Study on the distribution law of TCM syndrome types and influencing factors based on 1 684 patients with unstable angina pectoris of coronary heart disease / 国际中医中药杂志

Objective:To investigate the distribution law of TCM syndrome types and the differences in influencing factors among different syndrome types in unstable angina pectoris (UA), so as to provide an objective basis for TCM syndrome differentiation and treatment of UA.Methods:A retrospective study chose 1 684 inpatients in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Henan University of Chinese Medicine from August 2015 to April 2019. Epidata 3.0 software was used to input general information of patients [gender, age, length of hospital stay, BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP)], laboratory indicators[TC, TG, HDL-C, LDL-C, fibrinogen (FIB), thrombin time (TT), D-dimer (D-dimer), HbA1c], TCM syndrome types (qi and yin deficiency syndrome, phlegm turbidity and obstruction syndrome, qi deficiency and blood stasis syndrome, heart blood stasis syndrome, qi stagnation and blood stasis syndrome, heart and kidney yang deficiency syndrome) and other information. A database was established to analyze the distribution of TCM syndrome types and the relationship with the general information of patients, blood lipids, blood sugar and coagulation indexes. Logistic regression was used to analyze the influencing factors of different syndrome types.Results:The distribution of syndrome types in 1 684 UA patients was as follows: qi and yin deficiency syndrome (44.7%), phlegm turbidity and obstruction syndrome (35.3%), qi deficiency and blood stasis syndrome (7.4%), heart blood stasis syndrome (5.3%), qi stagnation and blood stasis syndrome (4.6%), heart and kidney yang deficiency syndrome (2.6%); more men than women ( P<0.05); there were significant differences in the distribution of gender, age, BMI, TC, and HDL-C among the 6 syndrome types ( P<0.05); the age of patients with phlegm turbidity and obstruction syndrome was younger than that of qi and yin deficiency syndrome and heart blood stasis syndrome ( P<0.05); the age of patients with qi stagnation and blood stasis syndrome was younger than that of qi and yin deficiency syndrome, heart blood stasis syndrome, and heart kidney yang deficiency syndrome ( P<0.05); BMI of patients with phlegm turbidity and obstruction syndrome was higher than that of qi and yin deficiency syndrome and qi stagnation and blood stasis syndrome ( P<0.05); the level of TC in patients with phlegm turbidity and obstruction syndrome was lower than that of qi and yin deficiency syndrome and qi deficiency and blood stasis syndrome ( P<0.05); the level of HDL in patients with qi and yin deficiency syndrome was lower than that in qi deficiency and blood stasis syndrome and qi stagnation and blood stasis syndrome. Binary Logistic regression analysis found that TC [ OR(95% CI)=0.761(0.592, 0.978)] and HDL-C [ OR(95% CI)=2.131(1.145, 3.966)] were independent influencing factors for predicting qi deficiency and blood stasis syndrome ( P<0.05); age[ OR(95% CI)=1.017 (1.008, 1.026)], length of hospital stay [ OR(95% CI)=1.019 (1.001, 1.038)], DBP [ OR(95% CI)=0.984(0.975, 0.993)] and HDL-C [ OR(95% CI)=0.984(0.975, 0.993)] were independent influencing factors for predicting qi and yin deficiency syndrome ( P<0.05); age [ OR(95% CI)=0.965 (0.946, 0.985)], and HDL-C [ OR(95% CI)=2.329(1.206, 4.500)] were independent influencing factors for predicting qi stagnation and blood stasis syndrome ( P<0.05); age [ OR(95% CI)=0.982 (0.973, 0.991)], length of hospital stay [ OR(95% CI)= 0.978 (0.958, 0.997)], BMI [ OR(95% CI)=1.048 (1.015, 1.082)], DBP [ OR(95% CI)=1.014 (1.004, 1.024)] and HDL-C [ OR(95% CI)=0.505 (0.351, 0.726)] were independent influencing factors for predicting phlegm turbidity and obstruction syndrome ( P<0.05); age [ OR(95% CI)=1.031(1.003, 1.060)] and DBP [ OR(95% CI)=1.028(1.001, 1.056)] were independent influencing factors for predicting heart kidney yang deficiency syndrome ( P<0.05). Conclusion:The distribution of TCM syndrome types in UA shows a certain regularity, among which qi and yin deficiency syndrome and phlegm turbidity and obstruction syndrome are more common. Gender, age, BMI, TC, HDL-C are different among TCM syndrome types, which can provide some reference for UA TCM syndrome differentiation and treatment.

Ácido acetilsalicílico versus inibidores dos receptores P2Y12 para prevenção secundária em pacientes tratados por meio de intervenção coronária percutânea / Aspirin versus P2Y12 inhibitors for secondary prevention after percutaneous coronary intervention

Na atualidade, as intervenções coronárias percutâneas com implante de um stent farmacológico constituem o principal método de revascularização miocárdica em centros hospitalares terciários, independentemente da forma clínica de apresentação da doença arterial coronária. É de conhecimento geral que, para sua efetivação, há necessidade do uso de um esquema antiplaquetário duplo, constituído pela associação do ácido acetilsalicílico e um inibidor dos receptores plaquetários P2Y12, que é o cerne da prevenção das tromboses após implantes das endopróteses, sendo também indicado para prevenir a ocorrência de eventos aterotrombóticos na evolução clínica tardia, qualquer que seja o modelo de stent utilizado. Após período variável de tempo, independentemente de fatores como forma clínica de apresentação da coronariopatia e do tipo de stent implantado, esse esquema é interrompido, e, na atualidade, as principais diretrizes preconizam a suspensão do inibidor dos receptores P2Y12 e a manutenção do ácido acetilsalicílico em longo prazo como uma das principais medidas farmacológicas de prevenção secundária da aterosclerose. No entanto, recentemente, em razão de sua maior potência antiplaquetária e provável menor potencial de causar hemorragias significantes, em especial no tubo digestivo, os inibidores P2Y12 têm sido considerados alternativa válida e atraente como antiplaquetário de utilização em longo prazo, alternativa ainda não referendada pelas diretrizes. Esta revisão discute os pormenores relacionados a essa importante decisão que deve ser tomada pelo cardiologista no momento da interrupção dos diferentes esquemas antitrombóticos inicialmente utilizados após uma intervenção coronária percutânea. Em princípio, a escassez de estudos clínicos conclusivos e normativos, em especial na população tratada por meio de uma intervenção percutânea, faz com que o ácido acetilsalicílico ainda se mantenha como o único antiagregante plaquetário com indicação classe I com a finalidade de prevenção secundária da aterosclerose.

