Clinical features of the fulminant myocarditis / 中华全科医师杂志

Objective To review the clinical features of fulminant myocartitis,in order to provide assistance to the clinical management.Methods The clinic data of 183 patients with viral myocarditis,including 153 cases of acute myocarditis and 30 cases of fulminant myocarditis admitted in our hospital during January 2008 and Dec 2012 were retrospectively analyzed.The age of onset,interval after virus infect,initial symptoms,auxiliary examination,treatment,and turnover were compared in the study.Results The average onset age of fulminant myocartitis and acute myocarditis were similar [(22.3 ± 7.6) vs.(26.2 ± 12.6) years,P =0.105 5].There was a significant difference between the two gourps in the rate of patients with a explicit history of virus infection [30.0％ (9/30) vs.78.4％ (120/153),x2 =28.3,P ＜0.001],the average interval after virus infect [(3.1 ±2.2) vs.(7.0 ±3.80) d,P＜0.001] and the length of hospital stay [(12.1 ± 6.9) vs.(6.9 ± 4.50) d,P ＜ 0.001].Chest congestion (101/153,66.0％),feebleness (76/153,49.7％),fluster (74/153,48.4％) are the most onset symptoms of acute myocarditis,while chest congestion (24/30,80.0％),shortness of breath (14/30,46.7％),feebleness (13/30,43.3％) in flunimant myocarditis.Advanced A-V block (19/30,63.3％),cardiogenic shock (18/30,60.0％),ventricular arrhythmia(16/30,53.3％),Adams-Stokes syndrome(8/30,26.67％) and acute renal failure (8/30,26.7％) were the most complications of flunimant myocarditis.Temporary pacemaker (11 cases),extracorporeal memberane exygenator (7 cases) and intra-aortic balloon pump (7 cases) were applied in critical patients.In acute phase,21 cases were cured,9 cases was dead of cardiogenic shock and ventricular(27,30.0％).Two dead cases applied with ECMO because of delay.After leaving hospital,1 case was implanted permanent pacemaker,2 cases became chronic myocarditis and required hospitalization repeatedly.Conclusions The fulminant myocarditis has a rapid onset,most of which has no prodrome of virus infection or a shorter interval than acute myocarditis.Timely and effective mechanical circulatory support is critical for fulminant myocarditis.

Efficacy and safety of short-term intensive statin therapy in patients with acute coronary syndrome / 中华全科医师杂志

Objective To evaluate the clinical efficacy and safety of short-term intensive statin therapy in patients with acute coronary syndrome ( ACS) .Methods A total of 218 ACS patients admitted in Hangzhou First People′s Hospital from March 2013 to July 2013 were enrolled into this study .The patients were randomly assigned to receive atorvastatin 80 mg/d during hospitalization , and 40 mg/night after discharge for one month ( intensive group , n=107 );or receive atorvastin 20 mg during hospitalization and 20 mg/night after discharge for one month ( control group, n =111 ).The biochemical indexes were measured on the admission and after one-month treatment.Results After one-month treatment, the total cholesterol, triglycerides and LDL cholesterol of intensive group were significantly lower , and the high density lipoprotein cholesterol was higher than baseline values ( 0.75 ±0.14 ) mmol/L vs.( 1.52 ±0.88 ) mmol/L, P<0.05;(2.21 ±0.78)mmol/L vs.(4.55 ±1.12)mmol/L, P<0.05;(1.76 ±0.31)mmol/L vs.(2.23 ±0.77) mmol/L, P<0.05; (1.15 ±0.34) vs.(1.52 ±0.41) mmol/L, P<0.05.The liver enzymes creatine kinase in intensive group was not significantly changed , but the creatinine levels decreased (82.53 ±23.85)μmol/L vs.(57.81 ±15.27) μmol/L, P<0.05, and the blood homocysteine and ultra-sensitivity C-reactive protein levels also decreased compared with the baseline ( 10.52 ±4.66 ) mmol/L vs.(30.70 ±18.82 ) mmol/L, P <0.05;( 8.06 ±2.68 ) mg/L vs.( 19.75 ±11.91 ) mg/L, P <0.05. Conclusions Short-term intensive statin therapy can effectively reduce blood lipid , cholesterol and homocysteine levels and raise HDL cholesterol levels; also with its anti-inflammatory and renal protective effect the therapy can provide more clinical benefit for patients with ACS .

