ABSTRACT
Objective To observe serum sCD40L,MMP9 levels and their relevance with different types of coronary heart disease(CHD).Methods The present study was involved in 90 patients with CHD,including acute myocardial infarction(AMI)30 case,unstable angina pectoris(UAP)31 case,stable angina pectoris (SAP)29 case and another 25 normal controls.The serum MMP9 and sCD40L levels were detected with enzyme-linked immunosor-bent assay.Results The levels of MMP9,sCD40L in AMI and UAP group were significantly higher than those in SAP group[(69.48 ±4.76)ng/mL,(66.61 ±5.30)ng/mL,(30.44 ±7.66)ng/mL,t=1.425,0.075,all P0.05 ),and also there were no ststitically signiticant differeces in the serum MMP9,sCD40L levels between SAP group with control group (all P>0.05).MMP9 level in AMI and UAP group was positively related with sCD40L (r=0.96,P<0.01 and r=0.97,P<0.01 ).Conclusion The serum sCD40L and MMP9 levels of acute coronary syndrome(ACS)increase significantly,and can be used as an important index to assess the severity of CAD and predict the instability of plaque in CAD patients.
ABSTRACT
Objective To observe the changes of ischemia modified albumin (IMA),high -sensitivity C -reactive protein (hs -CRP)after percutaneous coronary intervention (PCI).The factors related to intervention procedures to patients with IMA and hs -CRP elevation after PCI and impact of the risk of IMA and hs -CRP on the clinical outcomes were investigated.Methods IMA,hs -CRP from vein blood of 90 cases received PCI were detec-ted before operation and after operation at time of 30 min,2h,6h and 24h.The clinical characteristics of patients and factors related to intervention procedures were recorded.The number of lesion vessels and the relative factors in PCI were compared.The clinical outcomes of the patients were followed up.Results After operation,IMA was significantly different compared with that before operation (t =2.293,P <0.05).The concentration of IMA peaked at 2h after operation,which was significantly different from that before surgery (t =1.116,P <0.01).The increase of IMA and hs -CRP were closely related with the inflation pressure,total times of inflation,dilated times,length and diameter of stent and the number of stents (t =3.678,P <0.01 ).The angina onset was more common and length of stay was longer in the patients with the rise of IMA and hs -CRP.Conclusion PCI may cause myocardial injury,which is associated to inflation pressure,total time of inflation,dilated times,length and diameter of stent and the number of stents.To a certain extent the level of troponin can predict the outcomes.
ABSTRACT
<p><b>OBJECTIVE</b>To assess a minipig model of acute myocardial infarction (AMI) established by percutaneous balloon occlusion using delayed-enhanced magnetic resonance imaging (DE-MRI).</p><p><b>METHODS</b>A minipig model of AMI was established by placement of a 2.0 mm×15.0 mm percutaneous transluminal coronary angioplasty balloon in the middle left anterior descending artery (LAD) through a percutaneous femoral puncture in the right inguinal region. The left anterior descending coronary artery (LAD) was occluded for 90 min, followed by assessment of the infarct size and cardiac function with DE-MRI, and the results were confirmed by pathological examination.</p><p><b>RESULTS</b>DE-MRI showed a mean infarcts size of 10.2∓2.9 cm3 in the minipig models. Compared to the control group, the minipigs with AMI had significantly increased end-diastolic and end-systolic volumes (P<0.05) with a decreased stroke volume, ejection fraction and cardiac output (P<0.001). These DE-MRI values were matched with the microsphere values obtained from short-axis slices in pathological examination.</p><p><b>CONCLUSION</b>We have established a feasible approach for evaluating minipig models of AMI as a platform for assessing the therapeutic effect of stem cell transplantation for AMI.</p>
