[Effects of Tongxinluo Capsule on Platelet Activating Factor, Vascular Endothelial Function, Blood Flow of Thrombolysis in Myocardial Infarction in Acute Myocardial Infarction Patients after Delayed Percutaneous Coronary Intervention].

OBJECTIVE: To explore effects of Tongxinluo Capsule (TC) on platelet activating factor (PAF), vascular endothelial function, thrombolysis in myocardial infarction (TIMI) blood flow, and heart function in acute myocardial infarction (AMI) patients after delayed percutaneous coronary intervention (PCI). METHODS: Totally 80 AMI inpatients were recruited at Department of Cardiology, People's Hospital of Jiangxi Province, from Jan. 2008 to Sep.2013. Those in line with inclusion criteria were randomly assigned to TC treatment group and the conventional treatment group by random digit table, 40 in each group. Besides, another 40 healthy subjects from examinees at Outpatient Department were recruited as a healthy control group. PCI was performed after 1-week treatment. Then blood samples were collected, and then blood contents of CD62P, CD63, GP II b/III a, ET-1, NO, and plasma von Willebrand factor (vWF) levels were detected. Coronary TIMI blood flow and corrected TIMI frame count (CTFC) were determined during PCI. Meanwhile, noninvasive blood pressure (BP) and heart rate (HR) were recorded before and after PCI, and cardiac function measured. They were compared with the healty control group. RESULTS: Compared with the healthy control group, blood contents of CD62p, CD63, GP II b/IIIa receptor compound, vWF, and ET-1 significantly increased, but NO significantly decreased in AMI patients (all P < 0.05). After 1-week intervention of TC, blood contents of CD62p, CD63, GP II b/IIIa receptor compound, vWF, NO, and ET-1 significantly decreased (P < 0.05, P < 0.01). Compared with the conventional treatment group at the same time point, blood contents of CD62p, CD63, GP II b/IIIa receptor compound, vWF, and ET-1 decreased more significantly in the TC group (P < 0.05, P < 0.01), increased NO levels were also more obviously seen (P < 0.01). The aforesaid parameters changed more obviously at day 30, as compared with those changes at week 1 (P < 0.05, P < 0.01). The TIMI blood flow grade and CTFC were more obviously improved after PCI in the two treatment groups. Better TIMI blood flow was seen in the TC group. TIMI level 3 blood flow rate was higher in the TC group than in the conventional treatment group with statistical difference (P < 0.05). The left ventricular ejective factor (LVEF) after PCI was obviously elevated in the TC group and the conventional treatment group (P < 0.01), and the improvement was more obviously seen in the TC group (P < 0.05). There were 6 cases of recurrent angina, 3 cases of ventricular tachycardial (VT)/ventricular fibrillation (VF), 6 cases of heart failure (HF), 1 case of cardiac sudden death in the conventional treatment group, with the total incidence of cardiovascular events being 40% (16/40). There were 2 cases of recurrent angina, 2 cases of VT/VF, 2 cases of HF, no cardiac sudden death in the TC treatment group, with the total incidence of cardiovascular events being 15% (6/40). There was statistical difference in the recurrent rate of cardiovascular events between the two groups (χ² = 2.27, P < 0.05). CONCLUSION: TC not only could prevent coronary embolism of AMI patients after delayed PCI, attenuate vascular endothelial injury, but also could improve TIMI blood flow, and strengthen cardiac systolic function.

Application of percutaneous balloon mitral valvuloplasty in patients of rheumatic heart disease mitral stenosis combined with tricuspid regurgitation.

