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Value of Duration of Myocardial Early Systolic Lengthening Assessed by Echocardiogram on Defining the Degree of Coronary Artery Stenosis

Qian HU ; Jia LIU ; Qingxiong YUE

Chinese Circulation Journal.2019;34(10):974-978. doi:10.3969/j.issn.1000-3614.2019.10.007

Objectives: To evaluate the degree of coronary artery stenosis with duration of myocardial early systolic lengthening derived from 2D speckle tracking imaging (2D-STD in patients with coronary artery disease (CAD). Methods: 185 patients with suspected CAD underwent 2D-STI before coronary CT angiography (CCTA) were included in this study. Duration of myocardial early systolic lengthening, LS, RS, and CS were measured by 2D-STI. According to the results of CCTA, the myocardial segment were divided into normal group (without coronary artery stenosis), mild stenosis group(coronary artery stenosis<50%), moderate stenosis group (50%>coronary artery stenosis < 70%) and severe stenosis group (70%>coronary artery stenosis <100%). Results: Duration of myocardial early systolic lengthening, LS, RS and CS were similar between mild stenosis group and normal group (P>0.05). Duration of myocardial early systolic lengthening was increased, and LS was decreased in moderate stenosis group than in normal group (P<0.05). Duration of myocardial early systolic lengthening was increased, LS, RS and CS were significantly decreased in severe stenosis group than in normal group (P<0.01). The cutoff value of early systolic lengthening for diagnose severe stenosis was 60.0 ms (area under ROC curve [AUCl=0.91, P<0.01), with the sensitivity 85.5% and specificity 74.1%, respectively. Conclusions: Duration of myocardial early systolic lengthening is prolonged in patients with significant CAD (moderate and severe stenosis), and might be used a useful parameter to identify patients with significant CAD (moderate and severe stenosis).

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Analysis for the Cause of Peri-procedural Myocardial Infarction and Risk Factors in Patients After Elective Percutaneous Coronary Intervention

Lei FENG ; Dong ZHANG ; Dong YIN ; Hao WANG ; Zhiyong ZHAO ; Guofeng GAO ; Kefei DOU

Chinese Circulation Journal.2017;32(5):431-435. doi:10.3969/j.issn.1000-3614.2017.05.004

Objective: To assess the risk factors for peri-procedural myocardial infarction (PMI) occurrence in patients after percutaneous coronary intervention (PCI) based on the new standard of US Society for cardiovascular angiography and interventions (SCAI). Methods: According to SCAI standard, a total of 3371 relevant patients with 3516 elective PCI in our hospital were enrolled. The baseline clinical features, coronary angiography (CAG) findings and PCI procedural elements were retrospectively studied, the independent risk factors for PMI occurrence were identified by multivariate Logistic regression analysis. Results: There was 108/3516 (3.1%) PMI occurred in all patients. Multivariate Logistic regression analysis presented that age (OR=1.037, 95% CI 1.016-1.058), treating multi-vessel lesions (OR=1.697, 95% CI 1.095-2.629), treating at least 1 bifurcation lesion (OR=1.869, 95% CI: 1.213-2.878) and the total length of lesion (OR=1.016, 95%CI 1.009-1.024) were the independent risk factors for PMI occurrence. Conclusions: Age, treating multi-vessel lesions, at least one bifurcation lesion and the total length of lesion were the independent risk factors for PMI occurrence in patients after elective PCI.

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Effect and Safety of Pre-operative Loading Ticagrelor on Myocardium Reperfusion in Patients With Acute ST-elevation Myocardial Infarction During Primary Percutaneous Coronary Intervention

Limin XIE ; Xiaoming WANG ; Rui YAN ; Pengwei YANG ; Wen LI ; Jifeng YAN

Chinese Circulation Journal.2016;31(6):550-553,554. doi:10.3969/j.issn.1000-3614.2016.06.007

Objective: To explore the effect and safety of pre-operative loading ticagrelor on myocardium reperfusion in patients with acute ST-elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI). Methods: A total of 105 acute STEMI patients received PCI within 12-hour of onset were studied and they were divided into 2 groups: Ticagrelor group, the patients received pre-operative oral chewing ticagrelor 180 mg,n=58 and Clopidogrel group, the patients received pre-operative oral chewing clopidogrel 600 mg,n=47. The baseline feathers, operative TIMI and corrected TIMI frame count (CTFC), TIMI myocardial perfusion grade (TMPG), no-relfow/slow lfow conditions were compared between 2 groups. Results: The baseline feathers and pre-operative TIMI were similar between 2 groups, bothP>0.05. Compared with Clopidogrel group, Ticagrelor group showed increased ratios of TIMI 3 lfow (94.8% vs 80.9%) and TMPG (89.7% vs 72.3%), bothP<0.05, improved CTFC (20.0 ± 4.9) vs (31.8 ± 3.9),P<0.001; decreased rates of no-relfow/slow lfow,P=0.016 and less MACE occurrence,P<0.05; while the post-operative bleeding events were similar between 2 groups,P>0.05. Conclusion: Prior PCI loading ticagrelor may reduce no-relfow/slow lfow incidence, improve myocardium reperfusion safely and therefore, decrease MACE occurrence in acute STEMI patients.

