ApplicationofMRIinevaluationofcoronaryarteryandmyocardiallesionsinpatientswithKawasakidisease / 实用放射学杂志

Objective ToexplorethevalueofMRIinthediagnosisofcoronaryarteryandmyocardiallesionsinchildrenwithKawasaki disease.Methods CardiacMRIof38patientswithKawasakidiseasewereretrospectivelyanalyzed.MRIsequencesincludedthree dimensionalsteady-statefreeprecession (3D-SSFP)coronaryarteryimaging,first-passperfusiontoassessmyocardialischemia,late gadolinium-enhancedmagneticresonanceimaging(LGE-MRI)toassessmyocardialhistologyfeatures,and2D-SSFPcinesequenceto evaluatecardiacfunction.Themaximumdiametersofcoronaryaneurysmsmeasuredin3D-SSFPwerecomparedwiththosemeasured inechocardiography(ECHO)byBland-Altmananalysis.Results Amongthe38cases,therewere28cases(73.7%)withaneurysmal dilatationinrightcoronaryartery(RCA)orleftcoronaryartery (LCA).Thehighestincidenceofaneurysmaldilatationwasinleft anteriordescendingbranch (LAD)in23cases,andfollowedbyRCAin19cases.ThemaximumdiameterofRCAaneurysm (7.66± 2.10)mm washigherthanthatofLADaneurysm (6.11±1.96)mm withP＜0.05.Myocardialfirst-passperfusionin5casesshowed leftventricularandventricularseptumsubendocardialischemia,LGE-MRIin5casesshowedmyocardialdelayedenhancementinleft ventricularfreewallandventricularseptum,andtheleftventricularejectionfractionsin4caseswerelessthan50%,withanaverage of(34.0±15.9)%.3D-SSFPandECHOshowedgoodconsistencyinthemaximaldiametermeasurementofRCAandLADaneurysm. Conclusion TheimagingfeaturesindifferentsequencesofMRIcanbeusedtocomprehensivelyevaluatethecoronaryarteryand myocardialhistologicalcharacteristicsofKawasakidisease,includingcoronaryaneurysms,thrombosis,myocardialfibrosisandchanges ofventricularfunction.

Multicenter core laboratory comparison of the instantaneous wave-free ratio and resting Pd/Pa with fractional flow reserve: the RESOLVE study.

OBJECTIVES: This study sought to examine the diagnostic accuracy of the instantaneous wave-free ratio (iFR) and resting distal coronary artery pressure/aortic pressure (Pd/Pa) with respect to hyperemic fractional flow reserve (FFR) in a core laboratory-based multicenter collaborative study. BACKGROUND: FFR is an index of the severity of coronary stenosis that has been clinically validated in 3 prospective randomized trials. iFR and Pd/Pa are nonhyperemic pressure-derived indices of the severity of stenosis with discordant reports regarding their accuracy with respect to FFR. METHODS: iFR, resting Pd/Pa, and FFR were measured in 1,768 patients from 15 clinical sites. An independent physiology core laboratory performed blinded off-line analysis of all raw data. The primary objectives were to determine specific iFR and Pd/Pa thresholds with ≥90% accuracy in predicting ischemic versus nonischemic FFR (on the basis of an FFR cut point of 0.80) and the proportion of patients falling beyond those thresholds. RESULTS: Of 1,974 submitted lesions, 381 (19.3%) were excluded because of suboptimal acquisition, leaving 1,593 for final analysis. On receiver-operating characteristic analysis, the optimal iFR cut point for FFR ≤0.80 was 0.90 (C statistic: 0.81 [95% confidence interval: 0.79 to 0.83]; overall accuracy: 80.4%) and for Pd/Pa was 0.92 (C statistic: 0.82 [95% confidence interval: 0.80 to 0.84]; overall accuracy: 81.5%), with no significant difference between these resting measures. iFR and Pd/Pa had ≥90% accuracy to predict a positive or negative FFR in 64.9% (62.6% to 67.3%) and 48.3% (45.6% to 50.5%) of lesions, respectively. CONCLUSIONS: This comprehensive core laboratory analysis comparing iFR and Pd/Pa with FFR demonstrated an overall accuracy of ~80% for both nonhyperemic indices, which can be improved to ≥90% in a subset of lesions. Clinical outcome studies are required to determine whether the use of iFR or Pd/Pa might obviate the need for hyperemia in selected patients.

