2009 Vol. 6, No. 2
Background and Objective Large randomized controlled trials have demonstrated that percutaneous coronary intervention (PCI) with the routine use of drug-eluting stents is safe and effective, however, the patients older than 75 years undergoing PCI are at increased risk for major adverse cardiac events, so that the patients are usually excluded from this trial. The aim of the present study was to assess the early clinical outcome and risk factors in old patients with acute ST elevation myocardial infarction (STEMI) following primary PCI. Methods We analyzed the outcome after stenting in 136 patients older than 60 years in our coronary care unit with acute STEMI, and the patients were further classified in 2 age groups: patients≥75 years and <75 years. Results Though the older group had a higher prevalence of adverse baseline characteristics and lower final TIMI flow than those of the younger, the procedural success had no difference between two groups. The main adverse clinical events (MACE) for the old group was a little higher comparing with the younger in 12-month following up. Conclusions Our study suggest that drug-eluting stent implantation in elderly patients with acute ST elevation myocardial infarction has high initial procedural success rates despite having more severe baseline risk characteristics, and to shorten the time form symptom onset to PCI and improve final TIMI flow strategy may decrease MACE among old patients following PCI
Objective Right ventricular outflow tract septum has become widely used us an electrode placement site. However, data concerning lead performances and complications for lead repositioning with this technique were scant. The purpose of this study was to observe longterm lead performances and complications of right ventricular outflow tract septal pacing and provide evidences for choosing an optimal electrode implantation site. Methods Thirty-six patients with septal active electrode implantation and 39 with apical passive electrode implantation were enrolled in this study. Pacing threshold, R-wave sensing, lead impedance, pacing QRS width and pacing-related complications for two groups at implantation and follow-up were compared. Results There were higher pacing threshold and shorter pacing QRS width at implantation in the septal group compared with the apical group. There were no differences between the septal and the apical groups in pacing threshold, R-wave sensitivity, lead impedance and pace-related complication during a follow-up. Conclusions Right ventricular outflow tract septum could be used as a first choice for implantation site because it had long-term stable lead performances and no serious complications compared with the traditional apical site.
Objective To investigate the relationships between vascular factors and plaque morphology in the patients with acute coronary syndrome(ACS). Methods Intravascular ultrasound(IVUS) was performed on 56 consecutively enrolled patients with ACS. Cytometric bead array for seven vascular factors(sPE,t-PA, MCP-1, IL-8,IL-6,sVCAM-1, and sCD40L) was measured by cytometry. The others biomarkers were tested by ELISA or biochemistry. Differences in bio-factors were compared between vulnerable plaque and non- vulnerable plaque groups, accte myocardial infarction (AMI) and ustable angina (UA) patients, and occurring plaque rupture. The relationship between the parameters of morphology and vascular factors was analyzed. Results There were positive correlations between sVCAM-1sPE, sVCAM-1-sCD40L, sCD40L-sPE, IL-6-IL8,IL8-MCP1, and MCP1-sVCAM-1；CRP (18.868±4.907mg/L vs 5.806±3.553 mg/L)and IL-6 (19.5 pg/ml [9.2 ~ 44.6 pg/ml]vs 5.3 pg/ml [2.3~13.4 pg/ml])were elevated in the vulnerable plaque group(P ＜0.05). sCD40L(473.82± 126.11 vs 237.94± 34.78 pg/ml),sPE(107.21±39.90 vs 49.06 ±5.61μg/L) and MCP-1(132.42 ± 17.85 vs 127.17±13.27 pg/ml) were increased in the plaque rupture group(P ＜0.05);There was correlation between tPA and plaque morphology(P ＜0.05). Increases in sCD40L, MCP-1, sPE, and TC were independent factors for plaque rupture. Conclusions IL-6 and CRP may be biomarkers for vulnerable plaque and for diagnosis of AMI. sCD40L,MCP-1 and sPE are potential markers when for plaque rupture patient present with severe ACS.
Objective To investigate the cause of high cardiovascular lethality in patients with diabetics mellitus. Methods Sections from autopsied coronary arteries and myocardium of dead patients with non-insulin-dependent diabetics mellitus and 12 dead control subjects were used for histomorphometric studies. Results The coronary atherosclerotic lesion in diabetics patients was not different in severity from those in controls. Nor was there difference in number of myofibers or diameters of myocardic fibers and capillaries. But the capillary density and the ratio of capillary number to myocardic fiber number in diabetics group were significantly reduced compared with control group(P<0.01),and the capillary basement membrane in the former was significantly thicker than in the latter(P<0.01).Conclusion The decrease in number of capillaries and the thickening of basement membrane enhance myocardiac vulnerability to further ischemia and hypoxia, which may undelie high lethality of myocardiopathy in diabetic patients.