Currently, percutaneous coronary intervention with a drug-eluting stent implantation is the main method of myocardial revascularization in tertiary care hospitals, regardless of the clinical presentation of coronary artery disease. It is well known that to be effective, it requires the use of a dual antiplatelet therapy, which is a combination of acetylsalicylic acid and a P2Y12 platelet receptor inhibitor, which plays a key role in preventing thromboses after endoprosthesis implantation and is also indicated to prevent atherothrombotic events in the late clinical course, regardless of the stent model used. After a variable period of time, depending on some factors, such as the clinical presentation of coronary artery disease and the type of stent implanted, this therapy is discontinued, and the main current guidelines recommend interrupting the P2Y12 receptor inhibitor and maintaining acetylsalicylic acid in the long term, as one of the main pharmacological measures for secondary prevention of atherosclerosis. However, recently, due to their greater antiplatelet potency and probable lower potential for significant bleeding, especially in the digestive tract, P2Y12 inhibitors have been considered a valid and attractive option as an antiplatelet agent for long-term use; but this alternative has not been endorsed by guidelines yet. This review discusses the details related to this important decision that must be made by cardiologists when discontinuing the different antithrombotic therapies initially used after percutaneous coronary intervention. In principle, the scarcity of conclusive and normative clinical studies, especially in the population treated by percutaneous intervention, means that acetylsalicylic acid is the only antiplatelet agent with class I indication for secondary prevention of atherosclerosis.

De-escalação de inibidores dos receptores P2Y12 após intervenção coronária percutânea / P2Y12 inhibitor de-escalation after percutaneous coronary interventions

Em pacientes que apresentam síndromes coronárias agudas e são tratados com intervenção coronária percutânea, a prescrição do esquema antiplaquetário duplo, composto de ácido acetilsalicílico e um inibidor dos receptores P2Y12, é mandatória, contribuindo para a redução de eventos cardíacos maiores. No entanto, ao mesmo tempo em que previne eventos isquêmicos, essa associação pode precipitar complicações hemorrágicas maiores, o que é mais comumente observado quando são prescritos os medicamentos mais potentes, como o prasugrel ou o ticagrelor. Essas constatações levaram à procura de alternativas terapêuticas capazes de manter a proteção contra eventos isquêmicos e, ao mesmo tempo, prevenir a ocorrência de hemorragias. Uma das estratégias que está em estudo é a de-escalação dos inibidores P2Y12, que consiste no uso dos medicamentos mais potentes numa fase precoce após o procedimento, com substituição deles pelo clopidogrel, após um período de, em geral, 30 dias de evolução; outra possibilidade seria a simples redução da dose do fármaco de maior potência, algo que, até o momento, só pode ser cogitado com o prasugrel. A de-escalação pode ser feita de forma guiada, utilizando testes de mensuração objetiva da agregação plaquetária ou exames para avaliar o perfil genético dos pacientes, ou não guiada, na qual o cardiologista simplesmente faz a substituição ou redução da dose ao fim do período estipulado, sem o auxílio de exames complementares. A literatura contempla ensaios clínicos com essas duas opções de estratégia, os quais são discutidos nesta revisão. Até o momento, nenhuma diretriz médica recomenda de forma explícita o uso regular dessa alternativa terapêutica.

In patients who have acute coronary syndromes and are treated with percutaneous coronary intervention, the prescription of a dual antiplatelet regimen, consisting of acetylsalicylic acid and a P2Y12 receptor inhibitor, is mandatory, contributing to the reduction of major cardiac events. However, while preventing ischemic events, this association may precipitate major bleeding complications, which is more commonly seen when more potent drugs, such as prasugrel or ticagrelor, are prescribed. These findings led to the search for therapeutic alternatives that could maintain the protection against ischemic events and, at the same time, prevent the occurrence of hemorrhages. One of the strategies being studied is de-escalation of P2Y12 inhibitors, which consists of the use of more potent drugs in an early phase after the procedure, replacing them with clopidogrel, after a period of, in general, 30 days of clinical course. Another possibility would be to simply reduce the dose of the most potent drug, which so far can only be considered with prasugrel. De-escalation can be done in a guided way, using objective measuring tests of platelet aggregation or exams to assess the genetic profile of patients, or unguided, in which the cardiologist simply replaces or reduces the dose at the end of the stipulated period, with no ancillary tests. The literature includes clinical trials with these two strategy options, which are discussed in this review. So far, no medical guideline explicitly recommends the regular use of this therapeutic alternative.