Expression of miR-126 and miR-508-5p in endothelial progenitor cells is associated with the prognosis of chronic heart failure patients.

BACKGROUND: MicroRNA (miRNA) expression profiles in endothelial progenitor cells (EPCs) contribute to EPC dysfunction in patients suffering from coronary artery disease. However, it remains unclear whether miRNA expression in EPCs is associated with the prognosis of chronic heart failure (CHF) secondary to ischemic cardiomyopathy (ICM) or non-ischemic cardiomyopathy (NICM). METHODS AND RESULTS: One hundred six patients with CHF (55 ICM and 51 NICM) and 30 healthy controls were followed until the end of 24 months or when the end point was obtained (cardiovascular death). The miRNA expression profile was analyzed by TaqMan Human MicroRNA Array Set v2.0 in 30 randomly assigned samples (ICM=10, NICM=10, and healthy controls=10). During the 24-month follow-up, 26 patients died from cardiovascular disease. Sixteen miRNAs (miR-126, miR-508-5p, miR-34a, miR-210, miR-490-3p, miR-513-5p, miR-517c, miR-518e, miR-589, miR-220c, miR-200a*, miR-186*, miR-7i*, miR-200b*, miR-595, and miR-662) were found to be differentially expressed between ICM and NICM patients. Survival analysis showed that miR-126 and miR-508-5p levels in EPCs were independent prognostic factors (P=0.003; HR (hazard ratio): 0.19; 95% CI (confidence intervals): 0.06-0.58, P=0.002; HR: 2.292; 95% CI: 1.37-3.84) for the outcome of ICM or NICM patients with CHF. Pathway enrichment analysis showed that the angiogenesis pathway was the most likely pathway regulated by miR-126 and miR-508-5p. CONCLUSIONS: The miRNAs miR-126 and miR-508-5p are associated with the outcome of ICM and NICM patients with CHF. These two miRNAs could be useful in the diagnosis of CHF patients, and might provide novel targets for prevention and treatment of CHF.

N-terminal prohormone B-type natriuretic peptide and cardiovascular risk in stable coronary artery disease: a meta-analysis of nine prospective studies.

To evaluate the prognostic value of N-terminal prohormone B-type natriuretic peptide (NT-proBNP) for patients with stable coronary artery disease, we searched for all published English-language articles indexed in MEDLINE and PubMed through July 2011. Nine independent, prospective, cohort studies that assessed the association between NT-proBNP value and long-term prognosis were identified. The interested endpoints of this meta-analysis were all-cause mortality and cardiovascular mortality and cardiovascular events. A general variance-based method was used to pool the hazard ratio (HR). In a comparison of individuals in the top quartile with those in the bottom quartile of baseline values of NT-proBNP, the combined adjusted HR was 2.74 (95% confidence interval [CI], 1.85-3.62). The combined HRs for the second and third quartiles compared with the first quartile were 1.33 (95% CI, 0.83-1.82) and 1.85 (95% CI, 1.23-2.48), respectively. In a subanalysis grouped by the median value, per 1 standard deviation increase or per 1000 pg/mL increase of NT-proBNP, the overall effect also showed that poor prognosis was significantly increased with the elevation of NT-proBNP (HR, 1.58; 95% CI, 1.16-2.01). Available prospective studies indicated strong associations between the circulating concentration of NT-proBNP and long-term prognosis in patients with stable coronary artery disease.

N-terminal pro-B-type natriuretic peptide is associated with severity of the coronary lesions in unstable angina patients with preserved left ventricular function.

