Objective To study the characteristics and the related risk factors of coronary artery changes in the elderly patients of coronary heart disease complicated with diabetes mellitus. Methods According to WHO diagnostic standards of diabetes, coronary heart disease(CHD) complicated with diabetes mellitus(65 patients) was indicated as CHD+DM group, and the coronary heart disease without diabetes(68 patients) was indicated as CHD group. All patients were examined by coronary angiographic semiquantitative(CAG), and blood pressure, oral glucose tolerance test, level of blood sugar, insulin, lipid, BUN and Cr were measured. The coronary artery changes were analysed by CAG, and the severity of coronary artery stenosis were evaluated by AHA standards. The related risk factors in coronary artery disease were analysed by pluralism straight line statistics. Results The coronary multivessel changes(75 4% vs 38 2%, P

Objective: To explore the effect of apelin on angiotensin II (Ang II)-induced cardiomyocyte hypertrophy and intracellular signal transduction mechanism in experimental rats.
Methods: The cardiomyocyte from 1 to 3 days neonatal rats were cultured with Ang II to induce the cardiomyocyte hypertrophy, and the cells were treated by apelin at different concentrations. The [3H] Leucine incorporation, cardiomyocyte surface area and total protein expression were analyzed to evaluate the degree of cardiomycyte hypertrophy. The protein expressions of intracellular BNP, β-MHC, nuclear factor 3 of activated T cells (NFATc3), calcineurin, phospho-calcineurin, calmodulin kinase II (CaMK II) and phospho-CaMK II were assessed by Western blot analysis. The mRNA expressions of BNP andβ-MHC were examined by RT-PCR.
Results: Apelin may inhibit Ang II induced cardiomyocyte hypertrophic response in a dose-dependent manner, the maximum inhibition was achieved at Ang II 1000 nmol/L. Meanwhile, apelin may inhibit Ang II-induced elevations of intracellular resting free calcium level, mRNA expressions of BNP andβ-MHC, protein expressions of NFATc3, phospho-calcineurin, CaMK II and phospho-CaMK II in a dose-dependent manner.
Conclusion: Apelin may inhibit Ang II-induced cardiomyocyte hypertrophy in experimental rats which might be related to Ca2+-dependent calcineurin signal pass ways.

Objective To investigate the relationship between glucose tolerance change and the coronary artery lesion in the patients with coronary heart disease. Methods One hundred and ninety three patients with coronary artery disease were divided into 3 groups according to WHO(1985) and American Diabetes Association (1997) standard of diabetic diagnoses: (1) normal glucose tolerance (NGT) group 122 cases; (2) impaired glucose tolerance (IGT) group 39 cases; (3) type 2 diabetes mellitus (DM) group 32 cases. All patients were examined by the coronary angiographic semiquantitative (CAG) and 75 g oral glucose tolerance test. Blood glucose, insulin, triglyceride (TG), total cholesterol (TC) and high density lipoprotein cholesterol (HDL C) were determined. The coronary artery changes were analysed by CAG, and the severity of coronary artery stenosis was evaluated according to American Heart Association standard. The risk factors of coronary artery lesion were analysed by pluralism stepwiss regression analysis. Results The coronary multivessel changes and the severity of coronary artery stenosis and calcification were more frequent in IGT group than those in NGT group (66.5% vs 35.1%, 8.9?3.6 vs 6.5?3.9, 6.3?3.6 vs 3.9?4.1 respectively, P

Objective: To observe the safety and efifcacy of excimer laser coronary atherectomy (ELCA) for treating the patients with coronary chronic total occlusion (CTO). Methods: A total of 3 coronary CTO patients treated by ELCA in our hospital from 2015-01 to 2016-11 were analyzed. The patients received guide steel wire gone through occlusion segment under the guidance of offside coronary angiography; drug-eluting stent implantation was conducted after ELCA treatment. The operative success rate with complication was observed and the occurrence of MACE was followed-up. Results: The device performing and interventional therapy were succeed in all 3 patients. No coronary dissection, perforation, slow relfow and thrombosis were occurred during the operation; no angina, myocardial infarction, target vessel revascularization and death were observed by follow-up study. Conclusion: Application of ELCA combining drug-eluting stent implantation was safe and effective for treating the patients with coronary CTO.