Ticagrelor combined with atorvastatin for the treatment of unstable angina pectoris / 中国基层医药

Objective:To investigate the efficacy of ticagrelor combined with atorvastatin in the treatment of unstable angina pectoris and its effects on cardiac function, brain natriuretic peptide (BNP) level, lipoprotein-associated phospholipase A2 (Lp-PLA2) activity, and glycosylated hemoglobin (HbAlc) level in patients with unstable angina pectoris.Methods:A total of 200 patients with unstable angina pectoris who received treatment in the Sahzu International Medical Center from January 2017 to January 2019 were included in this study. These patients were randomly assigned to receive either clopidogrel combined with atorvastatin (control group, n = 100) or ticagrelor combined with atorvastatin (observation group, n = 100) for 1 month. The clinical efficacy,BNP level, Lp-PLA2 activity, HbAlc level, clinical symptom, cardiac function, and adverse reactions were compared between control and observation groups. Results:Effective rate was significantly higher in the observation group than in the control group [95% (95/100) vs. 75% (75/100), χ2 = 15.69, P < 0.001]. After treatment, BNP level and Lp-PLA2 activity in the observation group were (101.21 ± 40.13) ng/L and (105.56 ± 12.56) pg/L, respectively, which were significantly lower than those in the control group [(151.57 ± 37.29) ng/L, (137.52 ± 16.88) pg/L, t = 9.19, 15.19, P < 0.001]. After treatment, the duration and frequency of angina pectoris in the observation group were (1.84 ± 0.49) minutes/time and (1.32 ± 0.21) times/week, respectively, which were significantly lower than those in the control group [(5.23 ± 1.72) minutes/time and (3.58 ± 0.71) times/week, t = 18.95, 30.52, both P < 0.001]. After treatment, the left ventricular end-diastolic diameter and left ventricular end-systolic diameter in the observation group were (33.28 ± 1.21) mm and (47.89 ± 5.61) mm respectively, which were significantly lower than those in the control group [(37.56 ± 2.14) mm, (53.25 ± 5.07) mm, t = 17.41, 7.09, both P < 0.001]. Left ventricular ejection fraction was significantly higher in the observation group than in the control group [(48.59 ± 5.81)% vs. (41.16 ± 5.83)%, t = 9.03, P < 0.001]. The incidence of adverse reactions was significantly higher in the observation group than in the control group [1% (1/100) vs. 12% (12/100), χ2 = 9.96, P = 0.002]. Conclusion:Ticagrelor combined with atorvastatin is highly effective for unstable angina pectoris in coronary heart disease because it greatly decreases BNP level and Lp-PLA2 activity. Therefore, the combined therapy deserves clinical promotion.

Efficacy of Nicorandil in the treatment of unstable angina pectoris in 30 patients / 中国基层医药

Objective:To investigate the efficacy of Nicorandil in the treatment of unstable angina pectoris.Methods:Sixty patients with unstable angina pectoris who received treatment in Department of Cardiovascular Disease, Suixi Hospital of Traditional Chinese Medicine, China during January-July 2020 were included in this study. They were randomly assigned to receive either conventional treatment including antiplatelet, increasing coronal blood flow velocity, lipid-lowering treatment and stabilization of atherosclerotic plaque (control group, n = 30) or Nicorandil treatment and conventional treatment (observation group, n = 30). Clinical efficacy was compared between the two groups. Angina attack, electrocardiogram changes and adverse reactions in each group were analyzed before and after treatment. Results:Total effective rate in the observation group was significantly higher than that in the control group [88.67% (26/30) vs. 53.33% (16/30), χ2 = 7.937, P = 0.005]. The frequency and duration of angina pectoris in the observation group were (1.53 ± 0.62) times/week, (1.93 ± 0.78) minutes, which were significantly lower or shorter than those in the control group [(1.97 ± 0.71) times /week, (2.60 ± 1.00) minutes, t = -2.359, -3.162, P = 0.025, 0.004). The total effective rate of electrocardiogram in the observation group was significantly higher than that in the control group [70.00% (22/30) vs. 43.34% (13/30), χ2 = 5.554, P = 0.018]. There was no significant difference in the incidence of adverse drug reactions such as nausea, dizziness and palpitation between the two groups (all P > 0.05). Conclusion:Based on conventional treatment, Nicorandil treatment for unstable angina pectoris can improve the clinical symptoms and electrocardiogram changes, exhibit remarkable efficacy, and therefore deserve clinical promotion.

Performance of cardiovascular risk scores in mortality prediction ten years after Acute Coronary Syndromes

SUMMARY BACKGROUND The objective of this study was to evaluate the performance of the Framingham risk score (FRS) and risk score by the American College of Cardiology/American Heart Association (SR ACC/AHA) in predicting mortality of patients ten years after acute coronary syndrome (ACS). METHODS This is a retrospective cohort study that included patients aged ≥ 18 years with ACS who were hospitalized at the Coronary Intensive Care Unit (ICU) of the Botucatu Medical School Hospital from January 2005 to December of 2006. RESULTS A total of 447 patients were evaluated. Of these, 118 were excluded because the mortality in 10 years was not obtained. Thus, 329 patients aged 62.9 ± 13.0 years were studied. Among them, 58.4% were men, and 44.4% died within ten years of hospitalization. The median FRS was 16 (14-18) %, and the ACC/AHA RS was 18.5 (9.1-31.6). Patients who died had higher values of both scores. However, when we classified patients at high cardiovascular risk, only the ACC/AHA RS was associated with mortality (p <0.001). In the logistic regression analysis, both scores were associated with mortality at ten years (p <0.001). CONCLUSIONS Both FRS and SR ACC/AHA were associated with mortality. However, for patients classified as high risk, only the ACC/AHA RS was associated with mortality within ten years.

RESUMO OBJETIVO Avaliar a performance do escore de risco de Framingham (ERF) e do escore proposto pela American College of Cardiology/American Heart Association (ER ACC/AHA) em predizer a mortalidade em pacientes dez anos após síndrome coronariana aguda (SCA). MÉTODOS Trata-se de um estudo de coorte retrospectivo que incluiu pacientes com idade ≥18 anos, com SCA, que estiveram internados na Unidade de Terapia Intensiva Coronariana (UTI) do Hospital das Clínicas de Botucatu, no período de janeiro de 2005 a dezembro de 2006. RESULTADOS Foram avaliados 447 pacientes. Destes, 118 foram excluídos, pois a mortalidade em dez anos não foi obtida. Logo, 329 pacientes com idade de 62,9±13,0 anos foram estudados. Dentre eles, 58,4% eram homens e 44,4% morreram no período de dez anos após a internação. A mediana do ERF foi de 16 (14-18)%, e do ER ACC/AHA foi 18,5 (9,1-31,6)%. Os pacientes que evoluíram a óbito apresentaram maiores valores dos escores. No entanto, quando classificamos os pacientes em alto risco cardiovascular, apenas o ER ACC/AHA foi associado com a mortalidade (p<0,001). Na análise de regressão logística, ambos os escores foram associados com a mortalidade em dez anos (p<0,001). CONCLUSÕES Tanto o ERF quanto o ER ACC/AHA foram associados com a mortalidade. No entanto, para os pacientes classificados como alto risco, apenas o ER ACC/AHA foi associado com a mortalidade em dez anos.

