Clinical features comparison of ST segment elevation and non ST segment elevation in adult patients with acute myocarditis / 中华急诊医学杂志

Objective ST segment elevation in adult patients with acute myocarditis is rare in adult.The purpose of this study was to report the outcome of ST segment elevation in adult patients with acute myocarditis in our hospital,in order to provide reference for clinical diagnosis and treatment.Methods A retrospective analysis of Beijing Anzhen Hospital during January 2002 to December 2015 for the diagnosis of acute myocarditis were 105 cases,divided into two groups,one group of ST elevation (ST elevation group) total 57 cases,another group of non ST elevation (non ST elevation group) total 48 cases.The clinical features,laboratory examination,treatment and prognosis were compared between the two groups.The composite primary endpoint of major cardiovascular events (MACE) during hospitalization included:mortality,cardiac shock and ventricular fibrillation.Results The average onset age of patients with ST segment elevation group and non ST segment elevation group were similar [(27.7 ± 10.1) years vs.(28.7 ± 10.0) years,P =0.603].There was a significant difference between the two group in patients of heart rate [(89 ± 22) beats/min vs.(80 ± 23) beats/min,P =0.028],systolic blood pressure on admission [(105 ± 17) mmHg vs.(115 ± 17) mmHg,P =0.003],diastolic blood pressure on admission [(66 ± 11) mmHg vs.(74 ± 11) mmHg,P =0.000],and total number of acute fulminant myocarditis [20 (35.1％) vs.7 (14.6％),P =0.024)].ST segment elevation acute myocarditis patients were significantly more at risk for MACE than non ST segment elevation acute myocarditis patients during hospitalization (P =0.04).Conclusion ST segment elevation acute myocarditis has acute onset and rapid progression.The incidence of MACE during hospitalization was significantly high.Mechanical support can be ve,ry favourable.ST segment elevation acute myocarditis is associated with excellent short-term prognosis.

A study in the correlation between vascular factors and plaque imaging morphology of coronary borderline lesions in patients with coronary heart disease / 中华急诊医学杂志

Objective To investigate the correlation between the levels of placenta growth factor (PLGF),soluble angiopoietin receptor-2 (sTie-2) and critical coronary artery plaque imaging morphology of coronary borderline lesions in patients with coronary heart disease (CHD).Methods In three consecutive years from April 2007 to September 2009,a cohort of 719 patients with borderline coronary lesions with stenosis in three main vessels with lumen diameter reduction varied all the way from more than 20％ to less than 70％ and with greater than 2.25 mm of the inner diameter were selected in this study from 4 teaching hospitals of tertiary class A in Beijing.These patients fell into three categories:unstable angina pectoris (UAP,n =292),stable angina pectoris (SAP,n =219) and coronary arteriosclerosis (AS,n =208).The vessels involved were analyzed using quantitative coronary angiography (QCA).Plasma levels of PLGF and sTie-2 were measured by using protein chip.The relationship between plasma levels of vascular factors,sTie-2,PLGF and coronary artery plaque imaging morphology among three groups were analyzed.Results (1) Plasma level of PLGF was 80.33 ng/L in the UAP group,which was significantly higher than 54.29 ng/L in the SAP group and 45.16 ng/L in AS group (both P ＜0.05).Plasma level of sTie-2 was 1353.06 ng/L in the UAP group,which was significantly higher than 1308.28 ng/L in the AS group (P =0.008).(2) There was significantly statistical differences in QCA between the SAP group and the UAP group as well as the AS group (both P ＜ 0.05) in terms of the minimal lumen diameter,diameter stenosis rate,minimal lumen cross-sectional area and cross-sectional area of stenosis.The plaque area in the UAP group was larger than that in the AS group (P =0.013).(3) The relationship between vascular factors and plaque imaging morphology was analyzed.There was significantly statistical difference in the involved lesions among the three groups (P ＜ 0.01).(4) There was a positive correlation between plasma level of PLGF and minimal lumen cross-sectional area (r =0.493,P =0.009).Conclusions The plasma levels of PLGF and sTie-2 reflect the level of neo-vascularization in the plaque,and could be taken as predictive factors for potential pathogenesis of coronary plaque.

