Clinical Outcomes of Elderly Patients with Non ST-Segment Elevation Myocardial Infarction Undergoing Coronary Artery Bypass Surgery / 전남의대학술지

The aim of this study is to investigate the clinical outcomes of the elderly patients with Non ST-segment elevation myocardial infarction (NSTEMI) undergoing coronary artery bypass surgery (CABG) compared to non-elderly patients. Patients with NSTEMI and undergoing CABG (n=451) who were registered in the Korea Acute Myocardial Infarction Registry between December 2003 and August 2012 were divided into two groups.; the non-elderly group ( < 75 years, n=327) and the elderly group (≥75 years, n=124). In-hospital mortality was higher in the elderly group (4.9% vs. 11.3%, p=0.015), but cardiac death, myocardial infarction, and major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, percutaneous revascularization, and redo-CABG after a one-year follow up were not different between the two groups. Predictors of in-hospital mortality in patients with NSTEMI undergoing CABG were left ventricular (LV) dysfunction (ejection fraction ≤40%) [hazard ratio (HR): 2.76, 95% confidence interval (CI): 1.16–6.57, p=0.022] and age (HR: 1.05, 95% CI: 1.01–1.10, p=0.047). So elderly NSTEMI patients should be considered for CABG if appropriate, but careful consideration for surgery is required, especially if the patients have severe LV systolic dysfunction.

Influence of microRNAs on cordiomyocyte viability in myocardial infarction and its therapeutic potential: Research progress / 第二军医大学学报

MicroRNAs (miRs), initially discovered in eukaryotes, are endogenous small noncoding RNAs that regulate gene expression. Myocardial infarction is a common cardiovascular event resulting in cardiac remodeling and subsequent chronic heart failure. A number of miRs have been reported to regulate important pathophysiological processes of myocardial infarction. They have multiple effects on the survival and proliferation of cardiomyocytes, which is of great significance to myocardial infarction and other ischemic heart diseases. In this review we introduced the general knowledge of myocardial infarction and miRs, and described several miRs which are crucial for survival and proliferation of cardiomyocytes. We also discussed the therapeutic potential and limitations of miRs in future treatment of myocardial infarction.

Estado actual de la terapia con células madre en el tratamiento de las cardiopatías / Stem cells for the treatment of cardiovascular diseases. An update

Available medical therapy is unable to completely prevent or revert the pathological cardiac remodeling secondary to ischemia or other injuries, which is responsible for the development of heart failure. Regenerative medicine through stem cells had an explosive development in the cardiovascular area during the past decade. Stem cells possess the capacity to regenerate, repair or substitute damaged tissue, allowing the reestablishment of its function. Stem cells can also modulate apoptosis, angiogenesis, fibrosis and inflammation, favoring the endogenous regenerative process initiated by the damaged tissue. These capacities have been corroborated in several animal models of cardiovascular diseases with positive results. In humans, therapies with bone marrow mononuclear stem cells, mesenchymal stem cells and cardiac stem cells are safe. Most randomized clinical trials in patients with myocardial infarction or cardiomyopathies of different etiologies have reported benefits on ventricular function, quality of life and even over mortality of treated patients. This article reviews the state of art of stem cell therapy in cardiovascular diseases, focusing on the most common cellular types used in patients with acute myocardial infarction and chronic cardiomyopathies of different etiologies.

Evaluation of thyroid dysfunction in acute coronary syndrome.