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Impact of Renal Function Injury on the Diagnostic Value of NT-proBNP in Patients With Heart Failure

Xiaoqun GAO ; Zhexun LIAN ; Yujun QI ; Cheng CHI

Chinese Circulation Journal.2016;31(12):1189-1192,1193. doi:10.3969/j.issn.1000-3614.2016.12.010

Objective: To explore the impact of renal function injury on diagnostic value of NT-proBNP in patients with heart failure (HF).
Methods: A total of 420 patients with cardiovascular disease at (50-75) years of age were divided into 2 groups based on left ventricular ejection fraction (LVEF): Control group, the patients with normal cardiac function, LVEF≥40%,n=232 and HF group, LVEF<40%,n=188. According to estimated glomerular ifltration rate (eGFR), each group contained 4 subgroups by Normal renal function (eGFR≥90 ml/min·1.73m2), Mild renal injury (90>eGFR≥60 ml/min·1.73m2), Moderate renal injury (60>eGFR≥30 ml/min·1.73m2) and Severe renal injury (eGFR<30 ml/min·1.73m2). The changes of NT-proBNP level at different subgroups were observed and the optimal cut-off values of NT-proBNP for HF diagnosis were measured.
Results: Compared with Control group, HF group had increased blood level of NT-proBNP,P<0.05; NT-proBNP level was negatively related to eGFR (in all patients:r=-0.664, in Control group:r=-0.686 and in HF group:r=-0.721,P<0.05). Within Control group, NT-proBNP level was similar between Normal renal function and Mild renal injury subgroups,P>0.05, while it was much higher in Moderate and Severe renal injury subgroups than Normal renal function subgroup,P<0.05. Within HF group, Severe renal injury subgroup had increased NT-proBNP level than other subgroups,P<0.05. The best cut-off value of NT-proBNP for HF diagnosis in patients with normal or mild renal injury was 1070 pg/mL (sensitivity: 91.8% and speciifcity 72.6%); with moderate renal injury was 7121 pg/mL (sensitivity: 80.2% and speciifcity: 89.7%); with severe renal injury was 33344 pg/mL (sensitivity: 83.3% and speciifcity: 80%).
Conclusion: Moderate to severe renal function injury could increase circulating level of NT-proBNP and therefore, the cut-off value of NT-proBNP for HF diagnosis should be elevated accordingly in patients of HF combing renal injury.

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Inhibition of Interferon-inducible Protein 16 Expression Reduces the Apoptosis in Human Aortic Adventitial Fibroblasts

Yan XIAO ; Fang SONG ; Qiang WU ; Jing HUANG

Chinese Circulation Journal.2017;32(5):511-514. doi:10.3969/j.issn.1000-3614.2017.05.021

Objective: To study the impact of interferon-inducible protein 16 (IFI16) inhibition on apoptosis of human aortic adventitial fibroblasts (HAAFs). Methods: Our research included 3 groups: ① IFI16-siRNA group, specific small interference RNAs (siRNAs) of IFI16 were transfected into HAAFs in vitro to make IFI16 gene silence, ②Con-siRNA group, non-specific siRNAs were transfected into HAAFs as negative control and ③Untreated HAAFs group, blank control. HAAFs cell cycle and apoptosis rate were examined by flow cytometry, IFI16 mRNA expression was measured by real time qRT-PCR, protein expressions of IFI16, p53, p21, Bax and Bcl-2 were detected by Western blot analysis. Results: Compared with Con-siRNA group and Untreated HAAFs group, IFI16-siRNA group showed decreased apoptosis rate of HAAFs (3.33±0.41) % vs (7.42±1.51) % and (6.49±1.10) %, P<0.05, reduced ratio of G0/G1 phase cells (56.64 ± 4.77 ) % vs (69.67±3.54) % and (68.29±4.14) %, P<0.05, while increased ratio of S phase cells (25.23±5.19)% vs (13.76±2.07) % and (14.04±3.00) %, P<0.05. Meanwhile, IFI16-siRNA group presented down-regulated IFI16 mRNA and protein expressions, decreased protein levels of p53, p21, Bax and increased protein level of Bcl-2, all P<0.05. Conclusion: Inhibited IFI16 expression could decrease HAAFs apoptosis, promote cell cycle transition from G1 to S phase which might be related to the suppression of p53/p21 signaling pathway and regulation of Bax/Bcl-2 expression.