Subject(s)
Animals , Angioplasty, Balloon, Coronary , Disease Models, Animal , Magnetic Resonance Imaging , Myocardial Infarction , Pathology , Swine , Swine, MiniatureABSTRACT
Background The present study investigated the prognostic value of medical comorbidities at admission for 30-day in-hospital mortality in patients with acute myocardial infarction (AMI). Methods A total of 5161 patients with AMI were admitted in Chinese PLA General Hospital between January 1,1993 and December 31,2007. Medical comorbidities including hypertension, diabetes mellitus, previous myocardial infarction, valvular heart disease, chronic obstructive pulmonary disease (COPD), renal insufficiency, previous stroke, atrial fibrillation and anemia, were identified at admission. The patients were divided into 4 groups based on the number of medical comorbidities at admission (0, 1, 2, and ≥ 3). Cox regression analysis was used to calculate relative risk (RR) and 95% confidence intervals (CI), with adjustment for age, sex, heart failure and percutaneous coronary intervention (PCI). Results The mean age of the studied population was 63.9 ± 13.6 years, and 80.1% of the patients were male. In 74.6% of the patients at least one comorbidity were identified. Hypertension (50.7%), diabetes mellitus (24.0%) and previous myocardial infarction (12%) were the leading common comorbidities at admission. The 30-day in-hospital mortality in patients with 0, 1, 2, and ≥ 3 comorbidities at admission (7.2%) was 4.9%, 7.2%, 11.1%, and 20.3%, respectively. The presence of 2 or more comorbidities was associated with higher 30-day in-hospital mortality compared with patients without comorbidity (RR: 1.41, 95% CI: 1.13-1.77, P = 0.003, and RR: 1.95, 95% CI: 1.59-2.39, P = 0.000, respectively).Conclusions Medical comorbidities were frequently found in patients with AMI. AMI patients with more comorbidities had a higher 30-day in-hospital mortality might be predictive of early poor outcome in patients with AMI.
ABSTRACT
Objective Brachial-ankle pulse wave velocity (baPWV) is widely used as a simple noninvasive measure of arterial stiffness. The aim of this study was to evaluate the usefulness of baPWV as a predictor of the carotid artery atherosclerosis in the elderly. Methods A total of 721 elderly participants (mean±SD age, 70.3 5.6years) were enrolled in the current study. All participant underwent both baPWV measurement and B-mode ultrasound for the intima-media thickness. Carotid atherosclerosis (CAS) was defined as the present of carotid plaque or and/or intima media thickness for at least 1.1 mm. Results A multivariate logistic regression analysis reveals that age, sex, brachial-ankle pulse wave velocity, smoking and LDL-C level showed a significant correlation with the presence of CAS. The odds ratios of CAS associated with a 500cm/s increase of brachial-ankle pulse wave velocity were 2.378 [95% confidence interval, 1.36 to 4.00, P<0.05], 3.733 [95% confidence interval, 1.729 to 8.058, P<0.01], 4.438 [95% confidence interval, 1.659 to 11.803, P<0.01]. The baPWV significantly correlated with IMT by bivariate correlation analysis (r=0.39; p=0.001). After adjusting for factors influencing, baPWV all the same correlated with IMT (r=0.35; p=0.001).Conclusion These results indicate that brachial-ankle PWV is an independent predictor of CAS in the elderly.It also means that the direct measurement of arterial stiffness by this simple method may be of great help for the evaluation of carotid artherosclerosis, at least in the elderly.