BACKGROUND: Tricuspid regurgitation (TR) is frequently associated with severe mitral stenosis (MS), the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty (PBMV) procedure in rheumatic heart disease patients with mitral valve (MV) stenosis and tricuspid valve regurgitation. METHODS: Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV: MV area (MVA), TR area (TRA), atrial pressure and diameter, and pulmonary artery pressure (PAP). The patients were followed for 6 months to 9 years. RESULTS: After PBMV, the MVAs increased significantly (1.7 ± 0.3 cm 2 vs. 0.9 ± 0.3 cm 2 , P < 0.01); TRA significantly decreased (6.3 ± 1.7 cm 2 vs. 14.2 ± 6.5 cm 2 , P < 0.01), right atrial area (RAA) decreased significantly (21.5 ± 4.5 cm 2 vs. 25.4 ± 4.3 cm 2 , P < 0.05), TRA/RAA (%) decreased significantly (29.3 ± 3.2% vs. 44.2 ± 3.6%, P < 0.01). TR velocity (TRV) and TR continue time (TRT) as well as TRV × TRT decreased significantly (183.4 ± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P < 0.01; 185.7 ± 13.6 ms vs. 238.6 ± 11.3 ms, P < 0.01; 34.2 ± 5.6 cm vs. 60.7 ± 8.5 cm, P < 0.01, respectively). The postoperative left atrial diameter (LAD) significantly reduced (41.3 ± 6.2 mm vs. 49.8 ± 6.8 mm, P < 0.01) and the postoperative right atrial diameter (RAD) significantly reduced (28.7 ± 5.6 mm vs. 46.5 ± 6.3 mm, P < 0.01); the postoperative left atrium pressure significantly reduced (15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P < 0.01), the postoperative right atrial pressure decreased significantly (13.2 ± 2.4 mmHg vs. 18.5 ± 4.3 mmHg, P < 0.01). The pulmonary arterial pressure decreased significantly after PBMV (48.2 ± 10.3 mmHg vs. 60.6 ± 15.5 mmHg, P < 0.01). The symptom of chest tightness and short of breath obviously alleviated. All cases followed-up for 6 months to 9 years (average 75 ± 32 months), 2 patients with severe regurgitation died (1 case of massive cerebral infarction, and 1 case of heart failure after 6 years and 8 years, respectively), 2 cases lost access. At the end of follow-up, MVA has been reduced compared with the postoperative (1.4 ± 0.4 cm 2 vs. 1.7 ± 0.3 cm 2 , P < 0.05); LAD slightly increased compared with the postoperative (45.2 ± 5.7 mm vs. 41.4 ± 6.3 mm, P < 0.05), RAD slightly also increased compared with the postoperative (36.1 ± 6.3 mm vs. 28.6 ± 5.5 mm, P < 0.05), but did not recover to the preoperative level. TRA slightly increased compared with the postoperative, but the difference was not statistically significant (P > 0.05). The PAP and left ventricular ejection fraction appeared no statistical difference compared with the postoperative (P > 0.05), the remaining patients without serious complications. CONCLUSIONS: PBMV is a safe and effective procedure for MS combined with TR in patients of rheumatic heart disease. It can alleviate the symptoms and reduce the size of TR. It can also improve the quality-of-life and prognosis. Its recent and mid-term efficacy is certain. While its long-term efficacy remains to be observed.

[Effect of tongxinluo capsule on platelet activities and vascular endothelial functions as well as prognosis in patients with acute coronary syndrome undergoing percutaneous coronary intervention].

OBJECTIVE: To observe the effect of Tongxinluo Capsule on platelet activities and vascular endothelial functions as well as prognosis in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) at different stages. METHODS: 160 patients with acute coronary syndrome were randomly assigned to Tongxinluo (TXL) group (80 patients) and the conventional treatment group (80 patients). And 50 healthy subjects were set up as the health control group. Patients' plasma platelet activating factors (CD62p, CD63), and glucose protein (GP) IIb/IIIa, and endothelium-1 (ET-1), von Willebrand factor (vWF), nitric oxide (NO) levels, and endothelium dependent flow-mediated dilatation (FMD) were detected respectively. Patients in the TXL group orally took TXLC for six months. The aforesaid indices were re-detected in all patients after two months and six months. Comparison between before and after treatment in the same group and inter-group comparison were performed in the two groups. RESULTS: Compared with the health control group, CD62p, CD63, GPIIb/IIIa, vWF, and ET-1 levels increased significantly in ACS patients after PCI (all P<0.01), NO and FMD significantly decreased (P<0.01). CD62p, CD63, GPIIb/IIIa and, vWF also increased, and FMD decreased after PCI (all P<0.05), but insignificant difference was found in ET-1 and NO (P>0.05). In the TXL group and the conventional treatment group, the levels of CD62p, CD63, GPIIb/IIIa, vWF and ET-1 decreased significantly (P<0.05, P<0.01), NO and FMD increased (P<0.05, P<0. 01) when compared with before treatment. Compared with the conventional treatment group, the decrement of CD62p, CD63, GPIIb/IIIa and vWF (P<0.05, P<0.01), and the increment of FMD and NO (both P<0.05) were more obvious in the TXL group. The aforesaid indices were more obviously different between 6-month treatment and 2-month treatment in the TXL group and the conventional treatment group (P<0.05, P<0.01). Seven patients suffered from angina, six from heart failure, three from ventricular tachycardiac (VT)/ventricular fibrillation (VF), and two died suddenly in the conventional treatment group after six months of treatment, while only one suffered from angina, one from heart failure, and none from VT/VF or died suddenly in the TXL treatment group after 6 months of treatment. CONCLUSION: TXL could be used in the prevention and treatment of coronary thrombosis, protect the vascular endothelial functions, as well as improve the prognosis of ACS patients after PCI.