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Expressions of Kidney β-Klotho and Fibroblast Growth Factor Receptor 1 in Experimental Rats Model With Vascular Calcification

Yuchen SHI ; Jinghua LIU

Chinese Circulation Journal.2017;32(5):507-510. doi:10.3969/j.issn.1000-3614.2017.05.020

Objective: To observe the impact of vascular calcification on kidney injury rats with the expressions of β-Klotho, fibroblast growth factor receptor 1 (FGFR1) in kidney tissue in order to find the predictor for early chronic kidney disease (CKD), to provide the prevention and investigation basis of vascular calcification and CKD. Methods: Vascular calcification model was induced by vitamin D3 and nicotine injection in experimental rats and the animals were divided into 2 groups: Normal control group and Calcification group. n=6 in each group. Serum levels of creatinine and urea nitrogen were examined by sarcosine oxidase method and UV-glutamate dehydrogenase method respectively; blood levels of calcium and phosphorus were detected by biochemistry method; kidney tissue alkaline phosphatases (ALP) activity was measured by ALP detection kit, protein expressions of β-Klotho and FGFR1 were assessed by ELISA.Results: Compared with Normal control group, Calcification group showed increased serum levels of creatinine (35.200±4.087) umol/L vs (26.000±5.0990) umol/L and urea nitrogen (6.900±0.623) mmol/L vs (5.400±0.803) mmol/L, both P<0.05; elevated kidney tissue ALP activity (60.510±31.090) U/g vs (26.590±8.664) U/g and β-Klotho protein expression (9.052±1.238) ng/mg vs (6.860±1.036) ng/mg, both P<0.05. Blood levels of calcium, phosphorus and kidney tissue FGFR1 protein content were similar between 2 groups. Conclusion: Large dose vitamin D3 and nicotine injection may induce vascular calcification and early CKD symptom in experimental rats; β-Klotho protein expression was significantly increased suggesting that β-Klotho had been involved in the early regulation of vascular calcification and it could be used for the early diagnosis of CKD at certain point.

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Expression of Myocardial Levels of Connexin 43, 40 in Experimental Dog Model of Sympathomimetic Atrial Fibrillation

Chenglin SHU ; Yan HE ; Zhiyu ZENG ; Hao LIU ; Jinyi LI ; Weiqiang HUANG ; Cheng LUO ; Jian XU ; Yanqun HUANG

Chinese Circulation Journal.2017;32(5):502-506. doi:10.3969/j.issn.1000-3614.2017.05.019

Objective: To explore the expression of myocardial levels of connexin 43(Cx43), Cx40 in experimental dog model of sympathomimetic atrial fibrillation (AF). Methods: 15 mongrels dogs were randomly divided into 3 groups: Control group, Rapid atrium pacing (RAP) group and RAP+isoprenaline (ISO) perfusion group. n=5 in each group. The hearts were taken to establish in vitro langendorff cardiac perfusion model. Atrial effective refractory period (AERP) and AF inducing rate were tested;intracellular expression and distribution of nerve growth factor (NGF) and tyrosine hydroxylase (TH) were examined by immunohistochemistry, total protein contents of Cx43 and Cx40 were measured by Western blot analysis, mitochondria morphology was observed by transmission electron microscope and mitochondria reactive oxygen species (ROS) generation was detected by fluorescent colorimetric method. Results: AERP was similar between Control group and RAP group (166±5.1) ms vs (160±3.2) ms which cannot induce AF; while it was shortened in RAP+ISO group (148±3.7) ms, P<0.05 which may successfully induce AF.Compared with Control group, mitochondria was slightly swollen in RAP group and the matrix was intact, while mitochondria was obviously swollen in RAP+ISO group and part of matrix was transparent; total protein contents of Cx43 and Cx40 were lower in both RAP group and RAP+ISO group, P<0.05; in addition, they were even lower in RAP+ISO group than RAP group, P<0.05. Compared with Control group and RAP group, RAP+ISO group had increased expression and distribution of NGF, TH and mitochondria ROS generation, P<0.05; NGF, TH and ROS in RAP group were higher than Control group, P<0.05. Conclusion: Sympathetic AF has been related to the contents and changes of myocardial levels of CX43 and Cx40; sympathetic nerve might trigger AF by oxidative stress induced down-regulation of myocardial CX43 and Cx40 in experimental dog model.