ABSTRACT
Objective To observe the surface structures of cardiovascular endothelial cells in situ with atomic force microscope (AFM). Methods Fresh aorta and aortic valve were dissected from 10 healthy male New Zealand white rabbits. Before fixed in 1% formaldehyde, the fresh tissues were washed in the buffer phosphate solution. Under general microscope, the fixed aorta or valve was spread on the double side stick tape which had already been stuck on the glass slide. The intima of aorta or the aorta side of valve was towards upside. Then the specimen was dried under 37 degrees centigrade in an attemperator and was washed with pure water. After dried again, the specimen was loaded on the platform ofNanoScope llla AFM and was scanned in tapping mode with the scanning speed of 0.5 HZ. Results The surface structures of endothelial cell on the fixed and dried tissue could be obsserved clearly in situ with AFM. Aortic endothclial cells were large, branched and arranged sparsely and parallel to the direction of blood flow, whereas endothelial cells on aorta valve surface were small, less branched and arranged intensively and vertical to the direction of blood flow. When the scanning range was dwindled, granular ultra-structures could be observed on the surface of endothelial cells, and, as the scanning range was dwindled further, fissure and convolution could be seen on the surface of granules from aortic endothelial cells. Centre cavity and surrounding swelling volcano-like structure could be seen on the surface of granules from endothelial cells of aortic valve. Conclusions It's feasible to observe the surface ultra-structures of cardiovascular endothelial cells in situ with AFM and morphological information provided by A FM might be of clinical value in future histopathological diagnosis.
ABSTRACT
Multiple organ dysfunction syndrome (MODS) is one of the leading causes of death in ICU patients.However,there have been few studies on the role of MODS as a cause of death in patients with acute myocardial infarction (AMI),particularly in those at advanced age.Our study aimed to investigate the incidence and to identify the predicting factors of MODS in elderly patients with AMI.Methods We identified consecutive patients with AMI who were discharged from the Chinese PLA General Hospital between January 1993 to June 2006.Medical records of 800 consecutive patients aged 60 years or over were analyzed retrospectively.Multivariate logistic regression was used to determine factors predicting in-hospital development of MODS.Results Twenty-seven (3.4%) patients developed MODS within 30 days after AMI.Compared with patients without MODS,patients with MODS had higher in-hospital mortality rates (55.6% vs 11.6%,P＜0.001 ) and more frequent complications of cardiogenic shock (25.9% vs 6.2%,P＜0.001),heart failure (HF) (59.3% vs 18.2%,P＜0.001 ),cardiac arrhythmia (44.4% vs 26.4%,P＜0.05) and pneumonia (55.6% vs 16.3%,P＜0.001).Multivariate logistic regression analysis showed the major predictors for the occurrence of MODS secondary to AMI were advanced age (≥ 75 years,odds ratio 2.64,95% confidence interval [CI] 1.13 to 6.61),heart rate/＞ 100 bpm on admission (odds ratio 1.74,[CI] 1.14 to 2.64),in-hospital complication of HF (odds ratio 3.03,[CI] 1.26 to 7.26) and pneumonia (odds ratio 2.82,[CI] 1.18 to 6.77).Conclusions MODS is not the uncommon complication in elderly patients with AMI and is associated with poor prognosis.Advanced age,heart failure and pneumonia are predictors of the development of MODS in patients with AMI.(J Geriatr Cardiol 2008;5:199-202)
ABSTRACT
Overt gastrointestinal bleeding (GIB) is one of the noncardiac complications in patients with acute myocardial infarction (AMI).Identification of patients at increased risk of overt GIB could aid in targeting more aggressive treatment,and lead to improved outcomes.The aim of this study is to determine the frequency,risk factors,and prognostic significance of overt GIB in patients with AMI.Methods A retrospective review of the medical records of 1443 patients admitted to the Chinese PLA General Hospital with AMI was conducted.Charts were reviewed for clinical characteristics,possible precipitating factors and complications.Patients were categorized as having or not having overt GIB(GIB associated with hemodynamic changes or the need for transfusions).Results Twenty nine (2.0%) patients developed overt GIB within 30 days after