Relationship between collateral circulation and cardiac function recovery in patients receiving percutaneous coronary intervention for a single left anterior descending artery / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the relationship between coronary collateral circulation following percutaneous coronary intervention (PCI) for a single left anterior descending artery and the recovery of cardiac function.</p><p><b>METHODS</b>A total of 625 patients with coronary heart disease were retrospectively analyzed, who received selective coronary angiography demonstrating lesions involving a single left anterior descending artery and underwent stent placement between January, 2010 and December, 2012. According to Rentrop's classification, the patients were divided into group A (n=280) with Rentrop grades 1-3 and group B (n=325) with Rentrop grade 0. Group A were further divided into 3 subgroups according to the source of collateral circulation, namely group A1 (n=200) with contralateral collateral circulation, group A2 (n=44) with contralateral+ ipsilateral collateral circulation, and group A3 (n=36) with ipsilateral collateral circulation. The outcomes of cardiac function recovery were compared between groups A and B and between the 3 subgroups in group A.</p><p><b>RESULTS</b>Compared with patients without collateral circulation, patients with collateral coronary circulation showed greater left ventricular ejection fraction increment and reduction in brain natriuretic peptide and red cell volume distribution width with also lower expansion left ventricular end-diastolic volume. Among the 3 subgroups in group A, cardiac function improvement was the most obvious in patients with contralateral+ ipsilateral collateral circulation (group A2) followed by those in group A3, and was the worst in group A1.</p><p><b>CONCLUSION</b>The presence of collateral coronary circulation promotes cardiac function recovery in patients receiving PCI for lesions involving a single left anterior descending artery. Patients with contralateral+ipsilateral collateral circulation have the best cardiac function improvement followed by those with contralateral collateral circulation.</p>

Renal denervation: a new therapeutic approach for resistant hypertension / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To review the advances in studies on renal denervation.</p><p><b>DATA SOURCES</b>References concerning renal denervation and resistant hypertension cited in this review were collected from PubMed published in English and those of renal denervation devices from official websites of device manufacturers up to January 2014.</p><p><b>STUDY SELECTION</b>Articles with keywords "renal denervation" and "resistant hypertension" were selected.</p><p><b>RESULTS</b>Renal and systemic sympathetic overactivity plays an important role in pathology of hypertension as well as other diseases characterized by sympathetic overactivity. Renal denervation is a new, catheter based procedure to reduce renal and systemic sympathetic overactivity by disruption of renal sympathetic efferent and afferent nerves through radiofrequency or ultrasound energy delivered to the endoluminal surface of both renal arteries. Although several studies have shown the efficacy and safety of renal denervation in the treatment of resistant hypertension and the potential benefit of the procedure in other diseases, Symplicity HTN 3 study, the most rigorous clinical trial of renal denervation to date, failed to meet its primary endpoint. The procedure also has other limitations such as the lack of long term, efficacy and safety data and the lack of the predictors for the blood pressure lowering response and nonresponse to the procedure. An overview of current renal denervation devices holding Conformité Européenne mark is also included in this review.</p><p><b>CONCLUSIONS</b>Renal denervation is a promising therapeutic approach in the management of resistant hypertension and other diseases characterized by sympathetic overactivity. In its early stage of clinical application, the efficacy of the procedure is still controversial. Large scale, blind, randomized, controlled clinical trials are still necessary to address the limitations of the procedure.</p>

Cardiorenal syndrome: pathophysiological mechanism, preclinical models, novel contributors and potential therapies / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To review the current knowledge about the pathophysiological mechanisms, preclinical models, novel contributors and potential therapies of cardiorenal syndrome.</p><p><b>DATA SOURCES</b>The literature concerning cardiorenal syndrome in this review was collected from PubMed published in English up to January 2014.</p><p><b>STUDY SELECTION</b>Original articles and critical reviews related to cardiorenal syndrome were selected and carefully analyzed.</p><p><b>RESULTS</b>Cardiorenal syndrome is a condition characterized by kidney and heart failure where failure of one organ worsens the function of the other thus further accelerating the progressive failure of both organs. The pathophysiology of cardiorenal syndrome is not fully understood, but may be caused by a complex combination of neurohormonal system activation, endothelial dysfunction, proteinuria, oxidative stress, uremic toxins and other factors. Managing cardiorenal syndrome is still a major therapeutic challenge in clinical practice because many of the drugs used to control heart failure can worsen renal function, and vice versa. Non-dialyzable uremic toxins, such as indoxyl sulfate, causing detrimental effects on the heart and kidney as well as stimulation of inflammatory responses, may be an effective therapeutic target for cardiorenal syndrome.</p><p><b>CONCLUSIONS</b>Suitable disease models of cardiorenal syndrome are urgently needed to investigate the pathophysiology and effective therapeutic approaches to the condition. Non-dialyzable protein-bound uremic toxins that may have cardiac and renal effects may provide therapeutic benefit to cardiorenal syndrome patients.</p>

Peripheral dendritic cell subsets and changes in plasma monocyte chemoattractant protein 1 in patients with coronary heart disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the association between peripheral blood dendritic cells subtype distribution and plasma monocyte chemoattractant protein 1 (MCP-1) concentration in patients with coronary heart disease (CHD).</p><p><b>METHODS</b>Sixty consecutive CHD patients admitted in our department during the period from November, 2010 to December, 2011 were enrolled, including 10 with stable angina pectoris (SAP), 25 with unstable angina pectoris (UAP), and 25 with acute myocardial infarction (AMI), with 28 healthy volunteers as normal controls. All the subjects underwent routine tests and coronary angiography. The percentages of peripheral blood myeloid dendritic cells (mDCs) and plasma cell-like dendritic cells (pDCs) in peripheral blood mononuclear cells were detected by flow cytometry, and plasma MCP-1 levels were detected using enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>The percentage and absolute quantity of mDCs and pDCs were significantly lower in AMI and UAP groups than in the normal control and SAP groups (P<0.001). In the CHD patients, the plasma MCP-1 level was significantly higher than that in the normal control group (P<0.001) with an inverse correlation with the percentage of peripheral mDCs.</p><p><b>CONCLUSION</b>MCP-1 may promote the migration of mDCs into atherosclerotic plaques and mediate the local immune and inflammatory responses to aggravate plaque instability in CHD patients.</p>