Objective To evaluate the application of multi-slice CT angiography(MSCTA) in cerebral vascular diseases.Methods 16-slice spiral CT angiography of 32 patients which clinically suspected cerebrovascular diseases were analyzed retrospectively.Source images were processed by GE Lightspeed CT Scanner;all axial images were transferred to an external workstation.The reconstructed images were processed VR,MPR,MIP in working-station.Results 10 of the 32 patients were normal, 17 were aneurysms,could be clearly displayed with the source, size,and neck width.3 were AVM,the location and scope could be observed.2 were vaso-occlusive.Conclusion Multislice spiral CT angiography is a safe ,quick and noninvasive method in diagnosing the cerebrovascular disease,it may be proposed as a first choice technique for screening and preoperative assessment for cerebrovascular disease.CTA is a valuable diagnostic method for various intracranial cerebral disease.

Objective To evaluate the immediate impact of radiofrequencycatheter ablation on left atrial (LA)volumes and function by velocity vector imaging(ⅤⅥ)and compare the LA function with and without atrial fibrillation after the operation.Methods Ten consecutive patients with paroxysmal AF were studied at baseline and within 3 days after ablation.Ten consecutive patients with persistent AF were studied within 3 days after ablation,in sinus rhythm.Ten patients with normal ventricular function were included in the study.ⅤⅥ was performed to assess LA sizes and strain,strain rate,velocity of the septum,lateral wall and the atrial roof from the apical four-chamber view.Results In patients with paroxysmal AF,global and regioal LA function was not significantly impaired after the ablation procedure.Subgroup analysis demonstrated that there were no significant difference in LA function betwwen patients with paroxysmal AF and control subjects,but the indexed LAVmax was significantly larger in all AF patients compared with control subjects.The global function of LA,including LAEF,LAaEF and LA expansion index significantly decreased in persistent AF patients.By contrast,the LA septal strain,velocity and lateral strain were lower than controls.Conclusions Radiofrequency catheter ablation has no influence on LA function assessed by ⅤⅥ within three days after the operation for patients with paroxysmaI AF.The function of persistent AF patients is absolutely lower than control subjects.

ObjectiveTo study the cardioprotective effects of ischemic post-conditioning on elderly patients with ST-elevation acute myocardial infarction (STEM1).MethodsConsecutive 215 patients with STEMI undergoing emergency percutaneous coronary intervention(PCI) were randomly assignedto receive ischemicpost-conditioningorconventional PCItreatment.The ischemic postconditioning (n=38) were conducted by 3 episodes of 30-second occlusion followed by 30-second reperfusion, while the control group (n= 46) was without any intervention after PCI.Reperfusion arrhythmias, corrected TIMI frame count (cTFC) and TIMI myocardial perfusion grade (TMPG)were compared between the two groups, respectively.Results The incidence of reperfusion arrythmias was less frequent in ischemic postconditioning group (21.1％ ,8/38) than in control group (45.7％ ,21/46) after PCI (x2 = 5.571, P＜0.05). The TIMI grade 3 flow was similar between two groups [(94.7％(36/38) vs. 82.6％( 38/46), x2= 2.919, P＞0.05], the cTFC levels (23.6±3.7vs. 26.1 ±5.9) and TMPG 3 perfusion [ 89.5％ (34/38) vs.69.6％ (32/46)] were significantly different (t= 5.434, P＜0.05; x2 = 4.899, P＜0.05, respectively) between two groups.ConclusionsIschemic postconditioning may reduce myocardial reperfusion injury in elderly patients with STEMI undergoing emergent PCI.

Aim To study the effects of telmisartan upon serum calcineurin.Methods 92 male SD rats with the same age were randomly divided into control group (N), sham operation group (S), 2K1C+distilled water group (K) and 2K1C+telmisartan group (T).S rats were performed the open-abdomen surgery without being restricted any renal artery, but the K and the T rats were restricted their left renal artery. Beginning from the third week after the surgery, the K rats started to be treated with the intragastric infusion of distilled water 10 ml·(kg·d)~(-1) , while the T rats with telmisartan 10 mg·(kg·d)~(-1) .And after being treated for 2, 4 and 8 weeks, rats were respectively measured the systolic blood pressure (SBP), the diastolic blood pressure (DBP) of the abdominal aorta. Before and after the operation, ultrasonography with probe of 7.5 MHz was used to obtain the structure and functional indexes, such as IVSd, IVSs, LVPWd, and serum calcineurin were evaluated by ELISA and colorimetric assay kit.Result Compared with the S group and the N group, ① the results of blood pressure (SBP, DBP) were significantly higher in K group (all P <0.01), after use of telmisartan, blood pressure was significantly reduced(P <0.01);② the thickness of interventricular septal and left ventricular posterior wall at the end of diastolic and systolic were significantly higher in K group (all P <0.01), after use of telmisartan, the thickness of those declined(all P <0.01);③ the level and activity of serum calcineurin were significantly higher in K group (all P <0.01), after use of telmisartan, the level and activity of calcineurin significantly fell(P <0.01).Conclusion The serum calcineurin of artery was also raised in the left ventricular remodeling. Telmisartan ameliorates ventricular remodeling effectively, which may be associated with decreasing the expression of artery serum calcineurin.