[Percutaneous coronary intervention of patients with complex small coronary artery lesion unsuitable for coronary artery bypass graft].

OBJECTIVE: To investigate the safety and efficacy of percutaneous coronary intervention (PCI) in patients with low left ventricular ejection fraction (LVEF) and complex small coronary artery lesions. METHODS: Complete or partial post-PCI revascularization of coronary artery was employed in 16 patients with a low LVEF and complex small coronary artery lesions who were unsuitable for CABG (coronary artery bypass grafting). All cases were observed with regards to immediate success rate of operation, complication, hospitalization duration, improvement of cardiac function and LVEF and major adverse cardiac events (including cardiac death, myocardial infarction and target lesion revascularization) at 12 months post-operation. RESULTS: All cases were successfully treated without death and severe complications while the hospitalization duration was (11 +/- 5) days. The follow-up survey at 12 months post-operation showed that no major adverse cardiac event occurred, the post-operative improvement of cardiac function was from III - IV grade to I - II grade, the improvement of LVEF was from 25% - 45% [(29 +/- 8)%] to 32% - 48% [(37 +/- 7)%], left ventricular end diastolic diameter (LVDd) was shortened from 52 - 79 (66 +/- 11) mm to 49 - 68 (58 +/- 8) mm. The reexamination of 14 cases by coronary angiography at 12 months post-operation showed that there was no intra-stent thrombosis while 20% - 40% intra-stent restenosis occurred in 2 cases. CONCLUSION: For patients with a low LVEF and complex small coronary artery lesions, PCI is a safe and effective method to lower the mortality rate of CHD patients with heart failure and improve the long-term patient prognosis.

[Effect of danhong injection on platelet activation and inflammatory factors in patients of acute coronary syndrome after intervention therapy].

OBJECTIVE: To explore the effect of Danhong Injection (DHI) on platelet activation and inflammatory factors in patients of acute coronary syndrome (ACS) after intervention therapy. METHODS: One hundred ACS patients were randomly assigned to the DHI group and the control group equally. Both were treated with the conventional treatment, including aspirin, clopidogrel, beta-receptor blocker, angiotensin converting enzyme inhibitor, etc. for 2 weeks after percutaneous coronary intervention (PCI), and to the patients in the DHI group, intravenous dripping of DHI was given simultaneously. Fasting venous blood of patients were collected before PCI and on the next morning of PCI to determine the platelet activation indices, expression of CD62p and receptor complex of glucose protein (GP) II b/III a by flow cytometry; plasma fibrinogen C (FIB-C) by scattering turbidimetry, and serum high-sensitivity C-reactive protein (hs-CRP) with emulsoid immuno-enhancing turbidimetric test kit. The outcomes were compared with those determined in 40 healthy persons for control. RESULTS: Serum levels of CD62p, GP II b/III a, FIB-C and hs-CRP in ACS patients were significantly higher than those in the healthy control (all P<0.01), and those were significantly higher after PCI than before PCI (P <0.05 or P<0.01). After being treated for 2 weeks, the 4 platelet activation indices were lowered to different extent in both groups, but the lowering in the DHI group was more significant than that in the control group (P<0.05). CONCLUSION: DHI can inhibit the platelet activation and inflammatory reaction in ACS patients after PCI.

[Effect of tetramethylpyrazine on platelet activation and vascular endothelial function in patients with acute coronary syndrome undergoing percutaneous coronary intervention].