Objective To evaluate the clinical therapeutic effects of trimetazidine on the treatment of unstable angina (UA) as well as its effects on endothelin-1 level and complications of patients. Methods One hundred and twenty patients with UA were randomized into the trimetazidine group (n =60) and the control group (n =60), the trimetazidine group was subjected to treatment with 60 mg trimetazidine everyday for six months plus conventional treatment, and the clinical symptoms, changes in electrocardiogram, changes in the number of plasma circulating endothelial cells (CEC) and endothelin-1 level of the two groups were observed after treatment for four weeks; and the incidence rates of cardiac arrhythmias, cardiac failure, hospitalization due to angina, myocardial infarction and sudden death were also observed after treatment for six months. Results 1) The total effective rate of integrative clinical therapeutic effects in the trimetazidine group and the control group after treatment for four weeks were 86.7% and 68.3%, respectively (P<0.05), and the excellence rates were 36.7% and 15% (P<0.01) respectively; the total effective rates for the therapeutic effects in electrocardiogram were 66.7% and 46.7%, respectively (P<0.05), and the excellence rates were 30.0% and 11.7%, respectively (P<0.01). 2) The number of plasma CEC and endothelin-1 level of the two groups after treatment for four weeks significantly decreased (P<0.05), but the decreases in the trimetazidine group were even significant (P<0.01). 3) The incidence rates for cardiac arrhythmia in the trimetazidine group and the control group after treatment for six months were 10% and 20% (P<0.05), respectively, and the incidence rates for cardiac failure were 8.3% and 18.3%, respectively (P<0.05), and the incidence rates for hospitalization due to angina were 10% and 15%, and the incident rates for myocardial infarction were 3.3% and 13.3% respectively (P<0.05). Conclusion Trimetazidine can significantly improve the symptoms of UA and myocardial ischemia, reduce the damages to blood vessel endothelium and complications, and improve the prognosis.
Objective To investigate the etiology and relative factors of dilated cardiomyopathy (DCM) in Chinese patients. Methods A case-control study was conducted to compare 233 patients with DCM in high-incidence areas (case group) and 150 patients with stable angina pectoris (control group). Life styles and history of diseases information was collected by questionaire; human anti-myocardial antibody IgG (AMA- IgG), human Coxsackie B virus IgG (CBV- IgG) and human adenovirus antibody IgG (ADV- IgG) were measured with ELISA. General chemical and toxicological indicators in drink water from high and low prevalence areas and serum trace elements also were compared. Results 1) Compared with the control group, the case group had more farmers (P < 0.01), with low average incomes (P < 0.01), higher alcohol consumption (P < 0.01) and higher incidence of the history of myocarditis (P < 0.01). 2) AMA-IgG, CBV-IgG and ADV-IgG levels were low and the positive rates of AMA-IgG, CBV-IgG and ADV-IgG of patients with DCM were respectively 7.78%, 6.67% and 6.67%, no statistical significance comparing with those in the control group. 3) The content of iron (1.36±2.18 vs 0.39±0.67 mg/L, P<0.05) and manganese (0.38±0.35 vs 0.15±0.14, P<0.01) in drinking water of high-incidence areas was significantly higher than that in low-incidence areas. 4) The content of serum iron (69.1±57.8 vs 20.0±17.5 μ mol/L, P<0.01) and copper (25.7±4.2 vs 19.7±4.5 μmol/L, P<0.01) in the case group evidently exceeded the normal range and obviously higher than that in the control group. Conclusions 1) The incidence of some DCM is related with low incomes, high alcohol consumption and myocarditis. 2) These data do not support that DCM is related with persistent virus infection and autoimmunization; 3) Iron and manganese contents exceeding standards in drinking water and the high content of serum iron and copper is comparatively related with the incidence of DCM.