Validación del score GRACE (Global Registry of Acute Coronary Events) para predecir mortalidad intrahospitalaria en el síndrome coronario agudo en Buenos Aires / Validation of GRACE score (Global Registry of Acute Coronary Events) as a predictor of in hospital mortality in acute coronary syndromes in Buenos Aires

RESUMEN Introducción: El score GRACE (SG) estima el riesgo de mortalidad intrahospitalaria (MIH) al ingreso de los pacientes con síndrome coronario agudo (SCA). La validación externa de este puntaje es necesaria, dadas las variaciones en las características de los pacientes y los sistemas de salud, además de las diferencias socioeconómicas y los cambios en el tratamiento. Recientemente se publicó la guía TRIPOD para estandarizar la metodología de estos estudios de validación. El objetivo del presente trabajo fue determinar si el SG predice adecuadamente la MIH en pacientes con SCA asistidos en el Hospital Dr. Juan A. Fernández (grupo de validación, GV). Material y métodos: Estudio de validación retrospectivo de cohorte, ingreso hospitalario entre 2001 y 2016. Se evaluó la discriminación con el área bajo la curva (ABC) y la calibración con la prueba de Hosmer-Lemeshow (H-L), se obtuvo la calibración general, la pendiente de calibración, el gráfico de validación y el cinturón de calibración. Se analizaron subgrupos según el tipo de SCA documentado: con supradesnivel del ST (SCA-ST) o sin este (SCA-no ST). Resultados: Se analizaron 2104 pacientes. Se observó mayor proporción de infarto con supradesnivel del ST (40,4%) y de MIH (5,56%) en el GV que en la cohorte a partir de la cual se desarrolló el SG (32% y 4,6%, respectivamente). El modelo mostró falta de calibración por subestimación de riesgos entre probabilidades del 3% y 13%. La pendiente de calibración fue adecuada, lo que indica que la magnitud del efecto de los predictores sobre la MIH fue similar a la del modelo. El ABC fue 0,86. En el SCA-ST, se observó subestimación de riesgos en probabilidades entre el 5% y 23%, con adecuada discriminación. En el SCA-no ST, tanto la calibración como la discriminación fueron adecuadas. Conclusiones: A pesar de la falta de validez estadística en la población total, las variables del modelo fueron predictoras de MIH en la población del GV. Se considera que el score G es clínicamente relevante, pero se sugiere su recalibración en nuestra población.

ABSTRACT Background: GRACE score (G) estimates in-hospital mortality risk (IHM) in patients with acute coronary syndromes (ACS). Given the variability of patients´ characteristics, health systems, socioeconomic environment and changes in treatment; external validation should be performed. The TRIPOD statement was published to standardize validation studies´ methodology. The objective of this study is to asses if G predicts IHM with precision in patients with acute coronary syndrome at Juan A. Fernández Hospital (validation cohort -V-). Methods: Retrospective validation study. Consecutive patients admitted between 2001 and 2016 were included. Discrimination was evaluated using the area under the ROC curve (AUC) and calibration was evaluated using de Hosmer-Lemeshow test, calibration-in-the-large, calibration slope, validation graph and calibration belt. Subgroup analysis by type of ACS was performed. Results: A total of 2104 patients were analyzed. Myocardial infarction with ST elevation (40.4% and 32%) and IHM (5.56% and 4.6%) was more prevalent than G estimation. Calibration was poor, risks were underestimated between probabilities of 3 and 13%. The calibration slope was adequate, therefore the overall effect and magnitude of predictors on IHM was similar to G. The AUC was 0.86. The model performed with underestimation of risk between probabilities of 5% and 23% in patients with ACS and ST elevation, the discrimination was good. Calibration and discrimination performed well in patients with non ST elevation ACS. Conclusions: Despite the lack of statistical validity of the model in the total population, the variables were predictors of IHM in the validation cohort. Therefore, G score is clinically relevant, but should be recalibrated in our population.

Clinical effect of trimetazidine combined with ticagrelor in the treatment of unstable angina pectoris complicated with chronic heart failure / 中国基层医药

Objective@#To observe the clinical efficacy and safety of trimetazidine combined with ticagrelor in the treatment of unstable angina pectoris (UAP) complicated with chronic heart failure (CHF).@*Methods@#From January 2016 to September 2018, 60 UAP patients complicated with CHF in Taizhou Cancer Hospital were selected and randomly divided into two groups according to the random number table method, with 30 cases in each group.The control group was given ticagrelor, while the observation group was given ticagrelor + trimetazidine.The clinical efficacy, angina attack, cardiac function indicators, adverse reactions were compared between the two groups.@*Results@#The total effective rate of the observation group was 96.67%, which was higher than 80.00% of the control group (χ2=4.043, P<0.05). With in 3 months after treatment, the number of angina attacks (6.59±1.32)times and the duration of single angina pectoris [(2.24±0.92)min] in the observation group were all lower than those in the control group(t=4.277, 4.076, all P<0.05). After treatment, the left ventricular ejection fraction [(49.36±6.25)%] and stroke output [(76.29±5.31)mL] of the observation group were higher than those of the control group (t=4.066, 4.093, all P<0.05), and the level of brain natriuretic peptide [(378.32±27.82)μg/L] of the observation group was lower than that of the control group (t=4.152, P<0.05). The incidence rate of adverse reactions of the observation group was 6.67%, which of the control group was 3.33%, there was no statistically significant difference between the two groups (χ2=0.351, P>0.05).@*Conclusion@#The combination of ticagrelor and trimetazidine can effectively reduce the attack of angina pectoris, improve cardiac function and has less adverse reactions.It is effective and safe for UAP patients complicated with CHF.