OBJECTIVES: To evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) values and the severity of coronary lesions at angiography in unstable angina patients with preserved left ventricular function. METHODS: A total of 133 patients with primary diagnosis of unstable angina were enrolled into this study. NT-proBNP level was determined before the angiography and Gensini score, a measurement of extent of myocardial ischemia, was calculated after the angiography by experienced cardiologists. Patients with >50% stenosis of the left main or 75% stenosis of one or more coronary branches with diameter >2 mm were defined as "angiography positive" and turned to percutaneous coronary intervention. RESULTS: There was a significant difference of circulating NT-proBNP level between the angiography positive and negative groups and the median NT-proBNP values were 367.5 pg/mL and 112 pg/mL, respectively (P < 0.001). A significant correlation was observed between log NT-proBNP and log Gensini score (P < 0.001). NT-proBNP level was a predictor of angiography positive result and the area under the receiver operating characteristic curve was 0.776 (95% CI 0.693-0.858). CONCLUSIONS: NT-proBNP level was found to be higher with the severity of myocardial ischemia. However, the ability of NT-proBNP to identify clinically significant angiographic lesions was moderate.

The immediate hemodynamic effects of intercoronary ischemic preconditioning on the coronary perfusion pressure and fractional flow reserve / 中国综合临床

Objective To observe the immediate hemodynamic effects of the intercoronary ischemic preconditioning on the coronary perfusion pressure.Methods The observational study recruited 17 patients who were hospitalized for stable coronary disease and had severe stenosis lesions (70％ ～ 85％ ) in one or two vessels per coronary angiography.They were randomized into ICPC ( n =8 ) group ( receiving two cycles of 1-min balloon inflation and 5-min reperfusion) and control group (n =9).Before interventional treatment,the ICPC group was given 2 cycles of intercomary ischemic preconditioning.The occlusive and non-occlusive pressures proximal and distal to the stenosis were collected before and after ICPC.Fractional flow reserve (FFR) was calculated upon the following equation:FFR =Pd/Pa ( Pa:hyperemic mean aortic pressure,Pd:hyperemic coronary pressure distal to the stenosis).Results Before and after ischemic preconditioning,coronary wedge pressure and FFR of ICPC group were significantly increased ( coronary wedge pressure was from [ 22.08 ± 19.14 ]mm Hg to [25.46 ±19.04]mm Hg,P=0.011;FFR.was from [70.30±16.05]％ to [77.53 ±13.42]％,P=0.001).The collateral flow was increased significantly.Coronary wedge pressure and FFR of control group did not improved obviously.There were significant differences in FFRs and coronary wedge pressures between ICPC and control groups.Conclusion Coronary ischemic preconditioning can improve coronary perfusion pressure,and rapidly increase the coronary pressure distal to the severe stenosis lesions.

Diagnostic value of serum ischemia modified albumin in coronary artery disease / 中华全科医师杂志

Objective To assess value of serum level of ischemia modified albumin (IMA) in diagnosis for myocardial ischemia of coronary artery disease (CAD). Methods Seventy-two patients with clinically suspected myocardial ischemia of CAD admitted to The First People's Hospital of Hangzhou during November 2009 to May 2010 ready for undergoing coronary angiography, the gold standard for diagnosis of CAD, were randomly selected for the study. The patients were divided into CAD and non-CAD groups based on their coronary angiography. Serum level of IMA was determined with cobalt-albumin binding ( ACB) assay before coronary angiography, which served as diagnostic standard for CAD. Logistic regression analysis method was used to evaluate varied levels of IMA with area under the receiver operating characteristic curve (AUCROC) in diagnosis for myocardial ischemia of CAD. Results Mean level of IMA was (97 ±24) U/ml and (81 ±15) U/ml for CAD group (n =51) and non-CAD group (n =21), respectively. Sensitivity and specificity of a cut-off value of IMA 83.69 U/ml in diagnosis for myocardial ischemia of CAD was 80 percent and 57 percent, respectively, with a predictive value of a positive test 82 percent and that of a negative test 55 percent, respectively, from AUCROC. Logistic regression analysis demonstrated that both hypertension (P=0. 022, 6 = 1.421, OR=4. 141) and level of IMA (P=0.003, b= 1.780, OR=5.928) were independent predictors for CAD. Conclusions Sensitivity, specificity and predictive value of a positive test of the level of IMA are relatively high in diagnosis for myocardial ischemia of CAD, which is an independent predictor of it.

