N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a good plasma marker for the diagnosis and differential diagnosis of the heart failure.For decompensated heart failure,the double-cut-point strategy including the diagnostic cut-off point and eliminated cut-off point was suggested,and the diagnostic cut-off point can be further divided according to age to further improve the diagnostic accuracy.If the patient's value was in gray interval,doctors should further analyzed the possible confounders,including age,renal function,BMI et al.Recently,more researches were carried out for NT-proBNP in patients with acute coronary syndrome,and some studies showed that its combination with troponin increased the diagnostic efficacy of acute myocardial infarction.The studies of NT-proBNP were still carried out in other areas including atrial fibrillation,cardiomyopathy,valvular disease,pulmonary embolism et al and had obtained the results of the beneficial clinical applications.

Objective To summarize clinical characteristics of coronary artery perforation during percutaneous coronary interventions.Methods Retrospective analysis of consecutive 32 patients who had coronary artery perforation in Fu Wai Hospital from April,2004 to August,2006 was carried out.Results Thirty-two cases of coronary perforation occurred during 7102 PCI procedures performed within this period(incidence:0.5%).These cases are comparatively complicated lesions including 81.3% of type B2+C and 62.5% of chronic total occlusion(CTO)lesions.Ellis classification:typeⅠ:14(43.8%),type Ⅱ:10(31.2%),type Ⅲ:8(25.0%),type Ⅳ:0.Mechanism of coronary artery perforation:guiding wire:21(65.6%),predilatation:6(18.8%),postdilatation:3(9.4%),stent implantation:2(6.2%).Clinical consequence:death:3(9.4%),cardiac temponade:7(21.9%),acute myocardial infarction(AMI):9(28.1%).Treatment:reversal of heparin-induced anticoagulation by application of protamine:14(43.8%),prolonged balloon inflation:9(28.1%),percardiocentesis:7(21.9%),implantation of membrane covered stent:4(12.5%),bail-out surgical repair:2(6.2%).Conclusion Coronary perforation during PCI is a rare complication;type Ⅲ perforation is associated with significant morbidity and mortality,which needs urgent and intensive treatment.

Objective To observe the characteristics of culprit lesions in AMI with previous PCI.Methods Retrospective analysis was carried out in 61 consecutive AMI patients with previous PCI treated with primary PCI from April, 2004 to April, 2006 in Fuwai hospital.Results Location of culprit lesions in the 61 patients (62.1?10.0 yrs; male 88.5%) were: LAD 47.5%, RCA 39.5%, LCX 13.0%. Comparing the medication of the patients during the first year after the former PCI, besides the continous use of aspirin (93.8% vs 100%,P=0.113), all patients had stopped using clopidogrel, and the use of ?-blockers, ACEIs and statins also dropped significantly after 1 year (46.9% vs 75.0%, P= 0.001; 34.4% vs 70.8%, P= 0.001; and 28.1% vs 77.1%, P= 0.000, respectively). The characteristics of the culprit lesions included: acute and sub-acute in-stent thrombosis in 12 cases (19.7%), late and very late in-stent thrombosis in 6 cases (9.8%), plaque rapture in 41 cases (70.5%), but no restenosis was involved. The time of the recurrant AMI after the former PCI were: 13 cases (21.3%) within 1 month including 12 cases of acute or subacute in-stent thrombosis and 1 case of plaque rupture in anther coronary artery 3 days after primary PCI; 16 cases (26.2%) after the first month to 1 year including 12 cases of plaque rupture and 4 cases of late in-stent thrombosis; 32 cases (52.5%) 1 year including 30 cases of plaque rupture and 2 cases of very late in-stent thrombosis. Conclusion The major mechanism of recurrant AMI after preoious PCI is plaque rapture.