Objective To explore the curative effect of tirofiban treatment on high-risk acute coronary syndromes (ACS) in elderly patients receiving an early percutaneous coronary intervention (PCI) treatment. Methods The 162 elderly cases including unstable angina pectoris and non-ST -segment elevation myocardial infarction (NSTEMI) undergoing early PCI were enrolled in this study.And they were assigned to early treatment group (n=82) and deferred selective group (n=80)according to the time of using tirofiban (Gp Ⅱ b/Ⅲ a inhibitor) treatment. The effectiveness of either strategic option on tissue-level perfusion was evaluated using the TIMI myocardial perfusion grade (TMPG) before and immediately after PCI. The corrected TIMI frame count (cTFC) was also used to assess coronary artery flow and myocardial perfusion. Bleeding complications and the composite end point events at 30 days were also evaluated. Results Of all the 162 patients, the TMPG 0-1 perfusion was observed in 65 patients (40.1%). The TMPG 0-1 perfusion was significantly less frequent in early treatment group (32.9%) than in deferred selective group (47.5%) before PCI (x2=3.58, P＜0.05); while the results of TIMI grade 0-1 flow (26.8% vs. 25.0%) and cTFC levels (34.2±11.8 vs. 34. 9±12. 7) before PCI were similar between the two groups (x2 =0. 07, P=0.47; t= 0.13, P=0.71, respectively). No differences were seen both in composite end point events at 30 days and bleeding complications (x2 = 0.31, P＞0.05; x2=0.004, P＞0. 05). Conclusions High -risk ACS patients treated with an early invasive strategy, routine upstream use of tirofiban are associated with improved tissue-level perfusion before PCI and does not increase bleeding complications when bleeding risks are carefully evaluated before enrollment.

Objective To assess the left ventricular(LV)contraction synchrony in patients with DDD pacing by velocity vector imaging(VVI).Methods Acoustic clip capture was performed in 13 patients before and after pacemaker implantation and obtained high-frame rate B-mode echocardiographic images.VVI was done in all three standard LV apical views and parasternal LV short axis(SAX)views.The time to peak systolic longitudinal velocity(Tvl)and systolic longitudinal strain(Ts1)in the LV apical views and the time to peak systolic radial velocity(Tvr)and systolic circumferential strain(Tsc)in the LV SAX views were measured bv VVI.The standard deviation of Tvl,Tsl,Tvr and Tsc(Tvl-SD,Tsl-SD,Tvr-SD and TscSD)and the maximal temporal difference of Tvl,Tsl,Tvr and Tsc(Tvl-d,Tsl-d,Tvr-d and Tsc-d)of 18 segments were calculated.Results Compared with the values at baseline,Tvr-SD,Tsc-SD,Tsl-d,Tvr-d and Tsc-d increased significantly in patients after pacemaker implantation(P＜0.05).Conclusions The longitudinal,radial and circumferential systolic asynchrony of the LV was commonly existed in patients after DDD pacing.VVI can be used to evaluate the systolic synchrony of the LV in patients with DDD pacing.