Diagnostic value of cardiopulmonary exercise test for coronary heart disease / 中华全科医师杂志

Cardiopulmonary exercise test and electrocardiogram exercise test were performed in 68 patients with suspected coronary artery disease,the diagnostic value of two tests was compared with coronary angiography results as the gold standard.The results show that the sensitivity,specificity,positive predictive value and negative predictive value of electrocardiogram exercise test for coronary heart disease were 51.28％,68.97％,68.97％ and 51.28％ respectively; those for ratio of O2 pulse peak in cardiopulmonary exercise test were 51.28％,75.86％,74.07％ and 53.66％ respectively.It suggests that the results of cardiopulmonary exercise test may have the same value as electrocardiogram exercise test in diagnosis of coronary artery disease.

Study of long-term safety and efficacy of domestic Firebird rapamycin-eluting stent / 中华老年医学杂志

Objective To evaluate the long-term safety and efficacy of domestic Firebird rapamycin-eluting stent in treatment of patients with coronary artery disease (CAD). Methods The 465 patients with CAD received percutaneous interventional therapy with domestic Firebird or imported Cypher rapamycin-eluting stent based on patients' will and they were followed up for more than 24 months. Results The 321 cases in Firebird group were followed up for (45.3 ±11.1)months, with 166 cases (51.7%) received reexamination by coronary angiography. The 144 patients in Cypher group were followed up for (46.1 ± 12. 1) months, with 82 patients (56.3%) received reexamination by coronary angiography. At the termination of follow-up, there were no significant differences in all-cause death (7.8% vs. 7.6 %, x2 = 1.32, P = 0. 250), cardiac death (5.9% vs.5.6%, x2 =0. 02, P=0. 877), acute myocardial infarction (2.8% vs. 3.4%, x2 =0. 15, P=0. 697),cardiovascular-cause rehospitalization (29.6% vs. 31.9 %, x2 =0.26, P=0. 610), acute and subacute thrombosis events (0.9% vs. 1.3%, x2 =0.19, P=0.661), late thrombotic events (1.2% vs.1.3%, x2 =0. 02, P=0. 900) and target lesion revascularization (3.4% vs. 4.2%, x2 =0. 15, P=0. 694) between two groups. Conclusions Domestic Firebird rapamycin-eluting stent has the same or similar long-term safety and efficacy with imported Cypher rapamycin-eluting stent.

Effect of the plasma interleukin- 1β level on prognosis of patients with ST-segment elevation acute myocardial infarction / 中华急诊医学杂志

Objective Atherosclerosis is widely accepted as a chronic inflammatory disease. Serum biomarkers for vulnerable plaques not only serve as diagnostic tools for the identification of patients with acute coro-nary syndrome, but also assist the identification of high-risk patients. However, the existing data are limited and conflicting. In the present study, we determined whether the plasma levels of interleukin-1β (IL-1β) are correlated with adverse cardiac outcomes in patients with ST-evaluate acute myocardial infarction (STEAMI) undergoing pri-mary percutaneous coronary intervention (PCI). Effect of the plasma intedeukin-1β level on prognosis of patients with ST-segment elevation acute myocardial infarction. Method This prospective single-center study included 96 patients with SIEAMI with onset < 12 h who underwent primary PCI, 271 patients with stable angina pectoris (SAP) and 148 control subjects without coronary artery disease who were consecutively admitted to hospital be-tween Mar, 2006 and Mar, 2008. Plasma IL-1β levels were measured by enzyme-linked immunosorbent assay in all subjects. The patients with STEAMI were then followed prospectively for the occurrence of major adverse car-diac events (MACE) (including cardiovascular death, non-fatal myocardial infarction, heart failure, and cardio-genie shock) during hospitalization. We determined the association between IL-1β levels with the risk of MACE using multivariate logistic regression. Results Compared with the SAP patients and control subjects, patients with STEAMI had higher levels of IL-1β (P < 0.05). During hospitalization, 32 patients (33.3%) experienced MACE [23 males, 9 females; age: (75.44±13.45) years]. In the STEAMI patients, IL-1β was elevated in patients with MACE compared with patients without MACE (median [range]: 26.52 [12.010 to 155.244] pg/mL vs 2.157 [0.433 to 83.021] pg/mL; P < 0.01) by non-parameter analysis. Significant and positive correlations be-tween IL-1β and cardiac troponin-I (cTnI) (r = 0.353, P =0.004) were observed by Spearman's correlations analysis. Multivariate logistic regression analysis revealed that IL-1β levels ≥20 pg/mL were significantly and in-dependently associated with MACE during hospitalization (odds ratio: 32.05; 95% confidence interval: 4.28 to 240.151; P =0.001). Conclusions The present study revealed that patients with STEAMI had elevated IL-1β levels on admission. The plasma IL- 1β level is an independent inflammatory predictor for in-hospital MACE in pa-tients with STEAMI undergoing percutaneous coronary intervention.