AMI.Patients with overt GIB had higher 30-day mortality rate than those without (44.8% vs.9.9%,P ＜ 0.001).Multivariate logistic regression analysis showed major determinants of in-hospital overt GIB secondary to AMI were gender of female (odds ratio 2.41,95% confidence interval [CI] 1.08 to 5.37),age=75 years (odds ratio 1.58,95% CI 1.13 to 2.20),prior history of AMI (odds ratio 2.28,95% CI 1.17 to 4.88),pneumonia (odds ratio 3.47,95% CI 1.50 to 8.03) and anemia at admission (odds ratio 2.37,95% CI 1.04 to 5.37).Conclusions In patients with AMI,overt GIB is associated with higher in-hospital mortality,and female sex,older age,prior AMI,pneumonia and anemia at admission are predictors of overt GIB during hospitalization.(J Geriatr Cardiol 2008;5:195-198)
ABSTRACT
@#Objective To explore the effect of aerobic exercise on platelet function in elderly patients with hypertension and type 2 diabetes.Methods81 elderly patients with hypertension and type 2 diabetes were divided into the routine treatment group (group A, n=41) and regular exercise group (group B, n=40). All patients of two groups were treated with routine treatment. The exercise with moderate intensity was performed in the group B for 3 months besides routine treatment. The platelet membrane glycoprotein CD62P, CD61 (Ⅲa) were detected by flow cytometric analysis and platelet aggregating ratio was measured before and after regular aerobic exercise.ResultsAfter three months, the systolic blood pressures were 166±3.6 mm Hg (group A) and 152±3.5 mm Hg (group B); the diastolic blood pressures were 93±4.2 mm Hg (group A) and 83±4.3 mm Hg (group B); the contents of blood glucose were 7.4±2.4 mmol/L (group A) and 6.3±1.9 mmol/L (group B); the positive percents of platelet membrane glycoproten CD62P were 27.3±2.2% (group A) and 21.5±3.3% (group B), CD61(Ⅲa) were 26.3±2.3% (group A) and 20.2±2.9% (group B) and platelet aggregation rates were 78.4±4.5% (group A) and 69.7±5.4% (group B), there was a significant difference between two groups ( P<0.05～0.01).ConclusionRegular aerobic exercise can decrease the positive percent of platelet membrane glycoprotein and platelet aggregation rate in elderly patients with hypertension and type 2 diabetes.
ABSTRACT
Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary angiography.Methods Eighty-two men and 14 women referred for consideration of coronary intervention were randomly selected. Observation by an overnight sleep monitor and Holter recording were performed to study sleep-disordered breathing (oxyhemoglobin desaturations≥4％ and apnea-hypopneas),heart rates, and ST-segment depressions (≥ 1mm, ≥1 min).Results Nocturnal ST-segment depressions occurred in 37 ％ of the patients. ST-segment depression within 2 min after an apnea-hypopnea or desaturation occurred in 17％ of the patients. This temporal association was seen in 21％ of the patients with nocturnal ST-segment depressions, more frequently in men (P＜0.05) and more frequently in those with severe disordered breathing (P＜0.05).Most of these ST-segment depressions were preceded by a series of breathing events: repeated apnea-hypopneas or desaturations or both in 73％ of the patients. Conclusions Episodes of nocturnal myocardial ischemia are common in patients with angina pectoris. A temporal relationship between sleep-disordered breathing and myocardial ischemia was present in some of our patients, and occurs more frequently in men and in those with severely disordered breathing. (J Geriatr Cardiol 2004;1(2):90-94.)
ABSTRACT
@#ObjectiveTo investigate the effect of β-adrenergic receptor(β2AR) stimulation on vascular smooth muscle cell apoptosis in physiological state and receptor overexpression model.Methodsβ2AR overexpression model was established by transgenic techniques. Hoechst 33342 staining as well as flow cytometer(FCM) detected were chosen to measure the incidence of vascular smooth muscle cell apoptosis.ResultsVascular smooth muscle cell exhibited significantly fewer viable cell rate when stimulated with β2AR agonist isoproteronol for 48 hours compared with control (P<0.01),while no difference at the time point of 24 hours. Much fewer viable rate detected by FCM and high apoptotic rate by Hoechst staining were observed when VSMCs overexpressing β2AR were stimulated with isoproteronol for 24 hours (P<0.01).ConclusionStimulation of physiological and overexpressing β2AR could induce apoptosis of vascular smooth muscle cell.
