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Objective@#To explore the relationship between coronary tortuosity and coronary microvascular disease (CMVD).@*Methods@#Patients with typical angina symptoms and without serious coronary artery stenosis by coronary angiography were enrolled from June 2014 to December 2016, and CMVD was diagnosed by single photon emission tomography (SPECT). According to the SPECT results, patients were divided to the CMVD group and non-CMVD group. The baseline clinical characteristics, results of coronary angiography were compared between the two groups. The logistic analysis was used to analyze the relationship between coronary tortuosity and CMVD.@*Result@#A total of 117 cases were enrolled, with 69 cases in the CMVD group and 48 cases in the non-CMVD group. No differences were found in gender distribution, age, hypertension, lipid abnormality, hyperuricemia and uses of statins between the two groups (all P>0.05). Incidence of diabetes (78.26%(54/69) vs. 35.42% (17/48) , P<0.05), hs-CRP ((4.29±2.15)mmol/L vs. (2.63±1.20)mmol/L, P<0.001), LDL-C ((2.98±0.96)mmol/L vs. (2.52±0.83)mmol/L, P=0.008) and homocysteine ((13.7±5.61)mmol/L vs. (11.5±4.38)mmol/L, P=0.025) levels were higher in the CMVD group than in the non-CMVD group. The data derived from echocardiographic examination were similar between the two groups. The Corrected TIMI frame counts were higher in the CMVD group than in non-CMVD group (LAD: 31.56±4.92 vs. 27.31±3.75, LCX: 29.47±4.18 vs. 26.62±3.19, RCA: 29.09±5.05 vs. 26.24±3.28, all P<0.001). The incidences of coronary atherosclerosis (76.81% (53/69) vs. 27.08% (13/48) , P<0.001) and coronary tortuosity ( (60.87% (42/69) vs. 33.33% (16/48) , P=0.035) were also higher in the CMVD group than in non-CMVD group. Logistic analysis found that coronary tortuosity (OR=6.111, 95%CI 2.707-13.794, P<0.001), diabetes (OR=6.565, 95%CI 2.883-14.948, P<0.001) and coronary atherosclerosis (OR=8.918, 95%CI 3.822-20.808, P<0.001) were independent risk factors of CMVD.@*Conclusion@#Coronary tortuosity, diabetes and coronary atherosclerosis are related to CMVD in this patient cohort.
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Objective: To explore the impact of ticagrelor on myocardial microcirculation in patients of non-ST elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI). Methods: A total of 80 NSTEMI patients treated in our hospital from 2015-03 to 2015-12 were enrolled. All patients received coronary angiography (CAG) and PCI, they were randomly divided into 2 groups: ticagrelor (TA) group and clopidogrel (CA) group, n=40 in each group. The baseline condition, PCI related parameters, plasma levels of SOD, MDA at pre- and 24h, 72h post-PCI were compared, the incidence of major adverse cardiac events (MACE) within 30 days after PCI was also compared between 2 groups. Results: The baseline condition, proportion of infarction-related vessels, average length and diameter of implanted stents were similar between 2 groups, all P>0.05. Compared with CA group, TA group had the less post-operative CTFC in LAD and RCA, P0.05. The ratios of acute pre-operative, post-operative TIMI grade 3 and slow flow incidence were similar between 2 groups, P>0.05. The peak values of CK-MB and cTnI in TA group were lower than CA group, P<0.05. Compared with baseline condition, MDA levels at 24h and 72h post-operation were increased in both groups, all P<0.001; compared with CA group, TA group had the lower MDA level at 24h post-operation, P=0.023, MAD was further reduced at 72h post-operation in TA group, P=0.043. Compared with baseline condition, SOD levels at 24h and 72h post-operation were decreased in both groups, all P<0.001; compared with CA group, TA group had the higher SOD level at 24h post-operation, P=0.013, SOD was elevated at 72h post-operation in both groups, the elevation was more obvious in TA group, P=0.049. The incidence of MACE was similar between 2 groups within 30 days of PCI,. Conclusion: Ticagrelor could improve myocardial microcirculation in NSTEMI patients after PCI; it was safe and without obvious adverse effects.