MMP‐9 and P‐selectin in UAP patients / 心血管康复医学杂志

Objective :To explore influence of Tongxinluo capsule ,Shuxuetong injection combined carvedilol on ECG , serum levels of matrix metalloproteinase (MMP)‐9 and P‐selectin in patients with unstable angina pectoris (UAP). Methods :A total of 105 UAP patients were randomly divided into routine treatment group (n＝52) and combined treatment group (n＝53 ,received Tongxinluo capsule ,Shuxuetong injection and carvedilol based on routine treat‐ment group) ,both groups were continuously treated for one month .LVEF ,cardiac output (CO) ,serum levels of MMP‐9 and P‐selectin , therapeutic effects of ECG and angina pectoris , and incidence of adverse reactions were measured and compared between two groups before and after treatment .Results :Compared with routine treatment group , there were significant rise in total effective rates of ECG (59. 62% vs.79. 25%) and angina pectoris (71.15% vs.90.57%) in combined treatment group , P＜0. 05 both .Compared with routine treatment group after one‐month treatment ,there were significant rise in LVEF [ (45.30 ± 5.60 )% vs.(59. 33 ± 5. 31 )%] and CO [ (3.15 ± 1.14) L／min vs .(4. 92 ± 1. 18) L／min] ,and significant reductions in serum levels of P‐selectin [ (25. 40 ± 2.34) ng／ml vs.(16.85 ± 1. 62) ng／ml] and MMP‐9 [ (37. 30 ± 8. 91) μg／L vs.(27.80 ± 8.63) μg／L] in com‐bined treatment group , P＝0. 001 all.There was no significant difference in incidence of adverse reactions between two groups , P＝0.334. Conclusion :Tongxinluo capsule ,Shuxuetong injection combined carvedilol possess significant therapeutic effect on UAP patients .They can significantly improve cardiac function ,serum levels of P‐selectin and MMP‐9 with satisfying safety ,which is worth extending .

Therapeutic effect of metoprolol tartrate on UAP and its influence on levels of blood lipids and inflam‐ matory factors／ / 心血管康复医学杂志

Objective :To observe therapeutic effect of metoprolol tartrate on unstable angina pectoris (UAP) and its influence on levels of blood lipids and inflammatory factors .Methods :A total of 96 UAP patients treated in our hos‐pital from Jan 2016 to Jun 2017 were randomly and equally divided into routine treatment group and metoprolol group (received metoprolol tartrate based on routine treatment ) ,both groups were continuously treated for 14d. Onset times and duration of angina pectoris ,visual analogue scale (VAS) score for pain degree ,levels of blood lip‐ids ,serum hsCRP ,TNF‐α ,MMP‐9 and plasma BNP ,and therapeutic effect were observed and compared between two groups before and after treatment .Results :Compared with routine treatment group after treatment ,there were significant reductions in onset times [ (5.67 ± 3.57) times／week vs .(2.81 ± 1. 18) times／week] and duration [ (4. 51 ± 1. 43) min／time vs.(1.37 ± 0. 87) min／time] of angina pectoris ,VAS score for pain degree [(5.69 ± 0.87) scores vs.(4. 08 ± 0.61 ) scores] ,levels of serum hsCRP [ (18.34 ± 4. 16 ) mg／L vs.(14.59 ± 3. 98 ) mg／L ] , TNF‐α [ (173. 41 ± 21.42) μg／L vs.(119. 03 ± 21. 83) μg／L] ,MMP‐9 [(368.51 ± 38. 24) μg／L vs.(303.77 ± 29. 97) μg／L] and plasma BNP [ (869.78 ± 82.89) pg／ml vs.(721. 36 ± 75.62) pg／ml] in metoprolol group , P＝0. 001 all. Conclusion :Metoprolol tartrate can improve therapeutic effect ,significantly improve angina and reduce serum levels of inflammatory factors in UAP patients .

Predictive value of NT-proBNP on admission on left ventricular ejection fraction and in-patients major adverse cardiac and cerebrovascular events in hospitalized patients with unstable angina / 中华心血管病杂志

Objective@#To explore the predictive value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) on admission on left ventricular ejection fraction (LVEF) and the in-hospital major adverse cardiac and cerebrovascular events (MACCE) in hospitalized patients with unstable angina (UA).@*Methods@#Data of 2 972 consecutive hospitalized patients with UA in Beijing Friendship Hospital from January 2013 to September 2017 were retrospective analyzed. Patients were divided into 4 groups according to the level of NT-proBNP on admission: 733 cases with NT-proBNP lower than 61 ng/L, 749 cases with NT-proBNP between 61 and 133 ng/L, 747 cases with NT-proBNP between 133 and 326 ng/L, and 743 cases with NT-proBNP higher than 326 ng/L. LVEF and in-hospital MACCE were compared among 4 groups and the predictive value of NT-proBNP on admission on LVEF and in-hospital MACCE was determined by multiple logistical regression analysis.@*Results@#LVEF value became lower with increasing on admission NT-proBNP value ((68.4±4.8)%, (68.2±5.2)%, (67.2±6.7)% and (62.6±10.4)%, F=77.98, P<0.01), while in-hospital MACCE was higher with increasing on admission NT-proBNP value (3.4% (25/733), 3.5% (26/749), 5.5% (41/747) and 7.3% (54/743), χ2=16.23, P<0.01) in NT-proBNP lower than 61 ng/L, NT-proBNP between 61 and 133 ng/L, NT-proBNP between 133 and 326 ng/L, and NT-proBNP higher than 326 ng/L group. Multiple logistic regression analysis showed that on admission NT-proBNP was an independent predictor for LVEF<50% (Exp(β)=5.875, 95%CI 3.382-10.207, P<0.001), but not predictor for in-hospital MACCE (Exp(β)=0.783, 95%CI 0.400-1.996, P=0.783).@*Conclusion@#The on admission NT-proBNP level is an independent predictor of left ventricular systolic dysfunction (LVEF<50%), but not an independent predictor of total in-hospital MACCE in hospitalized patients with UA.