Objective To investigate the myocardial perfusion abnormalities in patients with isolated left ventricular noncompaction (ILVNC) and analyze the correlation between MPI and MRI.Methods Nineteen patients (14 males,5 females,age range:15-76 years) with ILVNC diagnosed by cardiac MRI were recruited.All patients underwent 99Tcm-MIBI MPI.Both MPI and cardiac MRI were analyzed using a 17-segment model.The thickness ratio of the non-compacted to compacted layers of myocardium (NC/C) was calculated,and segments with NC/C＞2.3 were considered as noncompaction.The incidences of delayed enhancement (DE) and myocardial perfusion abnormalities in non-compacted segments and compacted segments were calculated.x2 test was used for categorical data.The Pearson and Spearman correlation coefficient were used to assess the relationship between the numbers of myocardial segments with myocardial perfusion abnormalities/noncompaction/DE and lgLVEF.Results Of 19 patients,myocardial perfusion abnormality was found in 16 (84.2％) patients.The incidences of perfusion abnormality were 33.6％ (36/107) in non-compacted segments and 31.9％ (69/216) in compacted segments,respectively (x2=0.09,P＞0.05).There were 31 segments with DE.The incidences of DE were 5.6％ (6/107) in non-compacted segments and 11.6％ (25/216) in compacted segments,respectively (x2 =2.94,P＞0.05).The incidence of reduced perfusion was higher in segments with DE than those in segments without DE (54.8％ (17/31) vs 30.1％ (88/292) ; x2 =7.80,P＜0.01).The lgLVEF and the numbers of myocardial segments with noncompaction/DE/myocardial perfusion abnormalities were not correlated(r=-0.35,0.15,-0.34,all P＞0.05).Conclusion Most patients with ILVNC have myocardial perfusion abnormality,which can be observed both in non-compacted and compacted myocardium.Further research is required to elucidate the role of myocardial perfusion abnormality in ILVNC.

Humans ; Percutaneous Coronary Intervention ; methods ; Radial Artery ; surgery

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 explore the efficacy of esmolol on cardiac ischemia in patients with serious coronary lesions who are not candidates for coronary revascularizations. Methods: Fifty seven aged patients (34 male) with serious coronary artery disease not candidates for coronary revascularizations were included. All patients had classical angina involved in cardiac ischemia, and definitely ischemic ST-segment depressions in surface electrocardiogram, however which were not relieved by routine treatment including intravenous nitrate or even morphine. All patients received loading dose injection and continuously intravenous infusion of Esmolol, and the baseline characteristics before treatment and the effects at 4 hours after infusion of Esmolol were carefully recorded. Results: After infusion of Esmolol, the ischemia-related symptoms of 41 patients completely relieved, and their ST depressions recovered to the baseline accompanied with significant reduction in blood pressure and heart rate (P＜0.0001 all) within (66±23) min. Moreover, nine patients were observed that their ischemia-related symptoms were relieved and ST alteration recovered partially (P＜0.0001 both) at four h after continuous infusion of esmolol. Conclusion: Esmolol is effective to relieve the serious cardiac ischemia-related symptoms and ST-T alteration of ECG in patients with serious coronary lesions.

Objective To evaluate the safety and clinical efficacy of renal artery stent treatment for severe atherosclerotic renal artery stenosis (ARAS) in the elderly. Methods In a prospective nonrandomized study in our hospital from January 2003 to April 2008, 147 consecutive elderly patients with ARAS (diameter reduction ≥ 65％) underwent percutaneous transluminal renal angioplasty and stenting (PTRAS) for resistant hypertension or reserving renal function. They were followed up for 6- 66 months and the effects of the procedure on renal function, blood pressure and cardiovascular events were observed. Results The success rate of PTRAS was 100％. During 6-66 months of follow up, both systolic and diastolic blood pressure were significantly decreased, and less antihypertensive medication was taken (P<0.01). Serum creatinine was significantly decreased during 6-48 months of follow up (P<0. 05) and did not change significantly during 54-66 months of follow up (P>0. 05). Blood urea nitrogen was significantly decreased during 6-24 months of follow up (P<0.05) and did not change significantly during 30-66 months of follow up (P>0.05). Complications related with the procedure occurred in 7 cases (4.8％). 17 patients failed to follow up (11.6％) and in 18 cases cardiovascular events occurred (12.2％), including 4 cases of renal events (2. 7％), 4 cases of myocardial infarction (2.7％), 2 cases of stroke (1.4％) and 8 cases of cerebral and cardiovascular events (5.4％) during 6-66 months of follow up. The survival rates of free-of-events at year 1, 2, 3, 4 and5 were 91.0%(121/133), 90.2%(83/92), 78.5%(51/65), 73.8%(31/42) and 54.8%(17/ 31), respectively. The survival rates at year 1, 2, 3, 4 and 5 were 94.0% (125/133), 90. 2% (83/ 92), 84.6%(55/65), 73. 8%(31/42) and 61.3%(19/31), respectively. Conclusions Renal artery stent as treatment for ARAS in the elderly has a beneficial effect on blood pressure control and on renal function during middle and long term follow up. The treatment may be helpful in reduction of cardiovascular events and mortality, which should be investigated further.