Objective To understand the relationship between age and chronic complications in hospitalized aged patients with hypertension, to provide evidence for hypertension prevention and control. Methods To retrospectively analyze the clinical and laboratory data on 17,682 patients with essential hypertension during Jan 1st, 1993-Dec 12th, 2008 in PLA general hospital. Results 1) Among all of the inrolled cases, those aged 60-64 account for 27.87%，65-69 years group account for 26.55%, 70-74 years group accounted for 23.96%, 75-79 years group accounted for 14.14%, 80-84 years group accounted for 5.26%, 85-89 years group accounted for 1.69%, >90 years accounted for 0.41%. 2) The prevalence rate of chronic complications in 60-69 years group were 31.3-31.2% for diabetes and,22.6-27.0% for cerebrovascular disease，9.5-11.1% for myocardial infarction, 6.7-9.1% for heart failure, 5.8-6.0% for renal dysfanction 4.9-6.8% for atrial fibrillation, 0.1-0.3% for multiple organ dysfunction syndrome (MODS) in the elderly（P<0.05）. 3) The first four complications of hypertension were diabetes(33.5%), cerebrovascular disease (31.9%), myocardial infarction(13.2%) and heart failure(12.3%) in 70-74 years group（P<0.05）, cerebrovascular disease (42.8%) , diabetes (32.8%), heart failure (16.5%) and myocardial infarction(15.9%) in 75-79 years group（P<0.05）, cerebrovascular disease (45.4%), diabetes (35.0%), heart failure (21.1%) and myocardial infarction(15.9%) in 80-84 years group（P<0.05）, cerebrovascular disease(42.5%), diabetes (35.8%), heart failure (23.1%) and renal dysfanction (17.7%) in 85-89 years group(P<0.05）,and cerebrovascular disease (45.2%), heart failure(31.5%) , diabetes (26.0%) and renal dysfanction (20.5%) in patients more than 90 years group（P<0.05）. Conclusions The prevalence rate and kinds of chronic complications in hospitalized aged patients with hypertension were changed with the increasing age, and the first kind of complication is cerebrovascular disease. It is of more importance to prevent the occurrence of renal dysfanction and heart failure in those hypertension patients who were more than 80 years old.
Objective To prospectively evaluate the safety and therapeutic efficacy of dalteparin in patients with high risk non-STelevation acute coronary syndromes (ACS) during percutaneous coronary intervention (PCI). Methods A total of 175 patients with high risk non-ST-elevation ACS were randomly assigned to 2 groups [dalteparin group and unfractionated heparin (UFH) group]. The patients in dalteparin group were given dalteparin at a dose of 5,000U subcutaneously soon after diagnosis and then an additional 60U/kg intravenous bolus of dalteparin before emergent PCI. Vascular access sheaths were removed immediately after PCI or coronary artery angiography; the patients in UFH group were given UFH intravenously at a dose of 25mg just before PCI and an additional 65mg bolus was administered if angiographic findings showed that the patients were suitable for percutaneous transluminal coronary angioplasty (PTCA). Sheaths were removed at 4-6 hours after PCI; Results Eighty-three patients in dalteparin group underwent PCI while 82 patients in UFH group underwent PCI; anti-Xa activities of 52 patients in dalteparin group were measured. The average anti-Xa activity was (0. 83 ± 0. 26) U/ ml at 15 minutes after intravenous injection of dalteparin and anti-Xa>0.5U/ml was obtained in 96.1% of the patients; hematomas at puncture sites were significantly fewer in dalteparin group as compared with UFH group (2. 3% vs 9. 2% , P< 0. 05); none of the patients in 2 groups suffered major bleeding events. No death, acute arterial reocclusion or emergent revascularization events occurred at 30 days after PCI. Conclusions Our study demonstrated that early subcutaneous injection of dalteparin at a dose 5,000U after diagnosis and an additional 60U/kg intravenous bolus of dalteparin before PCI is safe and efficacious for patients with high risk non-ST-elevation ACS undergoing emergent PCI.
Background and Objective Hyperlipidemia is one of the most potent and best substantiated risk factors for coronary heart disease (CHD). Purified Salvia miltiorrhiza extract (PSME) had been shown to have hypolipidemic effect in animal experiments. This study aimed to evaluate its lipids modulating effects in hyperlipidemic patients. Methods In this single-blind, placebo controlled study, lipid profiles of 80 hyperlipidemic patients were checked at same conditions. They were divided into two equal groups randomly (each composing of 40 patients). They were given PSME tablet (800 mg) three times per day, or placebo tablet. All patients were put on NCEP type Ⅱ diet and six weeks later, lipid profiles were checked. Results In PSME group, total cholesterol decreased by 27.32mg/dl (12.3% reduction), LDL-cholesterol decreased by 23.13 mg/dl (16.8% reduction) and HDL-cholesterol increased by 9.06 mg/dl(11.1%), all were statistically significant. Although triglyceride dropped by 12.12 mg/dl (5.1%) but this was not significant statistically (P=0.34). There were no significant changes of lipids levels in the placebo group. Conclusions PSME has significant favorable effect on total cholesterol, LDL-cholesterol, and HDL-cholesterol and may be a potential agent for the treatment of atherogenic dyslipidemia.