Analysis of the clinical data of patients with acute coronary syndrome complicated by hemorrhage during hospitalization / 中华内科杂志

ObjectiveTo investigate the clinical characteristics of patients with acute coronary syndrome suffering hemorrhage during hospitalization. MethodsThe clinical symptoms,diagnostic and therapeutic characteristics and in-hospital outcome of 3807 inpatients who were recruited into SINO-GRACE study in China due to acute coronary syndrome from March,2001 to December,2007 were collected.Statistical methods were adopted to compare the differences in clinical data between hemorrhage group and non-hemorrhage group.ResultsHemorrhage had happened in 57 out of 3807 inpatients with the incidence of 1.50％. Five patients, which accounted for 9.6％of the overall hemorrhage cases, were fatal hemorrhage.Nine patients were intracranial hemorrhage with the incidence of 0.24％. There were 155 deaths among the 3807 patients,with an overall mortality rate of 4.1％. The mortality of hemorrhage accounted for 3.2％in overall mortality. Patients with one of the following factors were more apt to hemorrhage:＞ 70 years old,previous hemorrhage history,renal failure history,heart failure history and clopidogrel and glycoprotein (GP)Ⅱ b/Ⅲ a receptor antagonist administration for coronary artery bypass grafting.Patients who developed hemorrhage might need prolonged hospitalization and were liable to develop heart-related adverse events,including re-infarction and sustained ventricular tachycardia/fibrillation after they were admitted in hospital over 24 hours. ConclusionPatients with acute coronary syndrome who underwent coronary artery bypass grafting,with advanced age,previous hemorrhage history,renal failure history,heart failure history or treated with clopidogrel and GPⅡ b/Ⅲ a receptor antagonist are more vulnerable to hemorrhage.

Effect of platelet aggregation rate level on the prognosis of percutaneous transluminal coronary angioplasty / 中国医师进修杂志

ObjectiveTo study the effect of platelet aggregation rate (PAR) level on the prognosis of percutaneous transluminal coronary angioplasty (PCI).MethodsFour hundred and one patients who performed PCI were divided into 4 groups:group 1 (PAR≤30％,103 cases),group 2 (PAR 31％ - 40％,102 cases),group 3 (PAR 41％ - 49％,103 cases ) and group 4 (PAR ＞ 49％,93 cases ).All the patients were followed up.The survival analysis was performed in 4 groups.ResultsThe data of survival table were tested by 3 methods among 4 groups:statistic was 0.612,degree of freedom was 3,P =0.894 in Log-rank (Mantel-Cox) test,statistic was 0.567,degree 9f freedom was 3,P =0.904 in Wilcoxon test and statistic was 0.586,P =0.900 in Tarone-Ware test.There was no significant difference among them.The mean follow-up duration was 2.2 years,and there was no significant difference in survival function among 4 groups (P ＞0.05).ConclusionPreoperative and postoperative measurement of PAR levels may not improve the prognosis.

Synergistic effect of atorvastatin and probucol on severity of coronary lesion in patients with borderline coronary lesion / 中华急诊医学杂志