Background & Objectives: 1} To describe thyroid hormone profile in patients with acute coronary syndromes (ACS) 2} To find, If any, short term prognostic significance of Thyroid diseases. Materials & Methods The study has been carried out at Shree Sayajirao General Hospital and Medical College Baroda during period of March 2011 to May 2012. The study comprised of patients with acute coronary syndrome admitted in ICCU of SSG, Hospital. Inclusion criteria were patients with acute coronary syndrome, irrespective of gender, race, ethnic group, age, and clinical severity, giving consent for being included as a part of the study. Exclusion criteria included patients using corticosteroids, amiodarone, or thyroid disease drugs, who had received any iodinated contrast agent within the previous two weeks, Patients with established diseases, such as neoplasias, chronic renal failure, chronic obstructive pulmonary disease requiring antibiotic therapy, liver cirrhosis, active infection, and decompensated diabetes mellitus, conditions that are known to affect thyroid function tests. Results: Of total 30 pts of STEMI, 30 % had increased level of Free T4 on day 0 and 23.07% had increased values on day 4. Of total 30 pts of NSTEMI/UA, 20 % had increased level of Free T4 on day 0 and 14.28% had increased values on day 4. The levels of TSH, free and Total T3 as well as Total T4 were not significantly different in either STEMI/NSTEMI group either Day 0 or Day 4. 21.67% of pts had evidence of Sick Euthyroid Syndrome on day of admission. Of the total 6 pts expired before day 4, 3 patients had evidence of Sick Euthyroid Syndrome at the time of admission. The association of Sick Euthyroid syndrome was found to be significant for mortality in patients of STEMI with 3 out of 4 expired patients of STEMI having SES at the of admission with significant p value {p <0.05} .There was no significant difference in mortality in patients of NSTEMI/UA having SES. Conclusion: Our results show the importance of recognizing the “Euthyroid Sick Syndrome” in coronary heart disease patients, suggesting an association with poorer prognosis in patients with ST elevated Myocardial Infarction in form of increased mortality and no association was found with mortality in patients having Non ST elevated Myocardial Infarction or Unstable Angina.

Efeitos da N-acetilcisteína no precondicionamento isquêmico: estudo em corações isolados de ratos / Effects of n-acetylcysteine on ischemic preconditioning: study in isolated rat hearts

OBJETIVO: Avaliar se a N-Acetilcisteína (NAC) altera o Precondicionamento Isquêmico (PC) em corações isolados de ratos usando apenas um ciclo de PC. MÉTODOS: Freqüência Cardíaca (FC), Fluxo Coronariano (FLC) e Contratilidade Miocárdica (dP/dt) foram registradas em 30 corações de ratos Wistar. Após anestesia, os corações foram perfundidos em sistema de Langendorff com solução de Krebs-Hensleit (K-H), equilibrada (95 por cento de O2 e 5 por cento de CO2). GI: Controle (n=6); GII: 20 min. isquemia (n=6); GIII: PC (n=6); GIV 50 µg/ml/min NAC antes do PC (n =6); GV: 100 µg/ml/min NAC antes do PC (n=6). Todos os parâmetros foram mensurados após 15 minutos de estabilização (T0) e T3, T5, T10, T15, T20, T25 e T30 minutos de reperfusão. Significância estatística foi considerada quando P<0,05. RESULTADOS: Foram observadas alterações na FC comparando GI com GII em T20 e T25 e comparando GI com GIII e GIV com GV em T10 e T20 (P<0,05). FLC foi diferente comparando GI com GII em T3 e T5, GI com GIV em T10 e GI com GV em T10 e T25 (P<0,05). dP/dt foi semelhante comparando GIII com GI e GV. GIII apresentou maior dP/dt que GIV, mas sem diferença estatística (P>0,05). dP/dt foi maior no GV comparado com GIV, mas com diferença estatisticamente significativa somente em T30. CONCLUSÃO: Os corações precondicionados tiveram melhor dP/dt, sendo alteradas pelo uso de NAC no GIV e não alteradas no GV.

