutive cohort of patients who underwent coronary angiography (CAG) between 2008 and 2009. The patients with multiple CAG were excluded. The patients received treatments with PCI, CABG, or conservative medication therapy and were followed for major adverse cardiovascular events (MACE) within 5 years.</p><p><b>RESULTS</b>A total of 253 patients were enrolled in this study, including 192 receiving PCI, 48 receiving CABG, and 13 treated conservatively with medications. The baseline clinical characteristics were similar among the 3 groups except for increased low-density lipoprotein (LDL) and total cholesterol (TC) in the medication group, and increased Syndax score in CABG group. During the follow-up, the incidences of MACE, AMI, death, stroke or heart failure did not differ significantly among the 3 groups (P>0.05). However, CABG group showed a higher incidence of the stroke than the other two groups although this difference did not reach a statistically significantly level (P=0.06).</p><p><b>CONCLUSION</b>Our study did not demonstrate that recanalization offers greater long-term benefits than medications for treatment of CTO, and the patients receiving CABG appeared to have a higher incidence of stroke.</p>

Study on steroidal saponins from Dioscorea zingiberensis and their platelet aggregation activities / 中国中药杂志

Using the absorbent resin, silica gel and ODS column chromatography as well as semi-preparative HPLC, ten compounds were isolated from 70% ethanol extract of tubers of Dioscorea zingiberensis C. H. Wright, and their structures were elucidated as trigoneoside XIIIa (1), parvifloside (2), trigoneoside IVa (3), deltoside (4), protobioside (5), lilioglycoside k (6), zingiberensis newsaponin I (7), deltonin (8), prosapogenin A of dioscin (9), and trillin (10) on the basis of NMR and MS spectral data analysis. Among these compounds, 1, 3, 5 and 6 were isolated from this plant for the first time. In the screening test on platelet aggregation, compounds 7 and 8 exhibited induction effect on platelet aggregation, while compound 9 exhibited significant inhibitory effect on platelet aggregation in vitro.

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>