Objective To study the changes of plasma cystatin C level (PcyC),and evaluate the effects of the joint use of atorvastatin and probucol on PcyC and severity of coronary lesion in patients with borderline lesion of coronary artery.Methods One hundred and thirty consecutive patients with borderline coronary lesion assessed by quantitative coronary angiography were enrolled into borderline coronary lesion group (BCL),and another 136 subjects without coronary lesion were enrolled as controls (CTR).And in the meantime,the subjects in BCL group were randomized (closed envelope method) into routine treatment subgroup ( RTT,n =60),and combined treatment subgroup in which patients were treated with atorvastatin 20 mg plus probucol 1.0 g daily in addition to routine medication ( CBT,n =70) for 6 months.There were no statistical differences in basic clinical features between two subgroups.PcyC,high-sensitive C-reactive protein (hs-CRP),total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol ( HDL-C ) and triglycerides (TG) were determined.Of them,104 patients in BCL group rechecked by coronary angiography.Comparison of biomarkers carried out between two groups by using a number of independent-sample t-test and analysis of variance.For enumeration data,chi-square test was used to compare mean values of biomarkers between groups. P ＜ 0.05 was considered statistically significant.Results PcyC levels were significantly higher in BCL group than those in CTR group ( P ＜ 0.05 ).Compared with RTT subgroup,levels of PcyC,TC,LDL-C,TG and hs-CRP were more significantly decreased in CBT subgroup (P ＜ 0.05,P ＜ 0.01 ).Moreover,there was a trend of slight decrease in the mean percent of stenosis (MPS) of coronary artery with borderline lesion in RTT subgroup treated for 6 months,whereas more marked decrease in the MPS of coronary artery with borderline coronary lesion in CBT subgroup treated for 6 months ( P ＞ 0.05 ; P ＜ 0.05 ).Conclusions Cystatin C plays an important role in the pathogenesis of coronary artery,and PcyC is associated with severity of coronary lesion,the combination of atorvastatin and probucol decreases the PcyC level,and it may be the treatment of choice for borderline lesion of coronary artery.

Clinical significances of plasma cystatin C levels in patients with coronary artery diseases / 中华急诊医学杂志

Objective To evaluate the relationship between plasma cystatin C concentration (PcyC) and coronary artery diseases (CAD). Method A total of 126 subjects with CAD evidenced by coronary angiography admitted from April 2007 to March 2009 were divided into three groups: stable angina pectoris (SAPs, n = 34),unstable angina pectoris (UAPs, n = 56) and acute myocardial infarction (AMIs, n = 36), according to the diag-nostic criteria of CAD set by WHO. Another 34 subjects without CAD were taken as controls. There were no statis-tical differences in demographics among four groups. Serum lipids profile, uric acid (UA), PcyC and high-sensi-tive C-reactive protein (hs-CRP) were determined. And in the meantime, all patients were followed up for six months and adverse cardiovascular events were recorded. Comparisons were made between groups with a number of independent-sample t -tests. Data were processed with analysis of variance to test the differences in means among four groups, and the means were compared with chi-square test. Statistical significance was established at a P val-ue of less than 0.05. Results Cystatin C levels were significantly higher in UAPs than that in SAPs and in controls (P < 0.05), but were much lower than that in AMIs (P < 0.05). And much higher concentration of hs-CRP was found in UAPs (P < 0.05) and in AMIs (P < 0.01). Cystatin C was positively and significantly corre-lated with age, hs-CRP, WBC, creatinine and UA (r > 0, P < 0.05), whereas a significantly negative correla-tion with high-density lipoprotein cholesterol was found (r = - 0.227, P < 0.05). These coefficients were obvi-ously high for creatinine (r = + 0. 612), and WBC (r = + 0.459). During the period of six-month follow-up, 26 patients with adverse cardiovascular events were found, and had significantly higher cystatin C levels than 22 con-trols at admission (P < 0.01). Conclusions Cystatin C plays a pivotal role in the course of CAD, and the PcyC is a strong predictor for the risk of cardiovascular events.

Ultrasound-mediated destruction of gene-loaded microbubbles enhanced the transfection of phospholamban antisense RNA into cardiac myocytes / 中华超声影像学杂志

Objective To explore whether ultrasound-mediated microbubbles destruction could enhance anti-sense RNA transfection and expression. Methods Phospholamban antisense RNA eukaryon vector PcDNA 4. 1-asPLB was successfully constructed and it was transfected into cardiac myocytes by various methods including calcium phosphate precipitation, ultrasound exposure and ultrasound-mediated microbubbles destruction. The expression of PLB and sarcoplasmic retculum Ca2+ ATPase (SERCA2a) in cardiac myocytes was tested by RT-PCR and western blot. Results The transfection and expression of PcDNA 4. 1-asPLB increased significantly in cells treated with ultrasound-mediated microbubbles destruction compared to other transfer groups( P ＜0.05). The expression of PLB was inhibited specifically after cardiac myocytes were transfected with PcDNA 4. 1-asPLB. There was no change of PLB expression after cardiac myocytes transfected with PcDNA 4. 1 ( P ＜0.05). Though the expression of SERCA2a never exhibited any changes after PcDNA 4. 1-asPLB transfection, the PLB/SERCA2a ratio decreased markedly. Conclusions As a highly effective antisense RNA transfer method, ultrasound-mediated microbubbles destruction can enhance the transfection and expression of the PcDNA 4. 1-asPLB significantly. The PcDNA4. 1-asPLB transfection inhibits the expression of PLB and result in decrease of PLB/SERCA2a ratio in cardiac myocytes.