OBJECTIVE: The aim of this study is to assess if N-Acetylcysteine (NAC) changes the Ischemic Preconditioning (IP) in isolated rat hearts using only one cycle of IP. METHODS: Heart Rate (HR), Coronary Flow (CF) and Myocardial Contractility (dP/dt) were registered in 30 Wistar rat's hearts. After anesthesia the hearts were removed and perfused with Krebes-Hensleit equilibrated solution with 95 percent of O2 and 5 percent of CO2 according Langendorff's method. GI: Control (n=6); GII: 20 min. ischemia (n=6); GIII: IP (n=6); GIV 50 µg/ml/min NAC before IP (n =6); GV: 100 µg/ ml/min NAC before IP (n=6). Parameters were measured after 15 min. of stabilization (T 0) and T3, T5, T10, T15, T20, T25 and T30 min. after reperfusion. Statistical significance was considered when P<0.05. RESULTS: There were changes on HR comparing GI with GII at T20 and T25 and comparing GI with GIII, GIV with GV at T10 and T20 (P<0.05). CF was different comparing GI with GII at T3 and T5, GI with GIV at T10 and GI with GV at T10 and T25 (P<0.05). Myocardial Contractility was similar comparing GIII with GI and GV. GIII had higher dP/dt than GIV but without statistical difference (P>0.05). dP/dt was higher in GV than GIV but with statistically significant difference only at T30. CONCLUSION: dP/dt was better in preconditioned hearts and was changed if using NAC in GIV. The use of NAC didn't change the effects of preconditioning on myocardial contractility in GV.

Dual-phase contrast-enhancement multislice computed tomography imaging in assessment of acute myocardial infarction-reperfusion injury / 上海第二医科大学学报

Objective To explore the value of dual-phase contrast-enhancement multislice computed tomography (MSCT) in the assessment of acute myocardial infarction volume and perfusion in porcine models. Methods The distal left anterior descending coronary arteries of 5 pigs were balloon-occluded for 90 min and followed by reperfusion. MSCT was performed 1 min (early phase) and 5 min (delayed phase) after administration bolus of 100 mL of iodinated contrast material 30 min after reperfusion. On the same day, hearts were excised, sectioned in 8 mm short-axis slices, and stained with TTC. Infarction volume was defined as the sum of the hyper-enhanced area and surrounding hypo-enhanced area in all slices on delay enhanced phase of MSCT and the TTC-negative area on TTC staining slices. Infarction volume was expressed as percentage of total slice volume. Results Acute infarction detected by MSCT was characterized by early myocardial perfasion defects in the early phase of the contrast bolus (early defects) with surrounding residual defects and late enhancement observed in the late phase. Mean CT attenuation value of early defects was significantly different from CT attenuation value of remote myocardium [(213±55)HU vs (304±30)HU](P < 0.05), CT attenuation values of residual defects and late enhancement were also significantly different from those of remote myocardium [(360±75) HU vs (90±37) HU and (152±23) HU vs (190±37) HU, repectively](P < 0.01, P < 0.05). The mean infarction volume was (8.9± 1.0)% on MSCT and (9.2±1.4)% on TTC pathology images. The infarction volume assessed by MSCT compared well with TTC staining slices. Conclusion Acute reperfused myocardial infarction zone has specific enhancement pattens different to remote normal zone on dual phase MDCT, which is in good agreement with in vivo Trc pathology in the assessment of acute reperfused myocardial infarction shortly offer reperfusion.

Clinical survey of MS Contin in the treatment of acute myocardial infarction / 医学研究生学报

Objective:To assess the therapeutic effects and adverse reactions of MS Contin in the treatment of acute myocardial infarction (AMI). Methods: 42 AMI patients were divided into experiment group and control group. Experiment group were given oral administration of MS Contin for 1 week besides the routine treatment of AMI for patients in the control group. Results: Between the two groups, the differences in the product of heart rate and blood pressure ( HR?BP) , the frequency of angina pecto-ris attack, the recovery time of the ST segment and the incidence of acute arrhythmia were significant. The most common side effects observed were: vomiting, constipation, hallucination, and the most severe toxic side effect was respiratory inhibition. Conclusion : In the treatment of AMI, MS Contin could relieve the pain effectively, reduce the incidence of angina pectoris attack and severe arrhythmia, decrease myocardial oxygen consumption, have tolerable side effects in the majority of patients. It is preferable to use MS Contin as a concurrent treatment of AMI.