ABSTRACT
0.05). The results indicated that prodromal angina pectoris showed no beneficial effcet on the outcome in patients of venarable age with acute myocardial infarction.
ABSTRACT
Objective The aim of the study is to explore the relationship of lung infection(LI)and multiple organ failure in the elderly(MOFE).Methods Consecutive patients ,who were admitted to the Institute of Geriatric Cardiovascular Diseases of the PLA General Hospital and the Endocardial Department of the Air Force General Hospital,withage≥65 years old were enrolled into 5 groups retrospectively by following criteria:acute LI alone,LI with the first presentation of acute lung edema,chronic bronchitis complicated with LI,chronic heart failure complicated with LI,and nic bronchitis and heart failure complicated with LI.Results Sixty-eight patients were selected of(72.5?7.6)years old ( 38 male).There were 4 cases of pure LI(4%),12 cases of LI firstly presented with the symptoms of acute lung edema(18%),16 cases of LI complicated with chronic bronchitis(24%),15 cases of LI based on chronic heart failure(22%)and 22 cases of LI complicated with chronic bronchitis and heart failure(32%).LI initiated MOFE in 25 cases(37%).Most of them were developed on the basis of chronic bronchitis and/or heart failure(34%).Mortality of secondary LI was higher than that of the primary LI(7.4% VS 0%,P
ABSTRACT
Objective To suggest the developmental direction of geriatrics based on the current status of domestic and international gerontological researches. Methods Professional literature in the gerontological field published domestically and abroad in recent 10 years were retrieved, and the current status and trend of progress in gerontology were analyzed. Results In recent 10 years, great progress was witnessed in geriatrics both in basic research and clinical diagnosis and treatment. With indept research concerining aging and anti-aging genetics, the secrets of prolonging longevity and the underlying mechanism of senescence of human being would be revealed, thus a theoretical basis for anti-aging strategy could be formalated. The research on multi-organ dysfunction, hypertension, coronary heart disease, multi-factor heart failure and senile degenerative valvular heart disease, Alzheimer disease, senile pulmonary disease and osteoporosis, and other common diseases in aged individuals might be able to reveal the clinical characteristics, improvement in their diagnostic accuracy, prevention, and control. The development of evidence-based medicine and community medicine would contribute to improve the quality of life and physical and mental health of the elderly people. Conclusions Gerontological research should focus on the causes and features of aging in the future to guide the clinical practice with the latest research findings, new medicines and prevention measures of common chronic diseases in elderly people, and also focus on community medicine to improve prevention and health care for the elderly people.
ABSTRACT
To evaluate the influence of known coronary artery disease(CAD)on perioperative cardiac events in elderly patients undergoing noncardiac surgery,3028 consecutive patients who underwent major noncardiac procedures, with or without a history of CAD, were analyzed in terms of types and nature of surgery, clinical history and perioperative cardiac complications. Among the patients CAD, there were more urologic operations, and clinical history of internal diseases compared with the patients without CAD. Patients with CAD had an increased odds ratio for myocardial ischemia and arrhythmia (OR, 20 3 [95% CI, 6 5 to 65 7] and OR, 7 4 [CI, 4 4 to 12 3]) during operation, and also for postoperative myocardial ischemia, myocardial infarction, cardiogenic pulmonary edema and arrhythmia (OR, 8 3 [95% CI, 4 7 to 14 7], OR, 3 9 [95% CI, 1 2 to 12 2], OR, 7 9 [95% CI, 3 8 to 16 6] and OR, 1 7 [CI, 1 3 to 2 4]) compared with patients without CAD. The results indicated that elderly patients with CAD who underwent noncardiac surgery were more frequently associated with clinical history of internal diseases, and had a higher rate of major perioperative cardiac complications.