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<p><b>OBJECTIVES</b>To investigate whether the administration of recombinant human B-type natriuretic peptide (rhBNP) before primary percutaneous coronary intervention (PCI) could further limit the infract size, improve left ventricular function, and alleviate cardiac dilation in patients with acute ST-segment elevation myocardial infarction(STEMI).</p><p><b>METHODS</b>A total of 93 consecutive patients presenting chest pain within 12 hours from the onset, suspicious of first STEMI located at anterior wall undergoing primary PCI, were eligible for enrollment and randomly assigned to either rhBNP group (rhBNP administration starting at 5 min before PCI, 1.5 µg/kg bolus intravenous injection followed by 0.007 5-0.03 µg·kg(-1)·min(-1) for up to 120 hours, n=48) or nitroglycerin (NIT) group (NIT treatment starting at 5 min before PCI, 10-100 µg/min intravenous infusion for 120 hours, n=45). Primary PCI was performed in both groups using post-conditioning (PC) technique. TIMI flow grade, corrected TIMI frame count, and TIMI myocardial perfusion grade were compared between the two groups at the time of infarct related artery (IRA) re-patency. The levels of serum creatine kinase MB isoenzyme (CK-MB) and troponin I (TnI) were measured. Echocardiography was performed at baseline 7 days and 6 months later.</p><p><b>RESULTS</b>Baseline characteristics were similar between the two groups. The percentage of TIMI grade 3 and TIMI myocardial perfusion grade 3 after PCI both tended to be higher in rhBNP group than those in NIT group (95.8%(46/48) vs. 86.7%(39/45), P=0.162) and (72.9%(35/48) vs. 62.2%(28/45), P=0.500). The corrected TIMI frame count was significantly decreased in rhBNP group (21.0±8.7 vs. 28.2±14.8, P=0.005). The myocardial infarct size expressed as the AUC of CK-MB ((3 249±1 101) U/L vs. (4 474±1 661)U/L, P=0.010) or AUC of TnI ((3 670±942) µg/L vs. (4 541±1 098) µg/L, P=0.021) was significantly decreased in rhBNP group compared with those in NIT group. At 7 days after primary PCI, the left ventricular ejection fraction (LVEF) tended to be higher (P>0.05), while the E/e' index and wall motion score index (WMSI) ((11.95±3.31 vs. 14.60±4.09, P=0.030) and (1.74±0.17 vs. 2.40±0.55, P<0.001)) were significantly improved in rhBNP group compared with those in NIT group. BNP level was also significantly lower in rhBNP group compared that in NIT group ((68.3±37.8) ng/L vs. (129.4±64.4) ng/L, P<0.001). During 6-month follow-up, LVEF and WMSI were significantly improved in rhBNP group compared those in NIT group(51.7%±12.7% vs. 46.9%±9.6%, P=0.024 and 1.69±0.35 vs. 1.92±0.47, P=0.020).</p><p><b>CONCLUSION</b>Administration of rhBNP before PCI with post-conditioning procedure can further improve myocardial perfusion, limit myocardial infarct size, ameliorate cardiac dysfunction and postpone left ventricular early-stage and long-term remodeling in STEMI patients undergoing primary PCI.</p>
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Humanos , Doença Aguda , Creatina Quinase Forma MB , Ecocardiografia , Infarto do Miocárdio , Peptídeo Natriurético Encefálico , Intervenção Coronária Percutânea , Troponina I , Função Ventricular EsquerdaRESUMO
Objective: To explore the effect of intravenous recombinant human brain natriuretic peptide (rhBNP) on regional myocardium deformability in patients with anterior acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI). Methods: A total of 35 patients with anterior AMI who received primary PCI within 12 hours of symptom onset in our hospital from 2013-06 to 2013-12 were enrolled in this study and randomized into 2 groups: rhBNP group, the patients received intravenous rhBNP,n=18, Control group, the patients received standard intravenous nitrates,n=17, and the intravenous pumping administration maintained for 72 hours in both groups. The echocardiography was conducted at immediately, 7 days and 1 month after PCI respectively to compare the relative parameters. The occurrence of major adverse cardiac events (MACE) were followed-up for 6 months in all patients. Results: The baseline condition was similar between the two groups,P>0.05 , the parameters of echocardiography as LVEF and WMSI at immediately and 7 days after PCI were similar between the two groups,P>0.05. Compared with Control group, rhBNP group had the increased LVEF and decreased WMSI at 1 month after PCI ,P0.05; SRs, SEe and Sra were increased at 1 month after PCI, allP0.05. Conclusion: Intravenous administration of rhBNP could improve the regional myocardium deformability and the systolic/diastolic function in patients with anterior AMI after primary PCI.