Enhanced homing of bone-marrow derived mesenchymal stem cells on rabbit myocardial ischemia by intravenous injection of mesenchymal stem cells under the mediation of diagnostic ultrasound and microbubbles / 中华超声影像学杂志

Objective To explore the targeting homing capacity of bone-marrow derived mesenchymal stem eells(MSCs) on rabbit myocardial ischemia by intravenous injection of MSCs under the mediation of diagnostic ultrasound and microbubble. Methods Density gradient centrifugation and adherent culture method were used in the isolation and cultivation of MSCs. MSCs were labeled with DAPI. Rabbit myocardial infarction(MI) models were builded by totally ligation of left anterior descending branch of coronary artery. DAPI labeled MSCs were implanted by intravenous injection with or without the mediation of diagnostic ultrasound and microbubbles. Forty-eight hours after cell transplantation, the hearts of MI rabbits were made of frozen section and observed under fluorescent microscope. The DAPI positive cells were counted in the MI and border area of rabbit heart and compared between two groups. Pathological changes of MI area were observed with HE staining under light microscope and transmission electronic microscope. Results The number of DAPI positive cells in MI and border area of rabbit in both groups were counted under fluorescent microscope. There were more DAPI positive cells in the MI area in ultrasound + microbubble + MSCs group (213.2±26.5) than that in the intravenous injection group (146.8±18.78, P<0.01). There were erythrocytes leaking out of the vessels in MI area in HE staining section under light microscope in ultrasound + microbubble + MSCs group while there were nearly none in the intravenous injection MSCs group. The intercellular space of endothelial cells of the vessels wall was increased and serum component leaked out of the vessel wall in ultrasound + microbubble + MSCs under transmission electronic microscope. Conclusions The targeted homing capacity of BM-MSCs in the MI area of rabbit heart can be enhanced under the mediation of diagnostic ultrasound and microbubbles.

Nocturnal myocardial ischemic events and sleep-disordered breathing in patients with coronary artery disease / 老年心脏病学杂志（英文版）

Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary angiography.Methods Eighty-two men and 14 women referred for consideration of coronary intervention were randomly selected. Observation by an overnight sleep monitor and Holter recording were performed to study sleep-disordered breathing (oxyhemoglobin desaturations≥4％ and apnea-hypopneas),heart rates, and ST-segment depressions (≥ 1mm, ≥1 min).Results Nocturnal ST-segment depressions occurred in 37 ％ of the patients. ST-segment depression within 2 min after an apnea-hypopnea or desaturation occurred in 17％ of the patients. This temporal association was seen in 21％ of the patients with nocturnal ST-segment depressions, more frequently in men (P＜0.05) and more frequently in those with severe disordered breathing (P＜0.05).Most of these ST-segment depressions were preceded by a series of breathing events: repeated apnea-hypopneas or desaturations or both in 73％ of the patients. Conclusions Episodes of nocturnal myocardial ischemia are common in patients with angina pectoris. A temporal relationship between sleep-disordered breathing and myocardial ischemia was present in some of our patients, and occurs more frequently in men and in those with severely disordered breathing. (J Geriatr Cardiol 2004;1(2):90-94.)

Therapeutic efficacy of puerarin in coronary heart disease patients with myocardial ischemia / 第二军医大学学报

Toassesstheeffectofpuerarinintreatingischemiacardiacdisease ,sixtycoronaryheartdisease(CHD) patientswith myocardialischemiawererandomlydividedinto 2 groups.Pueraringroup (30cases)wastreatedwithpuerarinpluswesternmedicine andcontrolgroup (30cases)withwesternmedicinealone .Thechangesofthetotalischemiaburden (TIB) ,ventricularpremature beat (VPB) ,heartrateandsystolicpressurelevelswereobservedbeforeandaftertreatmeat.Aftertreatmentwithpuerarinthe scoresofTIBlevelsweresignificantlydecreased (P 0 .0 5 ) .Thescoresofventricularprematurebeatlevelsweresignificantlydecreased (P