Effects of different therapies on coronary artery disease / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To analyse the effects of different therapies on coronary artery disease (CAD).</p><p><b>METHODS</b>A total of 1055 patients who suffered from CAD diagnosed by coronary angiography were divided into three groups, namely pure drug therapy, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) groups. Follow up was carried out from March to May in 2001, and the major adverse cardiac events (MACEs) including death, no-lethal myocardial infarction (MI) and revascularization were observed. In long-term observation, angina reoccurred, and their improvement was evaluated. The short-term period was defined as the duration of 30 days after discharge, and the long term period was defined as the duration from 30 days after discharge.</p><p><b>RESULTS</b>In the long-term period, the recurrences of angina both in PCI group and CABG group were lower than pure drug group (P 0.018, 0.002 respectively). No differences about long-term endpoint events were observed among these three groups (P > 0.05). Forty-two patients suffering from left main coronary disease were intervened by the three therapies, and there was no death or MI both in PCI and CABG groups, three patients died and suffered from AMI in pure drug therapy group (P = 0.015). In the short-term period, mortality in CABG group (5.77%) was higher than those in the other two groups (1.91% for PCI, and 1.40% for medical therapy, P = 0.002), and no obvious difference observed in the latter two groups. No significance was concluded about the recent MI among this three groups (P = 0.357). There were no differences on revascularization in these three groups.</p><p><b>CONCLUSIONS</b>Percutaneous coronary interventions can not only reduce the attack of angina but also improve the life quality of patients, however it can not improve the long-term existence but left main CAD.</p>

Clinical outcomes of unrestricted application of domestic Sirolimus-eluting stent / 中国介入心脏病学杂志

Objective To ivestigate the clinical outcomes of domestic Sirolimus-eluting stents(Partner stents)in unselected patients.Methods We reviewed the clinical data of 516 patients who had implanted the Paterner stents during August 2006 to Dotober 2007.We followed up all the patients by telephon or by clinical visits for(9?2)months.The incidence of MACE and the result of follow up angiogram was analysed.Further investigation was made in the relation between the restenosis rate and lesion morphorlogy.Results A total of 872 Partner Stents were implanted successfully in 516 patients.Among them,482 patients(93.4%)finished the clinical follow up and 239 patients(46.3%)received follow up angiogram.The MACE rate was 3.5% and the restenosis rate was 11.3% as share in angiogram.A 14% of the patients with reslenosis was concomitant with diabetes mellitus.We analysised the rate of restenoses of left main,bifurcation,chronic total occlusion,diffuse disease,in-stent restenoses,littile vessal,acute occlusion,ostial lesions,and just A-just lesion.Conclusion Implantation of domestic Partner stent was safe and effective,even in patients with diabetes mellitus.The MACE rate was low and the stent has shown satisfactory ontcomes in lesions such as left main,bifurcation,chronic total occlusion,diffuse disease,in-stent restenoses,littile vessal,acute occlusion,ostial lesions,and A-type lesion.