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<p><b>BACKGROUND</b>Transradial approach catheterization is now widely used in coronary angiography and angioplasty. The ulnar artery, which is one of the two terminal branches of the brachial artery, may be a potential approach for cardiac catheterization. The aim of this study was to evaluate the safety and feasibility of a transulnar approach for coronary catheterization in non-selective patients.</p><p><b>METHODS</b>A total of 535 consecutive patients were randomly assigned to transulnar approach (TUA) group (n = 271) or transradial approach (TRA) group (n = 264) upon arrival at the catheterization laboratory. Allen's test and inverse Allen's test were not routinely performed. Ultrasound-Doppler assessment of the forearm artery was performed before the procedure, two days after the procedure, and 30 days after the procedure. The primary endpoints of study were the rate of successful artery cannulation and the access-site related complications. The secondary endpoints included the number of needle punctures, total time for the procedure, and major adverse cardiac events (MACE).</p><p><b>RESULTS</b>Successful puncture of the objective artery was obtained in 91.5% of the patients in the TUA group, and 95.1% of the patients in the TRA group (P > 0.05). There was no significant difference in hematoma complications between the two groups (7.7% vs. 4.2%, P = 0.100). A motor abnormality of the hand was observed in one patient in the TUA group. There were no arteriovenous fistula or pseudoaneurysm observed in our study. Three (1.1%) patients in the TUA group and 8 (3.0%) patients in the TRA group had occlusion of the access artery (P = 0.137), but none of the patients had symptoms or signs of hand ischemia. There were no significant differences in MACE between the two groups during follow-up.</p><p><b>CONCLUSION</b>The transulnar approach is an effective and safe technique for coronary catheterization in non-selective patients.</p>
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Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cateterismo Cardíaco , Métodos , Angiografia Coronária , Métodos , Artéria Radial , Cirurgia Geral , Artéria Ulnar , Cirurgia GeralRESUMO
Objective To evaluate the effect on the reversal of left ventricular aneurysm (LVA) and on heart function of percutaneous coronary intervention (PCI) therapy at different time of acute myocardial infarction (AMI). Methods A total of 326 patients with primary anterior AMI-accompanied LVA diagnosed by left ventriculography (LVG) from January 2001 to July 2004 were enrolled in this study. They were randomized into 4 groups according to the time of accepting PCI:≤3 h group, 4-6 h group, 7-12 h group and one week group. At the baseline and 6 months after AMI, the parameters of left ventricular diastolic volume index (LVEDVI), left ventricular systolic volume index (LVESVI), left ventricular ejection fraction (LVEF), left ventricular wall motion score (LVWMS) and left ventricular end diastolic pressure (LVEDP) were measured by LVG. The paradox volume index (PVI) was measured by equilibrium radionuclide at one week and 6 months after AMI.At 3 year following up to, the major adverse cardiac events (MACE) were recorded. Results At 6 months after PCI, the LVESVI, LVEDVI, WMS and LVEDP were all decreased while LVEF was increased in the four groups as compared with pre-PCl (P<0.05, respectively). Those parameters changed most obviously in ≤3 h group. At the 6th month after PCI, the PVI was lower in ≤3 h group (12.1±2.1)% than in 4-6 h, 7-12 h and one week group [(15.4±2.4)%, (16.5±2.5)% and (20.4±3.7)%, all P<0.05]. Within the 3 years follow-up, the MACE was significantly lower in 3 h, 4-6 h and 7-12 h groups than in one week group, and the mortality was lower too [(2.8%, 3.0% and 3.1% vs. 17.9%, all P<0.05]. Conclusions The early, fully and permanent open of the infraction-related artery can effectively inhibit the left ventricular remodeling process, prevent LVA formation, improve LV function and prognosis.