Abstract Hyperglycemia has been identified as one of the important factors involved in the microvascular complications of diabetes, and has been related to increased cardiovascular mortality. Endothelial damage and dysfunction result from diabetes; therefore, the aim of this study was to determine the response of endothelial cells to stressful stimuli, modelled in normal and high glucose concentrations in vitro. EAhy 926 endothelial cells were cultured in 5 mmol/L or 30 mmol/L glucose conditions for a 24 hour period and oxidative stress was induced by exposure to hydrogen peroxide (H2O2) or tumour necrosis factor- α (TNF- α), following which the protective effect of the glucocorticoid dexamethasone was assessed. Apoptosis, necrosis and cell viability were determined using an ELISA for DNA fragmentation, an enzymatic lactate dehydrogenase assay and an MTT assay, respectively. High glucose significantly increased the susceptibility of EAhy 926 cells to apoptosis in the presence of 500 μmol/L H2O2 , above that induced in normal glucose (P<0.02). A reduction of H2O2- and TNF-α-induced apoptosis occurred in both high and low glucose after treatment with dexamethasone (P<0.05). Conclusion high glucose is effective in significantly augmenting stress caused by H2O2, but not in causing stress alone. These findings suggest a mechanism by which short term hyperglycemia may facilitate and augment endothelial damage.
Objective p38 Mitogen-activated protein kinase (MAPK) is a crossing center of various pathways. In this study, protein transduction system based on human immunodeficiency virus (HIV)-1 transactivator of transcription (TAT), which is an efficient delivery peptide of the foreign proteins into cells, was employed to study p38 MAPK functions in eukaryotic cells. Methods p38 And its dominant negative form, p38AF, were constructed into pET-His-TAT vector correctly to verify that the recombinant plasmids were well-founded through restriction enzyme digestion and DNA sequencing. The two proteins, His-TAT-p38 and His-TAT-p38AF, were expressed and purified in Escherichia coli by SDS-PAGE. Then they were incubated with ECV304 cells respectively and readily transduced into cells in a time-dependent and dose-dependent manner. The cells were stimulated by sorbitol. Activating transcription factor (ATF) 2 phosphorylation level was checked using Western blot to assess the activity of endogenous p38. Results Compared with controls, it was found that His-TAT-p38 increased the level of ATF2 phosphorylation in sorbitol-stimulated ECV304 cells, while His-TAT-p38AF inhibited it, indicating p38 MAPK protein delivery system based on TAT was constructed successfully. TAT-p38 and its dominant negative form possessed high biological activity after transduction into ECV304 cells by TAT protein delivery system. The results showed that p38AF fused with TAT could inhibit the transduction of endogenous p38 signal pathway in part, and other pathway might regulate p38 phosphorylation. Conclusions Our study provides a novel pathway to inhibit p38 signal pathway and establish a new method to study p38 function.
Objective To investigate the effects of amiodarone (AMD) on simvastatin (SV) in human liver microsomes and the possible underlying mechanisms. Methods Time-, NADPH- and concentration-dependent inhibitions were tested in HLM. The logarithm of relative inhibition values was plotted versus preincubation time (0, 5, 10, 15, 20min) for a series concentration of AMD used (0, 2, 5, 25, 50μmol/L), and the slopes determined by linear regression. These slope values represente the observed inactivation rate constants (kobs). A double-reciprocal plot was then constructed using the reciprocal of the kobs (y-axis) and the reciprocal of the associated inhibitor concentration (x-axis) to estimate the values of kinact and KI, which were two principal kinetic constants that were specific for mechanism-based inhibition (MBI).drug-drug interactions (DDI) potential was predicted based on in vitro data and by using the in vitro-in vivo extrapolation. Results The time-, concentration- and NADPH-dependent characteristics confirmed that when SV was the substrate of CYP3A4, the inhibition of AMD to CYP3A4 is MBI. KI and kinact value were calculated to be 5.1μmol/L and 0.018min-1. The CLint of SV was reduced 2.96-5.63 fold when it was administrated with AMD. Conclusion Based on the results, AMD would inhibit SV metabolism via the mechanism-based manner, which would lead to DDI when they are taken together. Careful clinical observation is recommended when AMD and SV have to be simultaneously prescribed.
Abstract Prevalence of dislipidemia is increasing rapidly in China and there has been a growing interest in Chinese herbal medicine for the treatment of hyperlipidemia both inside and outside China. In this article, lipids regulating effects of 9 herbs or their extracts and 5 herbal formulae which have been published in English-language literature are reviewed. Although evidence from animals and humans consistently supports the therapeutic activities of these Chinese herbal medicines, few multi-center large-scale clinical trials have been conducted to confirm the efficacy and evaluate their safety.