Effect of ultrasound guided thrombin injection for treatment of femoral arterial pseudoaneurysm / 中国介入心脏病学杂志

Objective To evaluate the effect and safety of ultrasound-guided percutaneous thrombin injection for the treatment of postcatheterization femoral arterial pseudoaneurysm.Methods Seventy-eight patients with femoral anterial pseudoaneurysm were included in this study.Pseudoaneurysms were treated by bedside compression in 50 of these 78 patients(group A),and by thrombin injection in 28 patients(group B).All patients were diagnosed by GE LOGIQ 9 Color Doppler Ultrasound.Ultrasound guided thrombin injection for femoral arterial pseudoaneurysme were carried out in patients in group B.Results Closure of the pseudoaneurysm was successfully in 82 percent(41/50) of the patients in group A.Six patients had vagus reflex,4 patients could not tolerate repeating compression and 5 patients were not effectively cured by compression and needed to receive remedial ultrasound-guided percutaneous thrombin injection.Closure of the pssudoareurysm by percutaneous thrombin injection was successful in all patients in group B.Successful immediate closure were noted in 25 patients and 2 patients needed second thrombin injection.One patient had vasovagal syncope and 12 patients had mild fever.No distal embolization,infection,hemorrhage or allergic reaction occurred.Conclusion Compared to compression therapy for treatment of femoral arterial pseudoaneurysme,ultrasound-guided percutaneous thrombin injection is a simple,safe and effective treatment alternative.

Effect of unfractioned heparin and low molecular weight heparin on expression of plasma hepatocyte growth factor in patients with unstable angina pectoris who undergo percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To investigate the effect of unfractioned heparin and low molecular weight heparin on expression of plasma hepatocyte growth factor(HGF)during percutaneous coronary intervention(PCI).Methods Seventy four patients with unstable angina pectoris were classfied into unfractioned heparin(UFH)group(n=49)and low molecular weight heparin(LMWH)group(n=25)according to the type of heparin used during PCI.The plasma levels of HGF were measured before,during,and after PCI in the patients.Results The plasma levels of HGF before procedure were of no statistical difference between the two groups.The levels of HGF were significantly increased during and after PCI in the unfractioned heparin and the LMWH group.Comparing with the pre-procedure level,the post-procedure level of HGF in the UFH group was 13 565.60?3 768.99 ng/L(vs 1 736.09?603.95 ng/L,P

Correlation of angiographic coronary atherosclerosis findings with plasma levels of von willebrand factor and ?-granule membrane protein / 介入放射学杂志

Objective To investigate the angiographic coronary atheroslerosis findings with the plasma levels of von Willebrand factor (vWF) and ?-granule membrane protein (GMP-140). Methods 74 patients undergone selectrive coronary angiography (CAG) were divided into 3 groups based on plaque morphology, Group S(n=15), concentric or eccentric stenosis with smooth borders; Group C(n=37), eccentric stenosis with complex borders; Group N (n=22), CAG without coronary atheroslerosis. 37 patients in group C were divided into group Ⅰ (n=10, one-vessel involved CAD), group Ⅱ (n=12, two-vessel involved CAD) and group Ⅲ (n=15, three-vessel involved CAD) based on major epicardial coronary branches lesion. These 37 patients were divided into group x(n=21, ≤3 segments) and group y(n=16,≥4 segments) based on coronry stenotic segments. The plasma levels of vWF and GMP-140 were assayed by ELISA before angiography. Results (1)The plasma levels of vWF and GMP-140 in group C were significantly higher than those in group S(P