Objective To investigate the effect and safety of early intervention and delayed intervention therapy on elderly patients and younger patients with non-ST segment elevation acute coronary syndrome. Methods The patients with non-ST segment elevation acute coronary syndrome were randomly divided into early intervention group (coronary angiography taken within 24 hours after grouping) and delayed intervention group ( coronary angiography taken after 36 hours after grouping). The primary endpoint was a composite endpoint of death, myocardial infarction and stroke during 180 days follow-up. Results A total of 815 patients were enrolled, including 198 elderly patients aged 75 years and above, and 617 younger patients aged below 75 years. The elderly patients had a greater incidence of the primary endpoint than that of younger patients ( P = 0. 00). The primary endpoint of early intervention group were obviously lower than that of delayed intervention group of younger patients ( P = 0. 01 ). There was no significant difference in primary endpoint incidence of early intervention group and delayed intervention group of the elderly patients (P =0. 39). Conclusions The elderly patients with non-ST segment elevation acute coronary syndrome who underwent intervention had greater incidence of death and myocardial infarction. Early intervention reduced the rate of myocardial infarction for the younger patients. There was no significant difference in primary endpoint incidence between early intervention and delayed intervention among elderly patients.

Objective: To explore the changing features of plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level in patients with hypertrophic obstructive cardiomyopathy (HCM) after alcohol septal ablation (ASA). Methods: A total of 82 HCM patients treated by ASA in our hospital were studied. According to plasmalevel of NT-proBNP, the patients were divided into 2 groups: High NT-proBNP group and Low NT-proBNP group,n=41 in each group. Plasma NT-proBNP was examined by ELISA; ventricular septal thickness (VST), left ventricular posterior wall thickness (LVPWT), maximal ventricular wall thickness (MLVWT) and left atrial diameter (LAD) were measured by echocardiography. There were 50 patients ifnished 1 year clinical or in-hospital follow-up, their NT-proBNP level and echocardiography were detected at 2 days and 1 year post-operation.The relationship between echocardiography parameter and NT-proBNP level was assessed; NT-proBNP was compared between pre- and 2 days, 1 year post-operation. Results:①In all 82 patients: compared with Low NT-proBNP group, High NT-proBNP group had increased VST (23.66±6.46) mm vs (20.79±4.56) mm,P=0.035, LVPWT (12.79±2.99) mm vs (11.50±2.35) mm,P=0.048, MLVWT (28.03±5.66) mm vs (25.18±4.81) mm,P=0.027 and LAD (40.73±4.86) mm vs (38.08±6.17) mm,P=0.049.②In 50 patients who ifnished 1 year follow-up study: compared with pre-operation, NT-proBNP level was slightly increased at 2 days post-operation (1841.79±1310.88) fmol/ml vs (1552.15±951.57) fmol/ml,P=0.066, while decreased at 1 year post-operation (1038.46±714.03) fmol/ml vs (1552.15±951.57) fmol/ml,P=0.000. Conclusion: Plasma NT-proBNP level was affected by atrial size and ventricular thickness in HCM patients, it may obviously decrease during long-term follow-up period.

Objective To analyze the correlation between septal branch characteristics and the prognosis of alcohol septal ablation ( ASA ) in patients with hypertrophic obstructive cardiomyopathy . Methods The clinical , echocardiographic , angiographic and procedural characteristics were analyzed retrospectively in 55 patients.Good prognosis was defined as left ventricular outflow tract gradient decreased by 50%at long term follow-up.The characteristics of septal branch were analyzed in terms of QCA .Results There were no differences in the length of the ablated septal branch , sizes of the adjacent branches , distances between the septal branch and the ostia of the coronary arteries and the volume of alcoholo consumed ( all P>0.05).Compared with poor prognosis group (n =27), the diameter of the ablated septal branches were significantly larger in the good prognosis group ( n=28 ) [ ( 1.75 ±0.36 ) mm vs.( 1.48 ±0.41 ) mm, P=0.012].The distance between the ablated branch and its adjacent branch was farer in the good prognosis group [(18.80 ±10.20)mm vs.(13.04 ±6.65)mm, P=0.020].In multivariate analysis, the diameter of the ablated branch (OR 9.258,95%CI 1.427-60.069, P=0.020)and the distance between the ablated septal branch and its adjacent septal branch (OR 1.102,95% CI 1.002-1.213, P =0.046) were found to be independent risk factors for good prognosis of ASA .Conclusions The diameter of the ablated septal branch and the distance between its adjacent septal branch are associated with better prognosis of ASA .