BACKGROUND: Smoking is an important cause of cardiovascular disease, its definite mechanism in inducing cardiovascular disease is still unclear, and whether there is linear correlation between the amount of cigarette smoking and cardiovascular risk still needs to be investigated.OBJECTIVE: To analyze the association between cigarette smoking and the severity of coronary atherosclerosis.DESIGN: A retrospective investigation and comparative study.SETTING: The First Affiliated Hospital of Nanjing Medical University.PARTICIPANTS: Totally 500 consecutive patients, who underwent coronary angiography for suspected or known coronary atherosclerosis, were selected from the First Affiliated Hospital of Nanjing Medical University from April 2004 to April 2005. The inclusive criteria included patients with history of chest pain and/or ischemic changes of electrocardiography (ECG), and those with suspected or known coronary artery disease by coronary angiography. Patients with spastic angina pectoris (acetylcholine-positive) were excluded. Patients with infectious processes within 2 weeks before catheterization, heart failure (Killip Class≥ 2 after acute myocardial infarction), hepatic dysfunction, vascular disease (aortitis should be treated with prednisolone), familial hypercholesterolemia, thyroid dysfunction, or adrenal dysfunction were also excluded. There were 370 males aged 42-76years with an average of (61±11) years and 130 females aged 45-75 years with an average of (61±12) years. There were no significant differences in the sex, age and general information among all the patients. This study was approved by the ethics committee of the First Affiliated Hospital of Nanjing Medical University and informed consent was obtained from each patient.METHODS: ① According to the smoking habit, 500 patients with suspected or known coronary artery disease were divided into smoking group (n=254) and non-smoking group (n=246). ② All the patients received anthropometric measurements including body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Blood samples were drawn from every patient at admission to the detect the leukocyte counts in peripheral blood, including total leukocyte count, neutrophil count, eosinophil count, lymphocyte count, monocyte count and basophil count. ③ The severity of coronary atherosclerosis was defined by the Gensini score system, based on the hypothesis that the severity of coronary artery disease should be considered as a consequence of the functional significance of the vascular narrowing and the extent of the area perfused by the involved vessel or vessels. In this scoring system, a greater reduction of the lumen diameter was assigned a higher score than a distal lesion. ④The association of smoking amount with Gensini score, anthropometric measurements and leukocyte count were studies with the Spearman correlation analysis.MAIN OUTCOME MEASURES: ① Results of BMI, SBP, DBP, leukocyte count and Gensini score; ② Results of the Spearman correlation analysis on the association of smoking amount with Gensini score, anthropometric measurements and leukocyte count.RESULTS: ① The total leukocyte count, neutrophil count, monocyte count in peripheral blood and Gensini score were significantly higher in the smoking group than in the non-smoking group.② The Spearman correlation analysis indicated that the amount of cigarette smoking was significantly associated with the total cigarettes smoked, total leukocyte count,neutrophil count, monocyte count and Gensini score (r=0.109, 0.100,0.135, 0.139, P ＜ 0.05-0.01).CONCLUSION: Smoking is significantly associated with the severity of coronary atherosclerosis, and the inflammatory response may be part of the mechanisms underlying the association between coronary artery disease and cigarette smoking.

OBJECTIVELow or moderate consumption of red wine has a greater benefit than the consumption of other beverages in the prevention of atherosclerosis and coronary heart disease and this is increasingly attributed to the polyphenol compounds in red wine, such as resveratrol. In the present study, we investigated the effect of resveratrol on platelet aggregation in vitro and in vivo.

METHODSPlatelet aggregation in rabbits and normal subjects was measured using Born's method.

RESULTSResveratrol, at 10 - 1000 micromol/L, significantly inhibited platelet aggregation in vitro induced by collagen, thrombin, and ADP in healthy subjects. The inhibitory effect was concentration-dependent. Hypercholesterolemia induced by high-cholesterol diet enhanced ADP-induced platelet aggregation. Resveratrol 4 mg x kg(-1) x d(-1) inhibited ADP-induced platelet aggregation in vivo despite no changes in serum lipid levels.

CONCLUSIONSResveratrol inhibits platelet aggregation both in vitro and in vivo. This may be one of the mechanisms by which resveratrol prevents atherosclerosis.

Animals ; Arteriosclerosis ; prevention & control ; Cholesterol, LDL ; blood ; Humans ; Lipids ; blood ; Platelet Aggregation ; drug effects ; Platelet Aggregation Inhibitors ; pharmacology ; Rabbits ; Stilbenes ; pharmacology

OBJECTIVETo investigate how the intra-cardiac activation was translates into the characterized flutter wave in patients with cavatricuspid isthmus-dependent counter-clockwise atrial flutter (CTI-AFL).

METHODSA total of 15 hospitalized CTI-AFL patients (mean age: (60 ± 14) years old, 1 female) from October 2012 to February 2014 were enrolled in the study. The activation map was re-constructed during AFL rhythm for left atrium and right atrium using 3-dimensional mapping system. The flutter wave in surface electrocardiogram was analyzed in combination with the intra-cardiac activation.

RESULTSThe mean left ventricular ejection fraction was (60.8 ± 6.6)%, and the left atrial diameter was (39.0 ± 3.4) mm. The mean tachycardia cycle length was (220 ± 24) ms. The activation map was completed in all cases. In inferior leads, the flutter wave was divided into three parts: slowly downward part, sharp downward part and the terminal positive part. The three parts corresponded to the fixed activation part of the macro-reentry.

CONCLUSIONThe distinctive flutter wave of CTI-AFL was determined by the unique macro-reentry activation in the right atrium. The activation of left atrium contributes to the downward part of the wave.

Aged ; Atrial Appendage ; Atrial Fibrillation ; Atrial Flutter ; Electrocardiography ; Female ; Heart Atria ; physiopathology ; Humans ; Male ; Middle Aged ; Ventricular Function, Left