Inhibitions of daidzein on intima proliferation of rat common carotid artery injured by balloon / 中国介入心脏病学杂志

Objective To observe the effect of daidzein on intima proliferation of rat common carotid artery injured by balloon. Methods 24 male Wistar rats were randomly assigned to 3 groups, 8 rats per group: high dose daidzein group (100 mg/kg?d), low dose daidzein group (50 mg/kg?d) and dissolvent control group. Duplicate the rat common carotid arteries injured by balloon models. Five weeks after operation, serum biochemical indicator such as TC, TG, BUN, ALT and MDA were measured using routine biochemical methods. And pathological sections of common carotid arteries were observed and the changes of vascular histomorphology were estimated by computer analysis of photomicrograms. Results Compared with control group, the intima areas was significant decreased in high dose group and low dose group (86 893?83 452 ?m2 vs 199 419?103 352 ?m2 vs 222 324?56 154 ?m2,P0.05). Conclusion Daidzein can inhibit the intima proliferation of Wistar rat common carotid arteries injured by balloon.

Evaluation of transisthmus conduction interval in predicting bidirectional block after ablation of typical atrial flutter / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To determine whether the extent of prolongation of the transisthmus interval after ablation predicts complete bidirectional block.</p><p><b>METHODS</b>Since 1996 to 2002, 30 consecutive patients underwent ablation procedures for isthmus-dependent atrial flutter. There were 23 males and 7 females [mean age (47.85 +/- 9.35) years]. With the use of fluoroscopic view of anatomy, radiofrequency ablation was performed during coronary sinus pacing at a cycle length of 600 ms.</p><p><b>RESULTS</b>Bidirectional block was achieved with ablation in 29 (97%) of 30 patients. The transisthmus intervals before ablation and after complete transisthmus block were (73.82 +/- 13.01) ms and (140.47 +/- 20.48) ms, respectively, in the clockwise direction (P < 0.0001), and (77.63 +/- 8.36) ms and (138.17 +/- 15.55) ms, respectively, in the counterclockwise direction (P < 0.0001). A period of incomplete isthmus block was observed during 17 (58%) of the 29 ablation procedures. The clockwise transisthmus intervals during incomplete block [(107.65 +/- 21.33) ms] were (45.5 +/- 8.7)% longer than the baseline transisthmus intervals. An increase in the transisthmus interval by > or = 50% in both directions after ablation predicted complete bidirectional block with 100.0% sensitivity and 83.3% specificity. The positive and negative predictive values were 90.6% and 100.0%, respectively. The diagnostic accuracy of a > or = 50% prolongation in the transisthmus interval was 83.3%.</p><p><b>CONCLUSION</b>The analysis of transisthmus interval is a valuable method for determining complete bidirectional isthmus block.</p>

Analysis of acute and subacute stent thrombosis after successful implantation of sirolimus-eluting stent in complex coronary lesions / 中国介入心脏病学杂志

Objective Current data on stent thrombosis(ST) in drug-eluting stent(DES) have come from randomized trials with strict entry criteria,which limits their generalizability to daily practice.The study sought to determine the real-world incidence of angiographically confirmed and possible stent thrombosis(ST) in an unrestricted population during the first 30 days after sirolimus-eluting stent(SES) implantation.Methods A cohort of consecutive complex patients treated with SES implantation was selected from Sep,2002 to May,2005.A total of 796 subjects entered the study.Results In the first 30 days after SES implantation,1 case had acute stent thrombosis and seven other cases had subacute stent thrombosis.Among these eight patients,ST presented as STEMI in three patients,NSTEMI in four patients and UAP only in one patient.Bifurcation stenting and long lesion stenting were the two significant risk factors(OR was 11.2 and 8.6 respectively,95% CI was 4.1 to 30.8 and 1.9 to 17.2 respectively,P

The therapy of stents implantation for coronary long lesion / 中国介入心脏病学杂志

Objective To evaluate the effects of single long stent and multiple contiguous stents for the therapy of the long coronary lesion. Methods According to the different means of stent implantation,64 cases of patients are divided into two groups:Group A for the single long stent,and Group B for the multiple contiguous stents. All of patient received coronary artery angiography in order to evaluate the rate of restenosis after 6～10 months. Results In hospital period, no acute or subacute thrombosis, no myocardial infarction and death occured. There was no difference for the restenosis rate of the stents between two groups. Conclusion The effects of both the single long stent and the multiple contiguous stents is similarity.