Objective: To summarize the characteristics of arrhythmia with the relevant factors affecting its prognosis in patients of apical hypertrophic cardiomyopathy (AHCM). Methods: A total 283 AHCM patients with echocardiography or cardiac magnetic resonance (CMR) conifrmed diagnosis in our hospital from 2005-01 to 2012-08 were summarized. The patients were divided into 2 groups: With arrhythmia group, n=103 and Without arrhythmia group,n=180. The endpoint event was followed-up by clinical and telephone visits in both groups and the relevant risk factors affecting AHCM prognosis were investigated by Cox regression analysis. Results: There were 269 patients ifnished the follow-up investigation, 98 in With arrhythmia group, 171 in Without arrhythmia group, and the death rate was 4.08% vs 1.17%, the occurrence of endpoint event was 18.37% vs 5.58%respectively. Cox regression analysis indicated that age (HR=23.051, 95% CI 1.08-1.068,P<0.005), left atrial diameter (HR=4.113, 95%CI 1.002-1.119,P=0.043) and NT-proBNP (HR= 18.653, 95% CI 3.433-26.650,P<0.005) were the independent risk factors affecting prognosis in AHCM patients. Conclusion: Arrhythmia is one of the common presentations of AHCM, it does not have much impact on survival, while it may cause ventricular ifbrillation and increase the occurrence of cardiovascular events.

Objective: To assess the effect of percutaneous transluminal septal myocardial ablation (PTSMA) on mid- to long-term left ventricular diastolic function in patients with hypertrophic obstructive cardiomyopathy (HOCM) by real-time three-dimensional echocardiography (RT-3DE). Methods: A total of 46 HOCM patients who received 2DE and RT-3DE examination before and after (with the mean of 18.8 months) PTSMA were studied. The ratios of E/A and E/Ea were analyzed, RT-3DE was conducted to collect the images, to obtain 17-segmant volume-time curve and to calculate the parameters of rEDV, rESV, rSV and rPFR respectively. Results: The follow-up echocardiography in all 46 patients indicated that the ratio of E/Ea decreased after the operation (12.04 ± 3.29) vs (15.70 ± 5.68),P<0.001, the rSV of left ventricular anterior wall middle segment and anterior septal middle segment decreased after the operation,P<0.05, while the rPFR of anterior septal middle segment, rear septal middle segment and apical segment increased,P<0.05. Conclusion: PTSMA may improve local left ventricular diastolic function in HOCM patients, RT-3DE provides a new method and viewing angle for HOCM evaluation.

Objective To evaluate the left ventricular segmental and global systolic myocardial function of the hypertrophic obstructive cardiomyopathy (HOCM) before and after transcoronary ablation of septal hypertrophy (TASH).Methods Twenty-six consecutive patients with HOCM were analysed by two-dimensional speckle tracking imaging (STI) before and after TASH.The left ventricular global and segmental systolic longitudinal strains and circumferential strain were measured.Results In the HOCM patients,the global and segmental longitudinal strains were lower than the healthy population before TASH.One week after TASH,a significant reduction of left ventricular outflow tract (LVOT) gradients occurred (P ＜ 0.001).The global and the alcohol-treated septal segmental longitudinal strains also decreased significantly[(-12.5±1.7)％ vs (-13.6± 1.6)％,P＜0.01;(-11.2±2.8)％ vs (-12.6±3.1)％,P ＜ 0.001].During 1 year follow-up after TASH,the mean NYHA function class improved after TASH (P ＜ 0.001) and the left ventricular outflow tract (LVOT) gradients and septal thickness decreased (P ＜0.001).The left ventricular global longitudinal systolic strain was increased [(-14.7 ± 2.0) ％ vs (-13.6 ±1.6) ％,P ＜0.01],and this was correlated with the decrease of the LVOT gradients (r =0.579,P ＜0.01).The alcohol-treated septal segments showed unchanged average longitudinal strain over time,while in the anterolateral and the anterior segments,the average longitudinal systolic strain increased (P ＜0.05).The basal and medial segments also showed increased average longitudinal systolic stain.However,the left ventricular circumferential strain had no changes after TASH.Conclusions TASH can significantly decrease the LVOT gradients and improve NYHA functional class with the increase of the left ventricular global and segmental longitudinal systolic function.