Effects of Wenxin granules and bisoprolol fumarate combined with aerobic exercise on serum matrix metallo-proteinase-1 and N-terminal pro-brain natriuretic peptide levels in patients with unstable angina pectoris / 中国基层医药

Objective To investigate the influence of Wenxin granules and bisoprolol fumarate combined with aerobic exercise on serum matrix metalloproteinase－1(MMP－1) and N－terminal pro－brain natriuretic peptide (NT－proBNP) levels in patients with unstable angina pectoris.Methods From January 2016 to February 2018, 92 patients with unstable angina pectoris in Lishui Hospital of Traditional Chinese Medicine were selected and randomly divided into control group(n=46) and study group(n=46) according to the digital table.On the basis of routine intervention,the control group was given bisoprolol fumarate for 2 weeks and aerobic exercise for 1 month, while the study group was given bisoprolol fumarate,aerobic exercise and Wenxin granules for 2 weeks.The frequency and duration of angina pectoris before and after 1 month of treatment,clinical efficacy,serum MMP－1 and NT－proBNP levels,blood rheology index(plasma viscosity,whole blood high shear viscosity,total blood low－cut viscosity,fibrinogen) and incidence of adverse reactions were observed.Results After 1 month of treatment,the frequency of angina pectoris was lower than that before treatment,and the duration was shorter than that before treatment,which in the study group [(2.09 ± 0.65)times/week,(2.24 ± 0.83)min/time] were better than those in the control group(t1=10.898,t2= 9.302,all P<0.05).The total effective rate of the study group(91.30% ) was higher than that of the control group (73.91% )(χ2 =4.842,P<0.05).After 1 month of treatment,the serum levels of MMP－1 and NT－proBNP in the two groups were lower than those before treatment,which in the study group [(196.10 ± 55.01) g/L,(403.82 ± 114.15)ng/L] were lower than those in the control group ( t1 =3. 619, t2 =4. 185, P <0. 05 ). At the end of treatment,the plasma viscosity,whole blood high－viscosity,whole blood low－cut viscosity,fibrinogen level in the two groups were lower than those before treatment,which in the study group were lower than those in the control group(all P<0.05).The incidence rate of adverse reactions in the study group was 15.22% ,which in the control group was 10.87% ,there was no statistically significant difference between the two groups (χ2 =0.383,P>0.05).Conclusion The combination of Wenxin granules, bisoprolol fumarate and aerobic exercise for patients with unstable angina pectoris not only can reduce the frequency of angina pectoris,MMP－1 and NT－proBNP levels,but also can improve the treatment of disease.Besides,it does not increase the risk of adverse reactions.

Influence of sodium creatine phosphate on PCI-related myocardial injury in UAP patients / 心血管康复医学杂志

Objective :To explore influence of sodium creatine phosphate (CP) on percutaneous coronary intervention (PCI)-related myocardial injury in patients with unstable angina pectoris (UAP).Methods : A total of 90 UAP pa-tients ,who were supposed to receive selective PCI ,were selected ,randomly and equally divided into routine treat-ment group and CP group (received CP treatment based on routine medication ).Plasma level of cardiac troponin I (cTnI) before and 18h after PCI ,plasma levels of C reactive protein (CRP) and brain natriuretic peptide (BNP) be- fore and 24h after PCI ,LVEDd ,LVESd and LVEF on two weeks after PCI ,and incidence of major adverse cardio-vascular events (MACE) within two weeks after PCI were measured and compared between two groups .Results :Compared with before PCI ,there was significant rise in plasma cTnI level on 18h after PCI ,and significant reduc-tions in plasma CRP and BNP levels on 24h after PCI in two groups ,P＝0-001 all ;compared with routine treatment group after PCI ,there were significant reductions in plasma levels of cTnI [ (1-58 ± 1-59) mg／L vs.(0-07 ± 0-04) mg／L] ,CRP [ (22-02 ± 2-14) ng／L vs .(11-40 ± 1-49) ng／L] and BNP [ (349-20 ± 28-57) ng／L vs .(175-20 ± 28-55) ng／L] in CP group , P＝0-001 all.Compared with routine treatment group ,there were significant reduc-tions in LVEDd [ (54-83 ± 1-23) mm vs.(50-74 ± 0-97) mm] and LVESd [ (45-65 ± 1-64) mm vs .(42-01 ± 1-84) mm] ,and significant rise in LVEF [ (52-41 ± 1-57)% vs.(65-21 ± 3-36)%] in CP group on two weeks af-ter PCI , P＝0-001 all.On two weeks after PCI ,incidence rate of MACE in CP group was significantly lower than that of routine treatment group (4-44% vs.28-89%) , P＝0-021- Conclusion : CP can significantly reduce plasma levels of cTnI ,CRP and BNP after PCI ,reduce PCI-related myocardial injury .