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Expression of TRPC1-BK Signal Complex in Aortic Smooth Muscle Tissue in Experimental Mice of Atherosclerosis

Dongyun LING ; Mengxun HUANG ; Lianfa WANG

Chinese Circulation Journal.2017;32(5):497-501. doi:10.3969/j.issn.1000-3614.2017.05.018

Objective: To observe the expression of transient receptor potential channel-1—large conductance Ca2+-activated K+channel (TRPC1-BK) signal complex in aortic smooth muscle tissue in experimental mice of atherosclerosis (AS). Methods: Our research included in 2 groups: Control group, wild C57BL/6J mice were fed by normal diet and AS group, ApoE-/- mice were fed by high fat diet to establish AS model. All animals were treated for 10 weeks, n=10 in each group. The total RNA and protein were extracted from aortic smooth muscle tissue in sacrificed mice. The mRNA and protein expressions of TRPC1, BKα and BKβ1 subunit were measured by RT-PCR, Western blot analysis and immunohistochemistry staining. Results: By RT-PCR examination, compared with Control group, AS group showed increased mRNA expression of TRPC1, P<0.05 and decreased mRNA expressions of BKα and BKβ1 subunit, both P<0.01. By Western blot analysis, compared with Control group, AS group had elevated protein expression of TRPC1, P<0.05 and reduced protein expressions of BKα and BKβ1 subunit, both P<0.01; by immunohistochemistry staining, AS group had the higher protein expression of TRPC1, P<0.01 and the lower protein expressions of BKα and BKβ1 subunit, both P<0.05. Conclusion: The mRNA and protein expressions of TRPC1-BK signal complex were affected in aortic smooth muscle tissue in AS mice, which speculated that TRPC1-BK signal complex might be become a new target for treating the relevant vascular disease.

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The Imaging and Clinical Feature Analysis for Behcet's Disease With Coronary Artery Involvement in 6 Patients

Aihua ZHI ; Ruping DAI ; Shiliang JIANG ; Bin LV

Chinese Circulation Journal.2017;32(5):493-496. doi:10.3969/j.issn.1000-3614.2017.05.017

Objective: To explore the imaging and clinical features of Behcet's disease with coronary artery involvement in order to improve the diagnosis and treatment in clinical practice. Methods: A total of 6 Behcet's disease patients with coronary involvement diagnosed and treated in our hospital from 1999-08 to 2016-11 were analyzed. Coronary angiography (CAG) and coronary CTA were performed for diagnosis. There were 5 cases received CAG and 5 cases received CTA examinations. Results: All 6 patients had the first clinical visit by sudden pericardial tapenade, myocardial infarction or cardiac shock. For diagnosis: the imaging presentation included coronary stenosis, occlusion and pseudo aneurysm formation. 3 patients had anterior descending artery involvement, 1 had the far-end of left circumflex involvement and 2 had the middle segment of right coronary involvement; all patients were combining large amount of pericardial effusion. For treatment: there were 3 patients with aneurysm received conservative treatment (1 case had open thoracic exploration), 1/3 lost contact and 2 having long-term normal life; 3 patients received coronary stent implantation without optimal effect. Conclusion: The patients of Behcet's disease with coronary involvement may easily form pseudo aneurysm; CAG/CTA has been helpful for diagnosis. Clear pre-operative diagnosis of etiology is important for treatment.

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Application and Assessment of CT Scanning in Percutaneous Pulmonary Valve Implantation

Junyi WAN ; Enning WANG ; Shiliang JIANG ; Zhongying XU ; Xiangbin PAN ; Huijun SONG ; Bin LV ; Kunjing PANG ; Qianqian LIU ; Gejun ZHANG

Chinese Circulation Journal.2017;32(5):489-492. doi:10.3969/j.issn.1000-3614.2017.05.016

Objective: To assess the application value of CT scanning in percutaneous pulmonary valve implantation (PPVI). Methods: A total of 19 patients with severe pulmonary regurgitation planed to receive PPVI in our hospital from 2014-05 to 2016-07 were studied. CT scan and transthoracic echocardiography (TTE) were conducted to collect the data of pulmonary root anatomy and to compare the difference of pulmonary annulus size measured by CT and TTE. The accuracy of pre-operative measurement was evaluated by the follow-up study at (1-26) months after the operation. Results: In all 19 patients, the mean anatomic measurements by CT were as follows: diameter of pulmonary annulus (24.3±3.5) mm, diameter of pulmonary sinotubular junction (25.4±4.0) mm, diameter at distal of main pulmonary artery (27.5±4.8) mm, diameter of right ventricular outflow tract (36.8±7.3) mm, length of main pulmonary artery (45.5±7.0) mm, diameter of left pulmonary artery (17.9±1.5) mm and diameter of right pulmonary artery (18.5±3.6) mm. The diameter of pulmonary annulus measured by CT was larger than TTE, P<0.05. During (1-26) months follow-up period, no patients suffered from stent fracture or translocation, peri-pulmonary valve regurgitation, obvious pulmonary regurgitation or coronary stenosis; 1 patient had increased flow rate at right pulmonary artery opening by stent blocking and 2 patients had residue mild stenosis of pulmonary valve. Conclusion: Pulmonary annulus size measured by CT and TTE was different; CT may precisely assess the morphology of pulmonary root with adjacent area which is important for pre-operative evaluation in PPVI patients.

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