OBJECTIVE: To explore the effect of tetramethylpyrazine (TMP) on platelet activation and vascular endothelial function after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). METHODS: Eighty patients with ACS were assigned to the TMP group (40 patients) and the control group (40 patients). Before and at the next day of PCI, patient's expressions of the indices of platelet activation CD62p, CD63 and glucose protein (GP) II b/III a were tested by flow cytometry, von Willebrand (vWF) by ELISA, endothelin-1 (ET-1) by RIA, and plasma content of nitrogen oxide (NO) were determined by enzyme reaction, at the same time, the flow-mediated dilatation (FMD) in brachial artery was measured as well using color Doppler. All the afore mentioned indexes were reexamined for comparing when patients in the TMP group received TMP treatment for 14 days. RESULTS: Before PCI blood levels of CD62p, CD63, GP II b/III a, vWF and ET-1 expression increased significantly (all P < 0.01), FMD and NO decreased significantly (P < 0.01) in ACS patients, as compared with those in the healthy control. After PCI, level of vWF increased significantly (P < 0.05), FMD decreased significantly (P < 0.05), while CD62p, CD63, GP II b/III a, ET-1 and NO changed insignificantly (P > 0.05). As compared with the control group, levels of CD62p, CD63, GP II b/III a, vWF and ET-1 decreased significantly (P < 0.05 or P < 0.01), FMD increased significantly (P < 0.05) in the TMP group. CONCLUSION: TMP can be useful for preventing and treating the intra-coronary thrombosis and protect the vascular endothelial function in patients undergoing PCI.

[Electrophysiologic study of the biphasic effects of cyclovirobuxine D on arrhythmias].

OBJECTIVE: To explore the possible mechanism of cyclovirobuxine D (CVB-D) in countering and inducing arrhythmia, by way of studying its electro-physiological effect on ventricular papillary muscles of rats in vitro. METHODS: The transmembrane potential of rat's isolated right ventricular papillary muscles were recorded using conventional glass micro-electrode technique. RESULTS: (1) CVB-D in concentration of 13.3-63.3 micromol/L, showed prolonging effect on the action potential repolarization time, mainly the action potential duration 50 (APD50), APD70 and APD90, in dose-dependent manner, in concentration of 33.3-63.3 micromol/L, it could inhibit the resting potential, action potential amplitude (APA) and maximum depolarization velocity (Vmax) in dose-dependent manner. (2) CVB-D also showed time-dependent effect, the effect initiated 10 min after 20 micromol/L was perfused in ventricular muscle, the APD50, APD70 and APD90 were potentiated gradually along with prolongation of action time and reached the peak at 30-40 min, without any potentiation thereafter. (3) CVB-D could markedly prolong the effective refractory period (ERP) of action potential, increase the ratio of ERP/APD. (4) CVB-D in concentration of 33.3 micromol/L could induce frequent, multifocal spontaneous arrhythmia in some cells when the action time was longer than 45 min. CONCLUSION: CVB-D has the action of anti-ventricular arrhythmia, the mechanism is correlated with the prolongation of APD and ERP of ventricular muscle as well as the increase of ERP/APD ratio, while it also has the effect of inducing arrhythmia, the mechanism might be concerned with excessive prolongation of APD and the inhibition on RP, APA and Vmax.

[Effect of adenosine on electrophysiological changes of ventricular myocardium in rats with experimental diabetes].

OBJECTIVE: To investigate the electrophysiological changes of ventricular myocardium of rats with experimental diabetes and the effect of adenosine on its electrophysiology. METHODS: Diabetes was induced in male SD rats, using a single injection of alloxan into tail vein. Untreated animals were used as controls. The electrocardiograms (ECG) were recorded 6 weeks after diabetes was induced. Effects of adenosine on ventricular myocardium in diabetic rats and controls were observed by measuring the transmembrane potentials with conventional glass microelectrodes. RESULTS: QT interval in ECG and action potential duration (APD) at all levels (APD30, APD50, APD70 and APD90) were significantly prolonged in right ventricular papillary muscle 6 week after diabetes was induced. No differences were observed in the resting membrane potential (RP), action potential amplitude (APA) and overshoot (OS) as well as the maximum rate of depolarization (Vmax) between the diabetic rats and control rats. At concentration of 10 approximately 400 micromol/L, ADO had little influence on all transmembrane potential parameters of right ventricular papillary muscle in diabetic rats and controls. At 500 micromol/L, ADO shortened APD30, APD50, APD70 and APD90 of control group, while having no effect on diabetic rats. CONCLUSION: QT interval in ECG and APD at all levels are significantly prolonged in right ventricular papillary muscle of experimentally induced-diabetic rats.