Influence of metoprolol tartrate combined Danhong injection on ECG and serum BNP and sICAM—1 lev— els in patients with UAP of CHD / 心血管康复医学杂志

Objective :To explore therapeutic effect of metoprolol tartrate combined Danhong injection on patients with unstable angina pectoris of coronary heart disease (CHD—UAP) and its influence on serum levels of brain natri—uretic peptide (BNP) and soluble intercellular adhesion molecule—1 (sICAM—1).Methods : A total of 104 CHD—UAP patients treated in our hospital from Mar 2013 to May 2017 were randomly and equally divided into metoprolol group (received metoprolol based on routine treatment ) and combined treatment group (received Danhong injection based on metoprolol group) ,both groups were continuously treated for two weeks .Onset frequency and duration of angina pectoris ,serum BNP and sICAM—1 levels before and two weeks after treatment ,and incidence of adverse reactions were observed and compared between two groups .Results : After two—week ,clinical total effective rate (84. 62%vs.63. 46%) and ECG total effective rate (90.38% vs.69. 23%) of combined treatment group were significantly higher than those of metoprolol group , P＝0. 014 ,0.007. Compared with before treatment ,there were significant reductions in onset frequency and duration of angina pectoris and serum levels of BNP and sICAM—1 after two—week treatment in two groups , P＝0.001 all ;compared with metoprolol group after two—week treatment ,there were sig—nificant reductions in onset frequency [ (6. 03 ± 0.72 ) times／week vs .(2.69 ± 0.54 ) times／week ] and duration [ (4. 82 ± 0.51) min／time vs .(2. 65 ± 0.70) min／time] of angina pectoris ,serum levels of BNP [ (652.43 ± 97. 15) pg／ml vs .(536. 27 ± 95. 40) pg／ml] and sICAM—1 [ (105.27 ± 29.14) ng／L vs.(81.03 ± 26. 43) ng／L] in combined treatment group , P＝0. 001 all.There was no significant difference in incidence rate of adverse reactions between two groups , P＝0.506. Conclusion : Metoprolol tartrate combined Danhong injection possesses significant therapeu—tic effect on CHD—UAP patients .It can effectively reduce serum BNP and sICAM—1 levels ,onset frequency and du—ration of angina pectoris with high safety ,which is worth extending .

Influence of different doses of clopidogrel combined aspirin on platelet related indexes and safety in UAP patients / 心血管康复医学杂志

Objective :To explore influence of different doses of clopidogrel combined aspirin on platelet related inde—xes and safety in patients with unstable angina pectoris (UAP).Methods : A total of 92 UAP patients treated in our hospital were randomly and equally divided into large dose clopidogrel combined group (received 150mg／d clopi—dogrel combined aspirin ) and routine dose clopidogrel combined group (received 75mg／d clopidogrel combined aspi—rin) ,both groups were continuously treated for three months .Therapeutic effect , medication safety , level of thrombolytic granule membrane protein (GMP)—140 ,maximum platelet aggregation rate (LTA—PAmax ) and ADP—induced maximum platelet amplitude (MAADP ) were compared between two groups .Results : After three—month treatment ,there were no significant difference in total effective rate ,incidence rate of major adverse cardiovascular events ,GMP—140 level ,LTA—PAmax and MAADP between two groups , P＞0. 05 all.Incidence rate of severe hemor—rhage in large dose clopidogrel group was higher than that of routine dose group (6.52% vs.2. 17%) without signifi—cant difference ( P＝0.609).Conclusion : Increased dose of clopidogrel combined aspirin doesn＇t obtain significant therapeutic effect ,but may be risk of hemorrhage for unstable angina pectoris ,which calls for clinical attention

Effects of Wenxin granules and bisoprolol fumarate combined with aerobic exercise on serum matrix metallo-proteinase -1 and N - terminal pro - brain natriuretic peptide levels in patients with unstable angina pectoris / 中国基层医药

Objective To investigate the influence of Wenxin granules and bisoprolol fumarate combined with aerobic exercise on serum matrix metalloproteinase -1(MMP -1) and N - terminal pro - brain natriuretic peptide (NT - proBNP) levels in patients with unstable angina pectoris. Methods From January 2016 to February 2018, 92 patients with unstable angina pectoris in Lishui Hospital of Traditional Chinese Medicine were selected and randomly divided into control group(n = 46) and study group(n = 46) according to the digital table. On the basis of routine intervention,the control group was given bisoprolol fumarate for 2 weeks and aerobic exercise for 1 month, while the study group was given bisoprolol fumarate,aerobic exercise and Wenxin granules for 2 weeks. The frequency and duration of angina pectoris before and after 1 month of treatment,clinical efficacy,serum MMP -1 and NT - proBNP levels,blood rheology index(plasma viscosity,whole blood high shear viscosity,total blood low - cut viscosity,fibrinogen) and incidence of adverse reactions were observed. Results After 1 month of treatment,the frequency of angina pectoris was lower than that before treatment,and the duration was shorter than that before treatment,which in the study group [(2. 09 ± 0. 65)times/ week,(2. 24 ± 0. 83)min/ time] were better than those in the control group(t1 = 10. 898,t2 =9. 302,all P < 0. 05). The total effective rate of the study group(91. 30％ ) was higher than that of the control group (73. 91％ )(χ2 = 4. 842,P < 0. 05). After 1 month of treatment,the serum levels of MMP - 1 and NT - proBNP in the two groups were lower than those before treatment,which in the study group[(196. 10 ± 55. 01) g/ L,(403. 82 ± 114. 15)ng/ L] were lower than those in the control group ( t1 = 3. 619, t2 = 4. 185, P < 0. 05). At the end of treatment,the plasma viscosity,whole blood high - viscosity,whole blood low - cut viscosity,fibrinogen level in the two groups were lower than those before treatment,which in the study group were lower than those in the control group(all P < 0. 05). The incidence rate of adverse reactions in the study group was 15. 22％ ,which in the control group was 10. 87％ ,there was no statistically significant difference between the two groups (χ2 = 0. 383,P > 0. 05). Conclusion The combination of Wenxin granules, bisoprolol fumarate and aerobic exercise for patients with unstable angina pectoris not only can reduce the frequency of angina pectoris,MMP - 1 and NT - proBNP levels,but also can improve the treatment of disease. Besides,it does not increase the risk of adverse reactions.