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Objective To evaluate the method of establishment of a minipig model of ischemic heart failure(HF) with acute myocardial infarction(AMI) by coronary balloon occlusion and coadministration of injecting of microthrombi and plastic microspheres.Methods A total of eighteen minipigs were selected.After coronary angiography,angioplasty balloons were placed in the mid-distal of left anterior descending(LAD).The balloon was inflated intermittently to occlude the LAD 3 times and then to occlude it continuously for 120 minutes.After the balloon was taken out,4F Judkins-type angiogrphic catheter was superelectively engaged in LAD and 3 mL intermixture of mierothrombi and plastic microspheres were injected at 10 minites interval until TIMI myocardial perfusion was grade<2 and left ventfieular end-diastolic pressure was maintained from 15 to 18 mmHg.Electrocardiogram(ECG),hemodynamic perameters,ultrasonic cardiogram,cTnI and CK-MB were measured.Myocardial infarction area was evaluated by histopathology.Results Fourteen days later,fifteen minipigs survived and fourteen satisfied the criteria(pulmonary capillary wedge pressure.PCWP>18 mmHg and eardio output (CO) decreased beyond 30% ). The changes of ECG, hemodynamic perameters, CKMB, cTnI and cardiac pathologic examination were in accordance with AMI. Conclusion A stable experimental method of establishment of minipig model of ischemic heart failure (HF) with acute myocardial infarction (AMI) by coronary balloon occlusion and coadministration of injecting of microthrombi and plastic mierospheres is succeded. This method has advantages such as closed chest, higher success rate and stability compared with the drug induced, taehycardia-pacing induced, coronary artery ligation induced or microsphere injection alone methods.
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Objective: To evaluate the influence of recombinant human brain natriuretic peptide(rhBNP)on ventricular remodeling and ventricular systolic synchrony in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).Methods: A total of 48 patients with AMI after PCI were randomized into two groups: rhBNP Group (n=25) and Routine treatment Group (n=23).Two dimension echocardiography was used to measure the index of left ventricular end-diastolic volume (LVEDVI), the index of left ventricular end-systolic volume (LVESVI), left ventricular ejection fraction (LVEF), the index of left ventricular mass (LVMI), the movement index of infarcted regional wall (RWMI) at 1 week, 4 weeks and 24 weeks after the treatment procedure.And at 1 week and 24 weeks period, equilibrium radionuclide angiography was performed respectively to evaluate the ventricular systolic synchrony.Results: ①1 week after PCI, LVESVI in rhBNP group was decreased and LVEF was increased than that in Routine treatment group (P<0.05, respectively).4 and 24 weeks after PCI, LVEDVI, LVESVI, LVEF were significantly different in rhBNP group than those in Routine treatment group (P<0.05,respectively).24 weeks after PCI, RWMI and LVMI were significantly decreased in rhBNP group than those in Routine treatment group(P<0.05,respectively).②24 weeks after PCI, phase shift, full width at half maximum and peak phase standard deviation were significantly improved in rhBNP group than those in Routine treatment group (P<0.05, respectively).Conclusion: Intravenous injection of rhBNP could inhibit left ventricular remodeling and improve left ventricular function.
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Objective To investigate the extablishment of minipigs no-reflow models after percutaneous coronary intervention of AMI. Methods A total of 20 wuzhishan minipigs (9?1 months old with body weight of 25?5 kg) were chosen. Left ventriculography and coronary angiography (CAG) were performed sequentially by femoral approach,AMI and no-reflow was set up by diliating balloon to occlude the coronary coronary and reperfusion after the injection of microthrombus into the left anterior descending artery. At the same time, left ventricular hemodynamics parameters were recorded. Changes in ECG and IC-ECG were monitored. Results (1) Sixteen animals survived after the procedures and fourteen of them reached the criterion of AMI with no-reflow (TIMI≤2, CTFC≥36.2). The model extablishment success rate was 70%. (2)The hemodynamics parameters including heart rate, PRI, LVEDP, and PCWP increased, but blood pressure decreased at the time no-reflow was formed compared with those before LAD was occluded. (3) During the experiment, the changes in ECG and IC-ECG were similar to those observed in human in AMI. Conclusion Minipig is an ideal species for the establishment of animal no reflow model reperfusion after microthombus injection and balloon occlusion of LAD.