Applicability of Longitudinal Strain of Left Ventricle in Unstable Angina / Aplicabilidade do Strain Longitudinal do Ventrículo Esquerdo na Angina Instável

Abstract Background: Unstable angina (UA) is a common cause of hospital admission; risk stratification helps determine strategies for treatment. Objective: To determine the applicability of two-dimensional longitudinal strain (SL2D) for the identification of myocardial ischemia in patients with UA. Methods: Cross-sectional, descriptive, observational study lasting 60 days. The sample consisted of 78 patients, of which fifteen (19.2%) were eligible for longitudinal strain analysis. The value of p < 0.05 was considered significant. Results: The group of ineligible patients presented: a lower proportion of women, a higher prevalence of diabetes mellitus (DM), use of ASA, statins and beta-blockers and larger cavity diameters. The main causes of non-applicability were: presence of previous infarction (56.4%), previous CTA (22.1%), previous MRI (11.5%) or both (16.7%) and the presence of specific electrocardiographic abnormalities (12.8%). SL2D assessment revealed a lower global strain value in those with stenosis greater than 70% in some epicardial coronary arteries (17.1 [3.1] versus 20.2 [6.7], with p = 0.014). Segmental strain assessment showed an association between severe CX and RD lesions with longitudinal strain reduction of lateral and inferior walls basal segments; (14 [5] versus 21 [10], with p = 0.04) and (12.5 [6] versus 19 [8], respectively). Conclusion: There was very low SL2D applicability to assess ischemia in the studied population. However, the global strain showed a correlation with the presence of significant coronary lesion, which could be included in the UA diagnostic arsenal in the future.

Resumo Fundamento: A angina instável (AI) é uma causa comum de internação hospitalar, a estratificação de risco ajuda a determinar estratégias para o tratamento. Objetivo: Determinar a aplicabilidade do strain longitudinal bidimensional (SL2D) para identificação de isquemia miocárdica, em pacientes com AI. Métodos: Estudo observacional transversal, descritivo, com duração de 60 dias. A amostra foi composta por 78 pacientes, sendo quinze (19,2%) elegíveis para análise do strain longitudinal. O valor de p < 0.05 foi considerado significativo. Resultados: O grupo dos não elegíveis apresentou: menor proporção de mulheres, maior prevalência de diabetes mellitus (DM), do uso de AAS, estatinas e betabloqueadores e maiores diâmetros cavitários. As principais causas da não aplicabilidade foram: presença de infarto prévio (56,4%), ATC prévia (22,1%), RM prévia (11,5%) ou ambos (16,7%) e presença de alterações eletrocardiográficas específicas (12,8%). A avaliação do SL2D revelou um valor de strain global inferior naqueles com estenose maior que 70% em alguma coronária epicárdica (17,1 [3,1] versus 20,2 [6,7], com p = 0,014). A avaliação do strain segmentar demonstrou associação entre lesão grave nas coronárias CX e CD com redução do strain longitudinal dos segmentos basais das paredes lateral e inferior; (14 [5] versus 21 [10], com p = 0,04) e (12,5 [6] versus 19 [8], com p = 0,026), respectivamente. Conclusão: Houve aplicabilidade muito baixa do SL2D para avaliar isquemia na população estudada. Entretanto, o strain global apresentou correlação com presença de lesão coronária significativa, podendo, futuramente, ser incluído no arsenal diagnóstico da AI.

Association between serum level of thyroid hormones and severity of coronary artery stenosis in postmenopausal women with UAP / 中华老年心脑血管病杂志

Objective To study the association between serum level of thyroid hormones and sever ity of coronary artery stenosis (CAS) in postmenopausal women with unstable angina pectoris (UAP).Methods Two hundred and three postmenopausal women with normal thyroid function were divided into UAP group (n=105) and control group (n=98).The patients in UAP group were further divided into mild-moderate CAS (n=35) and severe CAS (n=70) according to their Gensini score.The association between serum levels of TSH,FT3,FT4 and severity of CAS in UAP group was analyzed.Results The age was older,the history of smoking was longer,the incidence of hypertension,DM,chronic renal disease was higher,the systolic pressure and serum Lp (a) level were higher while that of FT3 and FT4 was lower in UAP group than in control group (P＜0.05).The serum level of TC and LDL-C was higher while that of FT3 was lower in severe CAS than in mild-moderate CAS (P＜0.05).Pearson correlation analysis showed that the serum level of FT3 was negatively associated with that of LDL-C (r=-0.217,P=0.026).Multivariate logistic regression analysis revealed that the low serum level of FT3 was closely associated with the severity of CAS (B=-2.388,OR=0.092,95％CI:0.026-0.326,P=0.000).Conclusion The low serum level of FT3 is closely associated with the severity of CAS in postmenopausal women with UAP.

Clinical value of non-invasive coronary flow reserve to evaluate the curative effect of percutaneous coronary intervention for patients with unstable angina pectoris / 中华超声影像学杂志

Objective To evaluate the value of non-invasive coronary flow reserve ( CFR ) for investigating the relationship between myocardial ischemia and coronary stenosis ,and the result after percutaneous coronary intervention ( PCI) in patients with unstable angina pectoris . Methods The rest blood flow spectrum and the maximum coronary diastolic blood flow spectrum were obtained respectively for 131 coronary artery lesions including the left anterior descending coronary artery ,the left circumflex coronary artery and the right coronary artery in 86 patients from the coronary artery flow imaging of transthoracic Doppler echocardiography ,then CFR was calculated . All patients were performed by coronary angiography . Patients with the rate of coronary stenosis > 70％ and CFR ≤ 2 .0 were treated by PCI . CFR was measured again at different intervals after PCI . Results ① As the degree of stenosis increased ,CFR decreased gradually .The coronary stenosis was negatively correlated with CFR ( r = - 0 .803 , P < 0 .001) . The sensitivity of CFR ≤ 2 .0 predicting coronary stenosis rate of more than 70％ was 82 .7％ ,the specificity was 87 .7％ . ② CFR of post-PCI was higher than that of per-PCI . With a follow-up of half a year ,CFR of all coronary arteries was greater than 2 .0(44/44) ,but restenosis occurred at one year after PCI in two left anterior descending coronary arteries . Conclusions Non-invasive CFR can evaluate the relationship between myocardial ischemia and coronary stenosis ,select indications for PCI and evaluate postoperative outcome for patients with unstable angina pectoris .